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Newly diagnosed with LADA and about to start glargine insulin

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Chris88

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Hello everyone.
I am new to the forum and have a question I hope somebody can help me with.
I am currently controlled on metformin sr 1g twice daily, sitagliptin 100mg daily and gliclazide 40mg twice daily (glucose levels usually between 4 and 9).
I was recently found to have GAD antibodies > 2000 and C peptide of 800 and thus diagnosed with LADA.
At an appointment today my diabetes specialist nurse prescribed me glargine insulin 6 units daily and told me to stop my oral hypoglycemics, my weight is 82kg.
I think this is a very low starting dose and will cause hyperglycemia. I am concerned as this has been linked with ketosis in the recent past.
I am considering waiting until Monday when I can talk to diabetes team and check this is correct before starting insulin. I understand there is no urgent need for insulin in early cases of LADA as insulin is still being produced and my glucose levels are reasonable.
Does anybody have any experience of this scenario? Any advice would be welcome.
Thanks
Chris
 
Hi Chris

Welcome. I don’t have a definite diagnosis of lada but my consultant thinks that’s what it might be. How long is it since you were diagnosed .? U need to do what u think is right for u but I think as u say I’d want to speak to my diabetic team at the hospital first. I am currently not on any medication as hba1c has fallen to 55 from 115 in about 9 weeks. Do you know your current hba1c?
 
Hba1c last checked 4 months ago: 48.
I am 57 years old and started with diabetes symptoms 12 months ago
 
It’s not way off target ? I am 41 started symptoms 6 months ago. Did they say why they wanted you to start insulin ? I take it you have GAD antibodies ?
 
@Chris88 With insulin you start on a low dose and build it up gradually if needed. You’re receiving good treatment by having your tablets stopped. Gliclazide can squeeze the remaining life out of your islet cells whereas early introduction of insulin will help preserve them.
 
Surely generally it is accepted that starting insulin sooner rather than later is helpful in LADA cases?

Plus - my Diabetes Specialist Nurse is based at the hospital diabetes clinic. Whatever the specialism, to get the extra university degree to qualify as a specialist nurse the nurse has to work fulltime exclusively in that specialism. eg, a friend is a Mental Health Specialist Nurse and he worked fulltime in the MH dept of a northern teaching hospital.
 
So, your blood sugars may be a little higher to start with but this is totally normal. Your insulin will be increased carefully and you should soon see better numbers. LADA is a form of Type 1 and you will find you need the normal regime of two different types of insulin as time passes. This is a good thing as it will give you better control and more normality and flexibility.
 
Absolutely it is @trophywench Diabetes U.K. says this (my bold):

“most healthcare professionals agree that the aim of treatment is to keep insulin being produced for as long as possible. So it’s recommended that insulin treatment is started early”

Getting insulin in quickly is best practice IMO.
 
Thank you for your replies.
It was the titration of insulin that concerned me as recent hyperglycemic episodes have resulted in ketosis.
I agree that it is important to start insulin to protect beta cell function and similarly to stop gliclazide as the this can hasten the demise of beta cells
 
Did you have DKA or ‘just’ ketones?

You could ask for a bolus/meal/fast insulin too. That would allow you to inject before meals when needed but also allow you to correct high blood sugar. It would be very useful to have in reserve even if you don’t need it yet.
 
If the 6 units really is too little for you, it can be raised by your team fairly swiftly once they know how you’re doing. It depends how high you’re going.
 
Just ketones thankfully. The intention is to add a quick/short acting insulin before meals when this is appropriate.
I think I will try the glargine tomorrow with regular glucose monitoring throughout the day and discuss with diabetes team on Monday.
Thank you Inka for your support.
 
@Chris88 - until you start injecting insulin you have no clue whatsoever how well or otherwise your body will react to it. As has been said - if your BG shoots into the stratosphere pdq, the dosage can be increased equally swiftly - or if it's too much - the opposite.
 
That’s the way to go 🙂Keep detailed records of your sugars and also your food intake. Note anything different eg exercise. All that info will help your team determine your dose.

Even if you’re expecting to be high, always keep hypo treatments with you.
 
Welcome to the forum @Chris88 from another late starter.

It is good that you have your diagnosis. LADA is just a slow onset of T1, and as your beta cells which make your insulin are being destroyed you will gradually need more insulin. The long acting (basal) insulin to deal with the glucose your body trickles out, and the quick acting (bolus) which deals with the glucose from carbs that you eat is the most flexible way to manage, and the sooner you are started in this the more closely you will be able to match ‘Norma’ needs, and also protect your remaining beta cells as best you can.

Simplistically if you glucose levels are high you need more insulin, if they are going low you need less. There is a bit of juggling to do to get that right and that is what your team are there to help you with. It is a lot to take on board at the start but quickly becomes a new normal.

Let us know how you get on on Monday.
 
I suspect their caution with insulin may be connected to your historically fairly ‘on the money’ HbA1c? Which suggests your BG levels may have been fairly on-target?

While starting doses can be predicted with a ‘units per kg of bodyweight’ approach, and then split between basal and bolus, it seems that your clinic are preferring to start you on just basal - perhaps to reduce the risk of hypoglycaemia?

Like others, I hope you get on a full and flexible insulin regimen as soon as possible - even if that means more injections in a day.

Look forward to hearing how you get on 🙂
 
Hi all, just a quick update after starting glargine insulin over the weekend.
I had originally been treated as Type 2 (metformin+ sitagliptin+ gliclazide) but recent tests showed high GAD antibodies and therefore diagnosed with LADA.
I was started on 6 units of glargine daily, nothing else.
I was concerned this was not enough and expected to become hyperglycaemic which often results in ketosis for me (thankfully not DKA!). I was frustrated at potentially losing control of glucose levels once again!
Well , as expected, 6 units was not enough, I ended up with BG of 14 and 17 after lunch and evening meals ( with resultant ketosis: which measured low risk when tested) but morning levels for BG were 5 or 6.
I managed to discuss with my Diabetes Specialist Nurse today who suggested I continue with 6 units of glargine once daily but add 4 units of lispro before lunch and evening meal. This seems to make sense so I took my first dose of lispro 1.5 hours ago.
I guess we will know more after a few days of the new regime and we can then titrate accordingly.
As many have mentioned having long and short acting insulin seems the best way to go and I think you were right; they were concerned about hypoglycaemia hence the low dose.
Thanks to all of you who supported me over the weekend particularly Inka who with kindness , understanding and gentle encouragement got me started on insulin.
Great forum; keep it up!
 
That’s great news that you’ve got the Lispro now too @Chris88 Once you get the hang of things, that will make a big difference 🙂

Thanks for the update 🙂
 
richardmillar11 said:
Hi Chris

Welcome. I don’t have a definite diagnosis of lada but my consultant thinks that’s what it might be. How long is it since you were diagnosed .? U need to do what u think is right for u but I think as u say I’d want to speak to my diabetic team at the hospital first. I am currently not on any medication as hba1c has fallen to 55 from 115 in about 9 weeks. Do you know your current hba1c?
Click to expand...
how did you get your levels down please and was you poorly with high Hba1c - husband is on insulin and metformin
 
Norfolklou said:
how did you get your levels down please and was you poorly with high Hba1c - husband is on insulin and metformin
Click to expand...
Mine came down with diet and only one week of metformin. No side affects but then I wasn’t on it very long. I wouldn’t say I was poorly with high hba1c but tired no energy hungry thirsty but that was it. Vision was a bit blurry and I was a bit dizzy from time to time
 
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