LADA treatment with insulin + metformin + DPP-4i?

[rebrascora]

Here we go.... hte link to the basal testing thread...

Basal Testing Made Easy

Here's a link for basal testing, which will hopefully clear up the myths for anyone starting on their pump journey http://diatribe.org/issues/13/learning-curve Plus this might help as well. http://diatribe.org/issues/26/thinking-like-a-pancreas

forum.diabetes.org.uk

 

[Piers]

Right There are different ways of doing the cpeptide test so you need to do whichever way you’ve been advised, fasting in your case it sounds.

The more useful way (in my view) is the stimulated view. This means eating a meal with carbs, no bolus insulin but take basal insulin as normal. Have the cpeptide test 2hrs after food and bg must be above something, can’t remember what exactly but think it was above 8-9ish.

The other method is to have a fasting cpeptide test. You take basal insulin as normal but have the cpeptide test in the morning before bolus and before breakfast. Sounds like this is the one you’re having.

There’s a seperate range for each scenario and your dr needs to interpret it against the equivalent range.

I think I had better ask my doctor which I'd not done till now. It sounds complicated. He probably won't know but can at least ask the test laboratory with more authority than me. Thank you very much for your advice.

Well, your 17 units of basal doesn’t sound excessive, but without knowing your ratios it’s hard to comment. A meal ratio is how many grams of carbs one unit of insulin covers. As an example, if you had a meal ratio of 1:10g and ate 50g carbs, you’d take 5 units of insulin.

Are some of your 5 or 6 doses of Novorapid for snacks or are they to correct high sugar

Right, carb counting and meal ratios are beyond me. All I know is that I try to limit carbs - but not exclude them.

I'd say that on an average day 3 Novarapid doses are for meals and another 3 are for corrections.

A basal test is where you check to see if your basal insulin is holding you reasonably steady in the absence of food throughout the day and night. It is done by skipping meals in rotation over several days. So one day you might skip breakfast and not eat until lunchtime and see what your levels do overnight and during the morning. Then the next day, you have breakfast early, but skip lunch and see what happens over that lunchtime/afternoon period when only basal insulin is working, then the next day or a couple of days later you have lunch as usual, but skip your evening meal and go all night without food.

If you have not had any formal education on basal bolus insulin usage, the BERTIE online course is often recommended although I am not sure if it is accessible from outside the UK.

There is a thread about basal testing in the pumps and technology section... I will see if I can find it and post a link.

Getting your basal dose right makes all the difference in the world to managing your diabetes as everything starts to make sense when you get the balance right..... until you need to adjust it again of course. Basal needs don't generally stay the same. Here in the UK many of us see a seasonal change in our needs and for me exercise makes a significant difference so I need to dial my dose down after exercise and increase it again when I am more sedentary.

I've not had any formal diabetes education - pretty much self-taught, and evidently lacking. I will certainly follow your advice and look for info on basal testing, BERTIE, etc. Thank you very much.

 

[Piers]

Here we go.... hte link to the basal testing thread...

Basal Testing Made Easy

Here's a link for basal testing, which will hopefully clear up the myths for anyone starting on their pump journey http://diatribe.org/issues/13/learning-curve Plus this might help as well. http://diatribe.org/issues/26/thinking-like-a-pancreas

forum.diabetes.org.uk

Great! Thank you so much.

 

[Inka]

Right, carb counting and meal ratios are beyond me. All I know is that I try to limit carbs - but not exclude them.

I'd say that on an average day 3 Novarapid doses are for meals and another 3 are for corrections.

If you’re doing 3 corrections most days, then something is wrong. Either your basal is too low, or your meal ratios are wrong (I know you don’t officially have meal ratios but I mean your insulin to carb balance is wrong). It could be both those things.

Personal question - are you overweight? What’s your BMI? You mention limiting carbs whereas most Type 1s eat a pretty normal diet.

In your situation, I’d first try to work out what your meal ratios might be. For example, if you had two slices of toast for breakfast and took 5 units of insulin (not counting any correction dose), then you can workout your ratio, eg if the hypothetical toast added up to 30g carbs, then your ratio would be 1:6g. Anyway, roughly work each meal ratio out and jot it down.

Then do some basal testing over the next week so you can see if that’s right. Basal is the foundation on which you build. Once your basal is right, you can look at each meal ratio (breakfast, lunch, evening meal).

 

[Piers]

If you’re doing 3 corrections most days, then something is wrong. Either your basal is too low, or your meal ratios are wrong (I know you don’t officially have meal ratios but I mean your insulin to carb balance is wrong). It could be both those things.

Personal question - are you overweight? What’s your BMI? You mention limiting carbs whereas most Type 1s eat a pretty normal diet.

In your situation, I’d first try to work out what your meal ratios might be. For example, if you had two slices of toast for breakfast and took 5 units of insulin (not counting any correction dose), then you can workout your ratio, eg if the hypothetical toast added up to 30g carbs, then your ratio would be 1:6g. Anyway, roughly work each meal ratio out and jot it down.

Then do some basal testing over the next week so you can see if that’s right. Basal is the foundation on which you build. Once your basal is right, you can look at each meal ratio (breakfast, lunch, evening meal).

Good morning Inka. I just calculated that my BMI is 24.2 which the NHS site says means I’m not overweight. Ok, so the next thing is for me to work on meal ratios and basal testing. Bye for now I have a lot of reading to do…. Thanks to everyone for your fantastic advice.

 

[Inka]

Let us know how you get on @Piers It’s a big job but take it slowly and methodically and you should be fine. Do remember we’re here if you have any questions 🙂