Hi from a silent reader - LADA adapting to insulin advice requested

[KathyG]

hi everyone, I’ve viewed and read many of the helpful and interesting conversations on the forum for years, but until now didn’t really have a need or additional knowledge to warrant posting. Things have changed!.

Like many in the LADA group I’ve been merrily thinking I was a type 2 for 7 years, controlling by diet and exercise alone to start with, but over the years ‘giving in’ to more and more tablets. For the past 6 months they’ve been testing and monitoring me as I’m normal weight with a 22 bmi but steadily rising sugar readings. Finally a couple of weeks ago the test results showed that I was type 1 but I’m still producing some insulin. For the past two weeks I’ve been using both fast and slow insulin, trying to find the right amounts with support from the diabetic nurse team. Similar story to many I know...

Here comes the bit I hope someone can help with - I’ve been through a couple of lows doing exercise and so have been following instructions to not inject after 4 hours prior to exercise and to take a banana just before exercising. Yesterday I followed the instructions and had a 45 min horse riding lesson then a friend came around and I had 2 glasses of wine before cooking tea. By the time I ate I was at 4.8, but on eating it went up and all fine, I had a couple more glasses of wine (spot what’s coming I think). I was woken early this morning by my Dexcom with a 3.1 reading and I’ve been on a roller coaster all day since.

I’m guessing from reading that drinking on an empty stomach is a no no and moderation is not 4 glasses of wine.. my question is when will I stabilise as I’m still going up and down dramatically over 10 hours later from the first (of 3) lows. Is there anything I should do specifically to slow the roller coaster? Tomorrow I’m flying to Beirut for work and this is not helping with the normal trip preparation stresses...

Any advice appreciated

 

[SB2015]

hi everyone, I’ve viewed and read many of the helpful and interesting conversations on the forum for years, but until now didn’t really have a need or additional knowledge to warrant posting. Things have changed!.

Like many in the LADA group I’ve been merrily thinking I was a type 2 for 7 years, controlling by diet and exercise alone to start with, but over the years ‘giving in’ to more and more tablets. For the past 6 months they’ve been testing and monitoring me as I’m normal weight with a 22 bmi but steadily rising sugar readings. Finally a couple of weeks ago the test results showed that I was type 1 but I’m still producing some insulin. For the past two weeks I’ve been using both fast and slow insulin, trying to find the right amounts with support from the diabetic nurse team. Similar story to many I know...

Here comes the bit I hope someone can help with - I’ve been through a couple of lows doing exercise and so have been following instructions to not inject after 4 hours prior to exercise and to take a banana just before exercising. Yesterday I followed the instructions and had a 45 min horse riding lesson then a friend came around and I had 2 glasses of wine before cooking tea. By the time I ate I was at 4.8, but on eating it went up and all fine, I had a couple more glasses of wine (spot what’s coming I think). I was woken early this morning by my Dexcom with a 3.1 reading and I’ve been on a roller coaster all day since.

I’m guessing from reading that drinking on an empty stomach is a no no and moderation is not 4 glasses of wine.. my question is when will I stabilise as I’m still going up and down dramatically over 10 hours later from the first (of 3) lows. Is there anything I should do specifically to slow the roller coaster? Tomorrow I’m flying to Beirut for work and this is not helping with the normal trip preparation stresses...

Any advice appreciated

As you have noticed, alcohol needs to be taken account of. Through trial and improvement, I have found that I need to turn my pump, which is delivering my basal insulin, down by about 10% for each glass of wine. I then cancel this when I wake for my usual night time pee, around 3:00.

Some hypos are a real pest to get settled and you can end up with a yo-yo day. One thing that has helped me to avoid this is to reset the reminder to test after a hypo from the previous 10 min, to 15 min. This has stopped me overtreating a hypo, and so avoiding the high after a hypo on most occasions.

You ask when things will settle, with LADA the destruction of the beta cells is a lot slower than in T1s diagnosed earlier. Hence the common problem of misdiagnosis as T2. As for how long it will be before the beta cells are alll gone, it is impossible to tell. I end up with step increases in my insulin needs now and then, and wonder whether that is another set of beta cells gone. To quote my consultant ‘you need as much insulin as you need’. We all have to adjust our ratios and sensitivity regularly and there are so many factors involved it is difficult to isolate the cause sometimes.

Keep testing and keep adjusting as necessary.

 

[KathyG]

Many thanks sb2015, I’ll try your reminder recommendation. Constantly watching the waves is not helping me so a break is a good idea. I’ve not experienced a night time low before and the thought of one while away from home on my own is a bit daunting. I’m sure it’ll be fine.

 

[Flower]

Hello and welcome @KathyG , glad you've joined us 🙂

This information from the Diabetes UK site is useful to know when adding some wine/alcohol to the diabetes & insulin mix -

Alcohol and hypos
If you use insulin or some other diabetes medications like sulphonylureas, you’re more likely to have a hypo. Drinking alcohol can then add to this, because it causes your blood sugar levels to spike or drop. If you’re not sure whether your medication can cause hypos or if they're affected by alcohol, it’s best to speak to your healthcare team.

If you drink a lot or on an empty stomach, you’re even more likely to have a hypo. Your liver works twice as hard when you drink, because it's trying to keep your blood sugar steady and at the same time trying to get rid of the alcohol. It just can’t keep up. So your blood sugar might drop and stay low until your liver has dealt with the alcohol. That’s why you might crave carbs and wake up the next morning with a headache.

Your risk of having a hypo doesn't go away after you stop drinking – it increases, and can last up to 24 hours.

It’s not uncommon for some people to mistake having a hypo for being drunk. So carry hypo treatments around with you and always wear some medical ID. You should also make sure that whoever you’re with knows you have diabetes, and knows how to help with a hypo if you need them to.

The risk of a hypo/ fluctuating levels can continue for up to 24 hours after drinking. Keep a good supply of quickly absorbed glucose to hand and don't drink on an empty stomach to try and minimise problems.
It is a work in progress approach to all these situations 🙄🙂 as @SB2015 says test and adjust as necessary.

 

[Bruce Stephens]

Yesterday I followed the instructions and had a 45 min horse riding lesson then a friend came around and I had 2 glasses of wine before cooking tea. By the time I ate I was at 4.8, but on eating it went up and all fine, I had a couple more glasses of wine (spot what’s coming I think). I was woken early this morning by my Dexcom with a 3.1 reading and I’ve been on a roller coaster all day since.

Most likely things will stabilise over time, but don't expect it ever to be entirely predictable. Exercise (even the fairly moderate kind I do) can lower blood sugar hours later (some people report it changing the next day). And of course alcohol changes things too.

 

[KathyG]

Hello and welcome @KathyG , glad you've joined us 🙂

This information from the Diabetes UK site is useful to know when adding some wine/alcohol to the diabetes & insulin mix -

Alcohol and hypos
If you use insulin or some other diabetes medications like sulphonylureas, you’re more likely to have a hypo. Drinking alcohol can then add to this, because it causes your blood sugar levels to spike or drop. If you’re not sure whether your medication can cause hypos or if they're affected by alcohol, it’s best to speak to your healthcare team.

If you drink a lot or on an empty stomach, you’re even more likely to have a hypo. Your liver works twice as hard when you drink, because it's trying to keep your blood sugar steady and at the same time trying to get rid of the alcohol. It just can’t keep up. So your blood sugar might drop and stay low until your liver has dealt with the alcohol. That’s why you might crave carbs and wake up the next morning with a headache.

Your risk of having a hypo doesn't go away after you stop drinking – it increases, and can last up to 24 hours.

It’s not uncommon for some people to mistake having a hypo for being drunk. So carry hypo treatments around with you and always wear some medical ID. You should also make sure that whoever you’re with knows you have diabetes, and knows how to help with a hypo if you need them to.

The risk of a hypo/ fluctuating levels can continue for up to 24 hours after drinking. Keep a good supply of quickly absorbed glucose to hand and don't drink on an empty stomach to try and minimise problems.
It is a work in progress approach to all these situations 🙄🙂 as @SB2015 says test and adjust as necessary.

Many thanks Flower, that was very helpful. The 24hours aspect seems to be right for me, I’ve had a reasonable night and have woken to a stable 7.7.

 

[KathyG]

Most likely things will stabilise over time, but don't expect it ever to be entirely predictable. Exercise (even the fairly moderate kind I do) can lower blood sugar hours later (some people report it changing the next day). And of course alcohol changes things too.

Thanks Bruce, yes I’m finding out new patterns and rules all the time, and agree it’s unlikely to be ever be entirely predictable. 2 weeks is early days I’m telling myself - I’ll adjust it’s just gaining the understanding of what’s crucial change when you’re learning so much. Hats off to everyone on insulin

 

[SB2015]

Thanks Bruce, yes I’m finding out new patterns and rules all the time, and agree it’s unlikely to be ever be entirely predictable. 2 weeks is early days I’m telling myself - I’ll adjust it’s just gaining the understanding of what’s crucial change when you’re learning so much. Hats off to everyone on insulin

2 weeks in is definitely VERY early on.
Well done for all that you have got sorted so far.

Keep coming back with any questions you have.
Plenty of help available here.