Honeymoon Phase - LADA T1D

[kalle]

@Carol

I’m curious about what app you use and how user friendly it is.

The one I’m using is called Lifesum. It’s mostly aimed at people who are trying to lose weight and is heavily focused on calories, but the carb counts are good too. There’s a barcode scanner and a large food library with user contributions, and that gives a good coverage of mostly everything that I come across.

My favorite function is the ability to create recipes, which is great when I make my lunch boxes. I’ll just enter all the ingredients and it gives me the values per serving. That way, when I have lunch at work I don’t have to think about the carbs and can focus on accounting for the other factors that go into insulin dosage.

@Carol

I actually met one recently who has been diagnosed with LADA and I wasn’t clear on how it’s the same or different than plain ol’ type 1.

The way I understand it, there’s no specific underlying difference between Type 1 and LADA, and the speed of onset is the determining factor. I think it’s just a question of drawing the line somewhere. In my case, even though I was diagnosed as an adult, onset of symptoms happened over just a few week and I’ve been insulin dependent from day one, so it was considered an obvious type 1.

[Pianoplayer7008]

My experience was a little different because I had major hormonal changes (pregnancy) that affected my BG levels and insulin sensitivity. I was diagnosed in April 2016, got pregnant in August, and went from no insulin therapy to both long and rapid acting by February. Delivered baby at the end of April, and my insulin needs immediately decreased to the point where I only needed rapid acting for simple carb/sugar heavy things. Since that time, I’ve seen a gradual increase in my need for insulin. I added long acting again this past November, but I’m still on a very low dose (4u).

@kalle

Actually, a doctor told me that there wasn’t much point in putting too much effort into the carb counting because there are so many other variables anyway.

I have found this to be true for me, up to a point. I started out very carefully carb counting, nailed down my ICR for different times of day, etc, but now I primarily dose by “feel” - what I think I need based on past experiences and kind of an eyeball of about how many carbs are in the portion I’m eating. There are a lot of foods I eat (like fruit) that have always required more than my ICR even when I was closely tracking, or foods that require me to split my bolus (dosing once before eating and then again an hour or two later, due to fat content causing a 2nd rise). I keep my BG between 70-140 most days, with occasional excursions up to 160-180 that I’m able to bring down very quickly. It does help that I use Afrezza for any meals that are truly unknown, because you don’t have to carb count at all with that, really.

I have found, despite the increased need for insulin, managing my BG hasn’t gotten particularly more challenging in the past few years. Sure, it can be annoying if I don’t dose enough or I dose a little too much and have to deal with a high or low, but again, even those are mild (highs barely hit 200, lows in 50-60s), so compared to most, I’m still doing really well.

Oh, and that reminds me - I used to have occasional reactive hypos after I was initially placed on insulin therapy, where I would dose insulin, eat, go high, and then an hour or so later, my pancreas would belatedly spurt out some insulin which, combined with a correction dose, would end up sending me low. It never happened consistently, so it was hard to predict and very frustrating. I don’t have that issue much anymore, so I do think that’s a sign of disease progression - that my pancreas no longer feels up to joining the fight.

[kalle]

I’ve heard about the BG effects of pregnancy. My second cousin with Type 1 had a baby about two years ago. It went perfectly well but required a lot of work and there were regular checkups at the hospital. At least that’s something I will never have to deal with, unless there are some unexpected advances in medical science

@Pianoplayer7008

I primarily dose by “feel” - what I think I need based on past experiences and kind of an eyeball of about how many carbs are in the portion I’m eating

I actually do a lot of dosing by feeling as well. I like to stick with my exact carb count when possible, but I don’t have an exact ICR figured out. It’s more like I know how many units of insulin are usually appropriate for a certain amount of carbs. The weighing and calculating is mostly a way to quantify what I’m eating, rather than a precise formula for dosing insulin. One advantage is that I get numbers for all macronutrients, not just the carbs. The app gives me a nice little pie chart with percentages of calories for carbs, fat and protein. That allows me to relate my experience with one food to a completely different one under similar circumstances.

@Pianoplayer7008

It does help that I use Afrezza for any meals that are truly unknown, because you don’t have to carb count at all with that, really

From what I’ve read about Afrezza, it does sound very convenient for those unknown meals. I haven’t seen any references to it being available in Sweden though. I guess I’ll just have to keep doing IM shots for now - those really help with correcting after a meal.

[Scotteric]

MDI is more than fine, I prefer it to a pump after years of using one. A Dexcom or Libre is more important than a pump except for those with very specific issues a pump can best address.

[kalle]

I agree. The CGM is a true game-changer. It really gives great feedback on the speed of digestion, not just the total carbs. It has helped me figure out my reaction to a lot of different foods and use that information when deciding what to eat. I don’t want to exclude anything completely, but in the end, it still a kind of cost-benefit analysis where some foods just aren’t worthwhile.

I’ve haven’t tried a pump, but my impression after reading about others using it is that it would some problem but also creates new ones. Since I like to minimize the number of variables, I appreciate not having to deal with site absorption issues, for example. Still, if true closed loop systems improve, I might change my stance in the future.

[Carol]

Thanks for the helpful information. I’ll check out the app when I’m home.

I appreciate learning about the different types of diabetes, too.

[Sam]

Good visual that Dr Stephen Ponder (sugar surfing author) just posted in his Facebook feed… as I suspected it shows that challenged c peptide (the only meaningful measure of it) often does not come to a distinct end, particularly in adults