Advice on T2 Starting Insulin Injections

[Hatton VR6]

Hi I have been type 2 for 17 years. My glucose levels have crept up to close to 20. My BMI is less than 25. An increase in metformin made no difference. I also walk 2 - 3 miles a day with the dog, further at the weekend. I was started on insulin injections this week starting with 4 units. I was advised to monitor glucose regularly throughout the day and increase my dose by 2 units at a time as required. Is this normal practice? How long should I leave between changes in the insulin dose? The glucose levels have dropped by 4 - 5. How long to changes in insulin dose take to affect blood glucose levels, as the insulin is long acting (18 hours), would it be the day of the change in dose?

 

[Deleted member 27171]

Hi @Hatton VR6
Welcome to the forum 🙂
Great to see that the change in treatment seems to be working already. Which insulin do you use? Many people find that when changing their dose of long acting it can take a few days to be confident of the results so would leave it at least that before further increases are applied.

 

[Hatton VR6]

Hi, Thank you. The insulin is Lantus Solostar.

 

[everydayupsanddowns]

Hi, Thank you. The insulin is Lantus Solostar.

Dose adjustment is very individual, and it can be hard to know bow much anyone will need, so it is generally safer to start cautiously and build up slowly.

Lantus is generally reputed to take about 3 days to ‘settle‘ after a dose change, so I would be a little cautious about making increases any more frequently than once a week if it were me... And if you start getting low BG, bear in mind that any reduction may leave you exposed to increased risk of hypos for 2-3 days after you dial down the dose.

Hope you are able to get your BGs in range before long. 🙂

 

[DaveB]

Hi. You've been given good advice already here. Are you also having a low-carb diet? Are you in fact Slim? If so I wonder whether you may be a late onset T1 with a very long honeymoon period? I'm just guessing but your BMI sounds good for a T2 with BS near 20 and not typical of a T2. I had a honeymoon period of nearly 10 years and also slim with high BS until insulin. Hopefully the Lantus will work well with the right dosage.

 

[Hatton VR6]

Hi, thank you some good advice in the replys. I am just under 6ft with a 32 inch waist. Ideally I could do with loosing a about 5 pounds. Corona brought a change to my exercise used to take train to work and cycle 14 miles to and from stations. Now use car and will do until a proven vaccine. Interesting thought about T1, I was thinking something similar, my mother was diagnosed as T1 at the age of 44 back in 1966 when I was 4. My great grandmother was also T1 late in life. My grandmother died early. My mother did a very good job of controlling her diabetes by testing regularly (the gp always complaining about the number of test stips used so she would cut them in half as no electronic meters then) with control being much easier when she moved to blood testing. I also have 2 other auto immune conditions. At the moment I am testing 7 - 8 times a day until I get it under control.

 

[trophywench]

I reckon you are a type of diabetes known as LADA, which starts off looking exactly like T2 and responding the T2 drugs until eventually nothing except insulin will touch it and henceforth is treated exactly as if it had been T1 all along. Now - this can actually be tested for (in the lab not on a meter via finger prick) by using blood tests for C-peptide and GAD antibodies.

Hence at the time when it does morf a bit more, a faster acting insulin to take before meals will most likely need to be added, as long acting insulins like Lantus can't deal with it all on their own and shouldn't be expected to.

You're not very far along that journey yet but nobody can predict how long it will take or what the road surface ahead will be like - bumpy or smooth?

 

[Inka]

my mother was diagnosed as T1 at the age of 44 back in 1966 when I was 4. My great grandmother was also T1 late in life....I also have 2 other auto immune conditions.

I’d be pushing for the C Peptide and GAD tests to see if you’re actually Type 1. Far too many late-onset Type 1s are misdiagnosed and under-treated. Even if you turn out not to be, I’d be wanting it ruled out for sure.

 

[Hatton VR6]

Hi, I had not heard of LATA before. I have looked at the internet. It does seem to fit with symptoms. Doubling the oral drugs had no effect. I did ask the GP if it was turning to T1 he said no but I am making some insulin but not enough. The drugs have been increased every year for the last 3. Gut instinct tells me I will also be on fast acting insulin at meal times in the future. I will ask for the test but suspect the response will be no! I am testing regularly to get an idea of what various foods do. When it settles will find the effect of 1 rolo, jelly baby etc.

 

[Hatton VR6]

Hi GP has refered me to consultant who is doing C peptide and GAD test.

 

[Inka]

Great news @Hatton VR6 🙂

 

[everydayupsanddowns]

Hi GP has refered me to consultant who is doing C peptide and GAD test.

Let us know how you get on @Hatton VR6 !

 

[Ljc]

Hi GP has refered me to consultant who is doing C peptide and GAD test.

That is good to hear.

 

[leonS]

"Making some insulin but not enough" is a classic description of a T1!!!!

 

[Hatton VR6]

Hi, GP phoned today, UHCW did not have mobile number to contact me. Confirmed as T1, glargine increased to same dose but twice a day. Also adding 5 units of rapid acting insulin not sure what type yet to be taken at meal times. Was expecting this with the spikes after meals, I also have 2 other autoimmune conditions.

 

[leonS]

Hi Hatton,

In many ways that is good news, a least you know where you are and you are under the care of someone who knows a thing or two.

By the way we do not turn into T1s, A T1 always was a T1 and someone got it wrong. No shame in that. What is wrong is to give a perfect description of a T1 and then say I was right all the time you are a T2.

I expect that you will be shown how to adjust your insulin so that you will be able to eat just about what you like.