Mixed outcome from phone appointment

[Lisa65]

Had phone appointment with the practice nurse, she had discussed my Libre data with the DSN and they were both happy with what I'm currently doing (15 units of abasaglar at night and eating low carb)
She didn't seem to know what LADA was when I mentioned it, and she didn't think I needed rapid acting insulin to deal with FOTF and any post meal spikes, even though I explained that I would only want to use tiny doses on an occasional basis to cover higher carb meals now and then. But she did say she would email the diabetic team at the hospital and ask.
Her suggestion if I wanted more coverage in the morning to help with foot to floor would be twice daily Humulin I instead of abasaglar, with the bigger dose in the morning. But again she said she would speak to the team about it.

But on the plus side, they are so happy with my use of the Libre and the way I've been able to get better control with it, that they are going to give it to me on prescription. So that was good 🙂

I'll get an Hba1c done in a couple of months, after I've been on the insulin a bit longer.

 

[helli]

She didn't seem to know what LADA was when I mentioned it

She is not alone. Many HCP avoid the term because is, at best, unknown and, at worse, ambiguous.
As it is a variant of Type 1, many prefer just to call it that. The only benefit I see in using the term is to highlight that more than 50% of people are diagnosed with Type 1 as adults and minimise the number of those incorrectly diagnosed with type 2.
Have you ever been tested for Type 1 (GAD and/or c-peptide tests)?

 

[Inka]

Her suggestion if I wanted more coverage in the morning to help with foot to floor would be twice daily Humulin I instead of abasaglar, with the bigger dose in the morning. But again she said she would speak to the team about it.

Humulin I won’t help with FOTF. You’d need to take it hours prior to getting up for it to do so . Humulin i is a good insulin,but you’d need a fast-acting insulin to stop/reduce FOTF.

 

[Lisa65]

She is not alone. Many HCP avoid the term because is, at best, unknown and, at worse, ambiguous.
As it is a variant of Type 1, many prefer just to call it that. The only benefit I see in using the term is to highlight that more than 50% of people are diagnosed with Type 1 as adults and minimise the number of those incorrectly diagnosed with type 2.
Have you ever been tested for Type 1 (GAD and/or c-peptide tests)?

Never had any tests, they just assumed T2 because I was 45 and somewhat overweight at diagnosis, although not now. Of course I probably am T2, but it would be good to know for sure, plus I'd like to know how much endogenous insulin I still have.

 

[Lisa65]

Her suggestion if I wanted more coverage in the morning to help with foot to floor would be twice daily Humulin I instead of abasaglar, with the bigger dose in the morning. But again she said she would speak to the team about it.

Humulin I won’t help with FOTF. You’d need to take it hours prior to getting up for it to do so . Humulin i is a good insulin,but you’d need a fast-acting insulin to stop/reduce FOTF.

Exactly, it won't make any difference.

 

[SB2015]

Never had any tests, they just assumed T2 because I was 45 and somewhat overweight at diagnosis, although not now. Of course I probably am T2, but it would be good to know for sure, plus I'd like to know how much endogenous insulin I still have.

T2 is a common assumption when adults present with symptoms of diabetes.

The tests for T1 are more expensive than some and there is often a reluctance to do these. The c-peptide would let you know how much insulin you are making. The Gad antibody test would tell them whether you have the antibodies destroying your beta cells.

As others have said there is no point in using an increase in Humalin to deal with spike and FTF. For those you need some quick acting insulin and your plan to use small amounts to address larger meals make sense.

Let us know how you get on.

 

[Lisa65]

I'll keep chipping away 😉
At least I got the Libre on prescription, which I hadn't asked for.

 

[Lisa65]

Thinking I might fork out for a private GAD and c-peptide test, just to satisfy my own curiosity. The Spire hospital in Southampton offers them, so I might look into that.

 

[Lisa65]

Looks like I might be getting my way after all, the practice nurse called me back, the diabetes team has suggested two possible options ; an SGLT or rapid acting insulin, although they would want me to do a carb counting course first.
I have an appointment with the DSN on 23rd January to discuss it

 

[Lucyr]

Looks like I might be getting my way after all, the practice nurse called me back, the diabetes team has suggested two possible options ; an SGLT or rapid acting insulin, although they would want me to do a carb counting course first.
I have an appointment with the DSN on 23rd January to discuss it

Is it an option to go on the waiting list for the carb counting course and use fixed doses and set carb amounts for meals in the meantime?

There’s literally no point going on a carb counting course if not already on rapid insulin. The course doesn’t actually teach you much about how to count carbs, that’s the simple bit, ours probably spent about 2-3hrs out of 4 full days on identifying and calculating carbs, if that.

The majority of the course was about adjusting your insulin doses, so looking at libre graphs and identifying which ratios or doses to change. You can’t do that and benefit from the course if not already on fast acting insulin. I doubt they’d even accept you on the course without being on it.

 

[rebrascora]

@Lucyr Unless the carb counting course is simply a half day with the diabetes dietitian, learning how to carb count as oppose to a DAFNE type course which is generally only open to Type 1s and insulin dependent Type 3cs, unless you have a very progressive clinic. I agree though that doing any course without actually having bolus insulin so that you can put it into practice straight away is less than ideal and for an intensive DAFNE type course, a waste of time.

@Lisa65 Good to hear that the clinic are possibly open to a bolus insulin. I think you might do yourself a favour by being a little less strict with your diet so that they can see an obvious need for bolus insulin.

I can understand you wanting some clarification via C-Peptide and antibody tests and I would keep pushing your nurse for these and if you continue to hit a brick wall, then consider private. The reason I say this is that if this gets 5 or 10 years down the road, the antibody test may not be reliable and as we know C-peptide can be less useful on it's own, especially as some insulin production can remain for many years after diagnosis. It is very frustrating that these tests are not considered for many people and the many clinicians refuse to contemplate he possibility that a Type 1 diagnosis can occur later in life and therefore resist testing for it.

 

[Lisa65]

Is it an option to go on the waiting list for the carb counting course and use fixed doses and set carb amounts for meals in the meantime?

There’s literally no point going on a carb counting course if not already on rapid insulin. The course doesn’t actually teach you much about how to count carbs, that’s the simple bit, ours probably spent about 2-3hrs out of 4 full days on identifying and calculating carbs, if that.

The majority of the course was about adjusting your insulin doses, so looking at libre graphs and identifying which ratios or doses to change. You can’t do that and benefit from the course if not already on fast acting insulin. I doubt they’d even accept you on the course without being on it.

I can ask all that at the appointment, I guess. Hopefully they will let me try fixed dose to start with,without having to do the course first.

 

[Lisa65]

Good to hear that the clinic are possibly open to a bolus insulin. I think you might do yourself a favour by being a little less strict with your diet so that they can see an obvious need for bolus insulin.

Good thinking, maybe I'll have a few more carby days between now and 23rd

 

[everydayupsanddowns]

Great to hear you are getting Libre on prescription @Lisa65 , and that you are moving towards your preferred plan of adding fast-acting insulin to your repertoire.

If you’d like a bit of a head start on the idea of carb counting, there’s apage covering the basics you could have a look at here:

Learn about carb counting

Being aware of the amount of carbs in food and drinks is important for everyone with diabetes, we've got some tips to help you do this.

www.diabetes.org.uk

 

[Lisa65]

Great to hear you are getting Libre on prescription @Lisa65 , and that you are moving towards your preferred plan of adding fast-acting insulin to your repertoire.

If you’d like a bit of a head start on the idea of carb counting, there’s apage covering the basics you could have a look at here:

Learn about carb counting

Being aware of the amount of carbs in food and drinks is important for everyone with diabetes, we've got some tips to help you do this.

www.diabetes.org.uk

Thanks Mike, I will have a look. I already count carbs to some extent, but I definitely need practice