Newly rediagnosed LADA from type 2 in 2012

[gillrogers]

Hi everyone, was rediagnosed as Lada in September last year after 8 years as type 2. Due to an awful amount of stress and an awful lot of walking to keep by blood sugars down under 10, my hba1cs kept coming back around 11. Then a new doctor arrived at our practice and decided to have me tested for LADA as I had gone down to 7.5 stone. The change after being diagnosed as positive and put on the right insulin, 1 long lasting and 3 meal doses and 9 months later I am now 10 stone with my last hba1c down to 7.2 mmol! However having decided to carb count and gone to a libre sensor as I have sudden drops to low or hypos without warning, I'm finding my bg levels are rising again. I struggle to get my carbs and insulin ratios right as they seem to be differant at differant stages of the day. And I've lost my driving licence due to the sudden and no warnibg lows. Getting quite down now, and think that I still have some of my own insulin that fluctuates working with the insulin shots.

 

[trophywench]

What insulins are you using Gill? Have you received any education on adjusting doses to match food and activity levels? And have you ever heard of a 'basal insulin test'?

 

[Ljc]

Hi, welcome to the forum.. I am glad that the dr realised you could have LADA and ensured you were tested .
Yes it will help Us if you could answer the questions Jenny has asked.

Some folks do need different ratios at different times of the day , many of us insulin junkies also notice our ratios change throughout the year, I need to do regular Basal tests to see if my Basal insulin needs altering also the timing of our bolus insulin may well be different to what we’ve been advised to do, your Libre graph should help with this .
At the moment you need to stay in close contact with your hospital team esp the DSN because you need lots of expert support while you are going through such a difficult time. It will get better, honest !

Have you noticed any pattern to your hypo’s , ie mostly after / before a particular meal or around a time of day that sort of thing.

 

[gillrogers]

I'm on 10 units of semglee and 1:10 of lispro for breakfast and lunch, and 1:10 to 1:30 depending on what the carbs are and if I've been rather mobile during the day, for dinner.

Is the basal test where you fast over night and see if you need to put that one up or down?

 

[gillrogers]

Hi, welcome to the forum.. I am glad that the dr realised you could have LADA and ensured you were tested .
Yes it will help Us if you could answer the questions Jenny has asked.

Some folks do need different ratios at different times of the day , many of us insulin junkies also notice our ratios change throughout the year, I need to do regular Basal tests to see if my Basal insulin needs altering also the timing of our bolus insulin may well be different to what we’ve been advised to do, your Libre graph should help with this .
At the moment you need to stay in close contact with your hospital team esp the DSN because you need lots of expert support while you are going through such a difficult time. It will get better, honest !

Have you noticed any pattern to your hypo’s , ie mostly after / before a particular meal or around a time of day that sort of thing.

Hi Ljc,
Yes , they can be just after a meal, and usually on days where I've been very active even if I have been keeping an eye on it and topping up with a snack. That hypo is always a sudden drop.
I've tried timing my bolous 15 mins before a meal. Guaranteed when I do that I will get very low or hypo just after eating. I inject into my thigh because I don't have much fat around my tummy so when I use that site I will guaranteed have a hypo.

 

[everydayupsanddowns]

Sorry to hear how frustrating and fickle your diabetes is behaving @gillrogers

This is a good write-up of basal testing if you wanted to give that a go - it really helps to keep this adjusted throughout the year, and once you’ve got it ‘basically right’ (or more often in the case of a single or split insulin injection ’as right as it can be’) you’d usually only need small tweaks as the seasons etc change.

Many members have also found these books really helpful in understanding their diabetes. Don’t worry about the title of the Hanas book, it suits all ages!

Type 1 Diabetes in Children Adolescents and Young People by Ragnar Hanas

Think Like a Pancreas by Gary Scheiner

If you’ve not been offered any structured education, you might also find BERTIE or DAFNE (available free online) really enlightening

Dose adjustment for normal eating (DAFNE)
https://dafne.nhs.uk

BERTIE
www.bertieonline.org.uk

 

[gillrogers]

Sorry to hear how frustrating and fickle your diabetes is behaving @gillrogers

This is a good write-up of basal testing if you wanted to give that a go - it really helps to keep this adjusted throughout the year, and once you’ve got it ‘basically right’ (or more often in the case of a single or split insulin injection ’as right as it can be’) you’d usually only need small tweaks as the seasons etc change.

Many members have also found these books really helpful in understanding their diabetes. Don’t worry about the title of the Hanas book, it suits all ages!

Type 1 Diabetes in Children Adolescents and Young People by Ragnar Hanas

Think Like a Pancreas by Gary Scheiner

If you’ve not been offered any structured education, you might also find BERTIE or DAFNE (available free online) really enlightening

Dose adjustment for normal eating (DAFNE)
https://dafne.nhs.uk

BERTIE
www.bertieonline.org.uk

Thanks @everydayupsanddowns . Yes I've done Bertie and Dafne, I've revised a couple of I times. I'll have a look at that basal testing. A lot of my problem us I get Panicking when I go low which doesn't help.

 

[gillrogers]

Oh my life! That basal testing sounds so complicated. @everydayupsanddowns , I do have a lot of stress going on (a daughter with severe mental health problems, and a living room floor that is saturated and may need to be dug out so living in the kitchen for the last 3 weeks! . I am using a libre 2 so it's probably all on there anyway. I've asked the dB nurses to look at my stats since last time and asked them if they think I could change my basal to a 2 dose one 12 hrs apart. Fingers crossed they'll come back this week sometime.

 

[everydayupsanddowns]

Oh my life! That basal testing sounds so complicated. @everydayupsanddowns , I do have a lot of stress going on (a daughter with severe mental health problems, and a living room floor that is saturated and may need to be dug out so living in the kitchen for the last 3 weeks! . I am using a libre 2 so it's probably all on there anyway. I've asked the dB nurses to look at my stats since last time and asked them if they think I could change my basal to a 2 dose one 12 hrs apart. Fingers crossed they'll come back this week sometime.

Haha! Yes it does sound like a faff... but it was a technique I discovered fairly soon after joining forums more than a decade ago, and it made a huge difference to my understanding of the separate jobs of the two insulins, how they react and interact, and how on MDI you sometimes have to choose a ‘best fit’ or ‘least worst’ option which can mean that at different times of day you may have (strictly speaking) more or less basal active than you need. This is fine... because you can react by adjusting boluses *but* it means that those adjustments are separate to whatever rationis appropriate for the time of day. So it was more of a case of sticking to regular carb counts at breakfast and lunch and keeping my basal tweaked for me, rather than constantly fiddling with meal ratios.

No idea if that makes any sense! But certainly just an extra unit of basal over the day can make a huge difference vs the amount of corrections I’d need to take if it’s missing. Just another bit of the fun and games of ‘diabetes maths’.

 

[gillrogers]

Haha! Yes it does sound like a faff... but it was a technique I discovered fairly soon after joining forums more than a decade ago, and it made a huge difference to my understanding of the separate jobs of the two insulins, how they react and interact, and how on MDI you sometimes have to choose a ‘best fit’ or ‘least worst’ option which can mean that at different times of day you may have (strictly speaking) more or less basal active than you need. This is fine... because you can react by adjusting boluses *but* it means that those adjustments are separate to whatever rationis appropriate for the time of day. So it was more of a case of sticking to regular carb counts at breakfast and lunch and keeping my basal tweaked for me, rather than constantly fiddling with meal ratios.

No idea if that makes any sense! But certainly just an extra unit of basal over the day can make a huge difference vs the amount of corrections I’d need to take if it’s missing. Just another bit of the fun and games of ‘diabetes maths’.

Actually it does make sense, @everydayupsanddowns . I think the libre has gone towards me seeing that there is a problem with basal and I'd rather get that sorted so I can sort the boluses out. These differant meal ratios are a nightmare and a big differance between breakfast and dinner. Last night I only needed 1 unit and then worried all evening that it wasn't enough. I knocked my basal down today, so touch wood I won't had the dinner time low followed by the hypo tonight either. Got a roast chicken and I expect it'll be 1 or 2 units. Hopefully it'll work.

 

[everydayupsanddowns]

Actually it does make sense, @everydayupsanddowns . I think the libre has gone towards me seeing that there is a problem with basal and I'd rather get that sorted so I can sort the boluses out. These differant meal ratios are a nightmare and a big differance between breakfast and dinner. Last night I only needed 1 unit and then worried all evening that it wasn't enough. I knocked my basal down today, so touch wood I won't had the dinner time low followed by the hypo tonight either. Got a roast chicken and I expect it'll be 1 or 2 units. Hopefully it'll work.

For what it’s worth, most people generally find their split between basal and bolus is somewhere between 60:40 and 40:60, so if your total daily dose is a lot different to that it can be an indication that the balance isn’t right (though not always!)

 

[gillrogers]

So if I've understood you correctly, I was 10 (basal) : 12 (bolus) , now 8 (basal) : 12 (bolus) ?

 

[everydayupsanddowns]

8+12 = 20u TDD

(8/20)*100 = 40%

Which would mean 40% basal, 60% bolus.

Pretty much where mine usually sits too 🙂