@lh378 I think it just means you might still make enough trace to help with your basic liver output need, but not enough to spill over to help with your boluses. 6-8 units for mealtime is not unusual, although I guess it depends on the carb count for the meal.
I eat whatever carbs I want, it comes down to a matter of timing of dosing or me. Not what I want to eat. If it’s something I like, I keep experimenting until I get it right.
@cardamom I have been LADA since 2003 and within 3-5 hours of no insulin I will be over 300. I know this because of pod failures after a pod change. Nowadays if I notice my numbers going up after an hour for no apparent reason I change it out pretty fast. It has never made sense to me that I rise so much so fast as my basal is less than 1 unit an hour. But it’s like no insulin, get her…
I have read that they think children that get it before the age of 7 have a slightly different form of the disease. Research was ongoing but unfortunately I didn’t tag the article.
But here is a nice article about still producing some insulin.
Right so that’s at 10 years. I suspect the number is lower for 30-40 years (I’m almost at 30 years myself), which is where the other study estimated 10%, but it’s just one study, so who knows how accurate that is.
My point is that it’s not surprising that there’s variability in this—I would expect to see more insulin production on average with LADA than childhood onset, and more with those recent diagnosed than not, but that all of it is variable across people (with considerable genetic determinants) and with exceptions. But it’s worth keeping in mind that if you’re someone who has a relatively easy time with control, or if your basal dosing works in a fairly simple or flexible way, or if you have longterm T1 of any sort with very few complications, at least part of it could be greater insulin production, and thus not universal. And that is just more factor behind YDMV (your diabetes may vary).
My WAG for carbs for the meal is between 28-30ish when I bolus 6 units. I try to best guess estimate the big carb items such as fruit, pasta/grain/legumes. For the green veggies or stuff like broccoli, I just guess around 3-5 g carbs. Best guess of insulin to carb ratio, about 1:6. I take half a unit or 1 unit extra if the pre meal number is more than 100.
My recent A1C is 5.5. I don’t know that I can believe this number for at least two reasons.
I often go up to 150, not unusual to 180 or even 200. In other words, the time that I’m between 70-120 or 140 is definitely not 100%. 2. The same blood test stated that my fasting BG was 75. I checked my glucometer and my Dexcom - both were much higher, BG around 100 at the time of the blood draw.
With the help of Afrezza, the BG is often brought down quickly without hypoglycemia. Still…I would imagine that an A1C of 5.5 is EITHER really good control without extreme highs and lows OR, lots of highs and lows. I know that I have a lot of highs, even if they are brought down quickly by Afrezza. However, I don’t have many lows. I am one of those timid ones, very scared of hypoglycemia. In my entire life, I probably have had less than 7 times of BG less than 65; maybe 2 times less than 55. Once below 40 (this scared me and my family!). So I don’t see how my A1C is 5.5 if I have many highs. 5.5 A1C does not seem to make sense.
Keep in mind that A1C depends on how long your red blood cells live, which can vary person to person and within the “3 month” timeframe used since it’s the average life of blood cell. Short lived blood cells can give false low A1C, which gave me a 4.1 during chemo.
@ih378 If the blood draw said 25 points lower than your Dex or meter it’s possible they are off? Especially if you calibrate your Dex to your meter? A lot of people use a blood draw (I am one) to check the accuracy of your meter and/or Dex. It could be you are going lower than you realize? But there is always the “20%” variability factor too.
@cardamom I don’t agree about the easier control if a LADA versus childhood. I actually think making some insulin, which would be irregular might be harder to control. I know of at least 6 people with over 50 years in, since childhood that have great control. One I know has been tested and makes no insulin and has an A1C of 5.1-5.3%.
5.5 is a normal a1c. Your air is normal with significant insulin management. Normal is normal… don’t overthink it. Just be happy you’re able to keep your A1C in the normal range.
My last a1c was also 5.5 and I shoot up to 180+ Almost every day no matter how diligent I am… which is also fairly normal for a middle age out of shape pot bellied man regardless of diabetes…
I didn’t know that!? @Sam. I thought that with BG’s up to 180, the A1C for sure would be closer to 6.
@Marie - with the G6- I don’t calibrate. I’ve found the two numbers to agree almost all the time except if I’m dehydrated, BG changing rapidly, or compressed it. I use the Contour Next meter which seems pretty good.
That’s an excellent way to get a good A1C. Congratulate yourself on your skillful BG management and consistent work to take care of yourself. As Sam mentions, and as your own experience shows, if you promptly bring your high BG excursions right back down to a good range there really isn’t enough time for much glycation to happen, so it doesn’t particularly raise the A1C…
It’s interesting because Samson needs almost no insulin overnight often, but when we tested his C-peptide levels, it was undetectable.
Not sure what that means, but just another data point.
I think the I think the typical labs that your local doctors office is doing are generally still likely to just say 0.0 wheras the latest and greatest being used in research might say for example .03 or .008 etc etc
Which might not be particularly meaningful in terms of day to day management, but it is significant looking forward to potential treatments etc… they’re discovering there’s almost always a seed vs no seed, so to speak…
The T1 antibodies testing “report” are pretty awful: Less than 5, or greater than 5. “My chart” - my doctor’s practice, just reported my GAD, and I think IIA as less than 5. Were the values 1, or 4.9? What are the “typical results” for T1 antibodies?
Nobody understands the levels including your doctors when it comes to antibody testing. The units aren’t even standardized from one lab to the next. You’re right it’s a mess, as my doc explained to me (after contradicting himself several times) is just consider it a positive or negative based on the result
I’m not up on the current research results, but a few years ago the results said that the A1C value captures nearly all of the risk factor of high BG, and that evaluating the number and height of hyperglycemia episodes basically gives no significant added predictive power.
Some questions and updates:
is anyone using Acarbose, or the generic together with bolus insulin (or maybe without bolus insulin)?
The doctor rechecked c peptide:
My recent c peptide is low------->0.5
The anti body tests are negative. What the heck does this mean? I am not a Type 1 ? I produce very little meal time insulin and some basal insulin? Previous Endo thought that I was most similar to LADA- but tried to prescribe glimepiride for me.
I use 7 units of Tresiba for basal; and for bolus I use Novolog. The bolus amount can be as much as 10 + or more units for a meal. Often, meal time bolus is 6-7 units.
My pancreas does not appear to be able to keep up with the meal time rise in BG. So I use Novolog. My question is : would Acarbose work for me? I think I still produce insulin because my Tresiba amount is not much. So, I think that a drug like Acarbose may help me, perhaps eliminate or reduce the quantity of meal time insulin.
what do you think? BTW - The negative antibodies result is shocking news to me.
There are a few type 1’s that don’t test positive for antibodies, they don’t know why. My DE is one of those, she makes no insulin but doesn’t have the antibodies. There are several “forms” of type 1.
If you test positive for the antibodies that’s a definitive yes. But if you have low c peptide that is also a yes. A type 1 especially a LADA/type 1 slowly loses the ability to make insulin and their c-peptide will be low normal or low and that can vary some as you lose the ability over time to make insulin. Eventually it lands at zero or close to zero. But your pancreas will keep trying sometimes up to 8 years plus to keep making insulin. But a type 2 will test high or high normal because they have a different issue, they are insulin resistant, so they make enough insulin and usually more than normal as their body tries to make up for it.
You should get a copy of the results and see what tests they ran. They commonly just test for the one most common antibody test which is Gad, but there are a few other antibody tests. But there are several type 1 types of diabetes that just don’t fit the common molds. There is also one that is caused by steroid use or panceas trauma, sometimes in those cases insulin production can return.
Late-onset type 1 diabetes can be difficult to identify. Measurement of endogenous insulin secretion using C-peptide provides a gold standard classification of diabetes type in longstanding diabetes that closely relates to treatment requirements. We…
There are seven known autoantibodies associated with type 1. There are an unknown number of unknowns. Generally they test for 1 or 3 of them. Nowhere near all type 1s have any of them.
It is not a very meaningful thing to not have a positive result. If any were positive that’d be meaningful toward helping to distinguish type 1 from type 2… but their absence doesn’t in and of itself mean anything noteworthy.
They used to be referred to as a CDE which is a Certified Diabetes Educator. I’ve noticed a lot more often that the “C” has been dropped, but I’m not sure why.
