What is your experience with taking insulin during the honeymoon period? I have read conflicting studies and need to hear from some actual people with actual experience -if that makes sense.
I’m recently diagnosed with LADA (1/23). I was discharged from the hospital with a T2 diagnosis at first and prescribed Metformin (500mg 2x/day). A few antibody tests later plus a visit to an endocrinologist and my diagnosis was changed to LADA. At the time of my dr visit, my sugar levels were coming down (mid 200s at home) due to Metformin, moderate carb diet and walking. Endo prescribed long acting insulin 12units/day + continue Metformin. Since I was getting increasingly better numbers with just Metformin, diet and exercise, I decided not to fill Rx for insulin and see where it would take me. I test 3x/day by finger stick before meals. Here are my numbers for the past few days:
130, 105, 93
111, 103, 113
121, 81, 92
102, 97, ?
So, my questions to the group: If I can maintain these numbers with Metformin, diet and exercise, what benefit would there be to adding insulin now? Does adding insulin prolong beta cell production and pancreas health?
Your numbers are good, it just won’t last. But when will it change who knows?
It’s good that you have found out you are LADA/type 1. Too many of us are misdiagnosed for quite a while. Medication, lifestyle changes work at first because you are still making some insulin. And it’s erratic, so sometimes it’s hard to judge what you need. There are several theories that starting insulin early might ease the burden on your pancreas and keep it producing insulin for longer. I’m not sure they have really figured that out yet. For some reason in the US they like to start LADA/type 1’s on a long acting first, in the UK they start people on a fast acting or both at first.
But long acting insulin doesn’t give you a lot of flexibility. Fast acting does. A fast acting insulin you can adjust the dose to what you eat and what you need for the day. A basal insulin you have to stay at a basically low rate, so it’s not too much on the days you are still naturally producing more insulin, which also means on some days you will run high when you aren’t producing enough. Honestly I would start carb counting and push for adding a fast acting bolus insulin. That way if there is a day that your blood sugars run high, you can take an adjustment. If you want something higher carb, you can take a dose if needed. It will also help you to learn to start to use a bolus insulin and get used to it before you have no choice.
Some people want to put off using insulin as long as possible, it is a choice for a bit. That has to be a decision you make. But personally the better control on a fast acting and carb counting asap is the best option in my opinion. I’m not sure you actually need insulin yet, so it looks like you have time to decide.
I suggest doing some post meal bg checks to see if there are higher bg peaks after meals. May change the timing of wait before eating, or show high bgs after carby meals. Adjusting mix of carbs, fats, proteins will impact how quickly bgs rise after meals.
You’re doing great!!
Just a word of caution. LADA honeymoons can be erratic and can last years. Please consider a CGM if you do start insulin soon.
For the first year I would produce meal time insulin like 10 percent of the time. I would also only need basal certain hours of the day. I started on Omnipod quickly and this was wonderful because I could just turn off the damn basal when needed. All led by Dexcom. With even a small Lantus dose 5 units I would have to have carbs several times a day.
I don’t know if Metformin is still a good idea now that you know your LADA? You might ask your provider about that? Most people I know get taken off once T1 has been diagnosed.
Hi @jpf and welcome! I’m also T1/LADA (diagnosed last year), so happy to share my perspective.
Your pre-meal fingersticks look terrific. But there’s a lot of information that they miss. Typically it’s good to check 2 hours or so post-meal as well to see where you’ve “settled.” But even this can be deceptive, since in those 2 hours you may swing extremely high before coming back down. It’s not just the average BG that matters, it’s also the variability and the time in range. Here’s one way to visualize it (image from diabetesnet.com):
Fingerstick data alone (unless you do a lot of tests!) can’t distinguish these. CGMs can (with some caveats). So if you want to know how you’re doing, you might see if your endo can give you a sample sensor to get started.
You may not need any insulin yet, which would be great! But if you do, it’ll control those large swings out of range. A basal will help some with that, but rapid-acting insulin is more effective. They started me on 4u of Tresiba, but I was still having post-meal excursions, so I started Humalog as well. Whether that is the right choice for you will depend on how your graph looks overall. But if you do start insulin, push hard to get a CGM prescribed at the same time. (I didn’t have this, which still dumbfounds me.)
On beta cell preservation, I’ve seen studies that say both things. I wouldn’t make that a main factor guiding your treatment. No one seems to know how to reliably prolong honeymoons.
I really like this idea! Thanks Marie! I see the endo again on March 1.
By carb counting, do you mean calculating the actual carb count of each meal? And if so, do you use a specific resource to find the carb quantity of each item?
Thanks so much for sharing your experience!
Thank you MM2! This is another great idea! I will start that tomorrow.
I really hadn’t thought about protein and fat impacting bg. Would love to read more on that if you have any resources to share.
Thank you! That is a good point! I will for sure ask about this. The endo said he planned to “wean me off” the Metformin but I have no idea what the plan is.
I looked up Omnipod and Dexcom lol still getting used to all the new lingo. Do you recommend the Dexcom CGM?
I can’t tell you how much relief I felt reading this. Thank you so much!
My understanding is that I’m getting a CGM on Wednesday. Do you have a recommendation? I don’t know if I’ll have a choice but I definitely would like to know if people have a preference.
New lingo is a understatement lol. It definitely takes awhile to get use to all the terms lol. A good thing about LADA honeymoon is that you can study insulin and not be as overwhelmed when starting it. Be sure to read the book Think Like A Pancreas(your local library probably has it). Also TCOYD has some terrific videos on you tube. They have great simple lessons on the basics with some humor added in.
I’m not a CGM expert or anything but here is my two cents. Check with your insurance coverage when making a choice. Be sure to get one with a alarm. That would be either the freestyle libre 3, dexcom g6 or g7, or eversence. The are all great and I think it comes down to personal preference. Unless you are planning on a pump soon. In that case you would need the dexcom G6.
If you want a dexcom and your insurance won’t cover G7 quite yet I would get the freestyle libre 3 for a few weeks until the G7 is covered. Once you get Dexcom g6 you’ll be stuck with it for 3 months because of the transmitter.
Here is link to a very detailed explanation. Some refer to this as TAG for total available glucose.
Your experience will vary based on food choices. If you eat mostly carbs, then not too much different. Larger % protein and fat meals may require bolus later in meal, with extended pump bolus if available.
@MM2 I love that link! !
On a CGM.
It makes our life so much easier, a lot less finger sticks and a 24/7 graph. The Dexcom is much better because you can calibrate it. But depending on what your insurance coverage is, a Dexcom can be more expensive. The accuracy of the Dexcom becomes a lot more important when taking insulin. Not so much really if you aren’t. None of us are familiar yet with the new Dexcom 7, it was just approved and released this month. Dexcom, Libre 2 and Libre 3 have alarms.
On carb counting. Start looking at all packages for the carbs and then you deduct the fiber to get the net carbs. You will learn how much insulin you need for how many carbs. But take note, as time goes on, your insulin need will go up as your body produces less and less. But eating a bowl of spaghetti could be 45 carbs versus a bowl of broccoli being 5 carbs. One requires a lot more insulin than the other, whether your body produces it or you have to inject it.
For carb counts, there is Calorie KIng, but that site isn’t working today so… not sure what is up with that. I prefer Calorie King on my PC at home and Fat Secret on my phone. Mostly I look at labels and you also end up memorizing foods you eat a lot. And some things you have to guess…I’m sure there are a ton of other sites too!
For example at home, (I am a vegan), I love a bowl of veggies with tofu or seitan. A large package of frozen mixed veggies(varies depending on blend some) is 16 carbs. My favorite flavored seitan right now is 29 carbs per package. Half of that mix is 23 carbs. Sometimes I add cashews, vegan cheese, gravy etc and that is on the package to tell me what to add to my count. My toast is 10 carbs. An apple is 20, a banana 25. (sizes can vary).
Some type 1’s use Metformin. Usually it’s because a type 1 sometimes develops insulin resistance and it helps with that. I believe it also blocks absorption of some glucose and cuts down on how much glucose the liver produces.
@jpf With the numbers you have and with recent diagnosis, have you/your Endo looked into the drugs recently developed for delaying full onset of T1? If the anti-body tests are positive, it would seem just a matter of time until all your beta cells are killed off and full T1 onset occurs. You also may be a candidate for clinical studies of new treatments that basically “cage” your beta cells as protection from the antibodies. I encourage you to talk with your doc, best to research the treatments yourself first rather than going in blind. If your doc isn’t aware of the treatments/trials, you can help educate them…or alternately find a new doc that stays current on the “bleeding edge” of treatment. In the meantime, keep doing whatever you’re doing…the numbers are good from any T1’s perspective!
That’s the truth. LADA type 1 is often very slow in the destruction of the Beta cells. I am type 2 on a pump because my Beta cells are about wore out. This along with genetically driven insulin resistance makes dosing, both basal and bolus a constant struggle.
Considering that Metformin does not stimulate the Beta cells to secrete insulin, but works by slowing digestion, decreasing liver glucose dump and, just a bit, increasing insulin sensitivity, a low dose of Metformin can be helpful for some with type 1 LADA or not. There are some possible unpleasant side effects that are not usually life treatening. They usually resolve themselves after a while.
I have no clue whether @jpf should start a basal insulin such as Lantus at this time. They certainly should have a CGM if they begin using any type of insulin, so they can monitor the effects. Maybe a very low dose, such as 5 to 10 units which would average about .3 units per hour.
All this is my opinion which may or may not be helpful.
Thank you! That was a very interesting article - with the added benefit of informing me about Regular insulin. Not scratching my head anymore about why that Super Bowl meal of many many chicken wings with buffalo sauce sent my bg high overnight.
I am learning so much from everyone’s answers! Just can’t put into words how helpful it’s been.
Thank you Josie! Called today - honestly, this type of concrete advice is so helpful. I’ve gotten caught up in reading studies and articles and losing sight of the basic actions I need to take.
Ah, a sibling, I’ve been accused of being unable to see a tree for the forest, but then sometimes I get all detailly.
Thank you! It sounds like these are the 3 most popular that I see in the forum.
I have not talked to the endo about alternatives. I did look into the current clinical studies through my patient gateway but didn’t see anything diabetes related. If you know of a way to access a bigger pool of studies, please share. I’m all for it!
I have read about pramlintide, GLP-1 RAs like liraglutide, and SGLT2 inhibitors for lowering A1Cs but nothing on preserving beta cell function.
Thank you for the user friendly description of Metformin!
I haven’t had too many side effects but I am really trying hard not to lose any more weight. Those eight weeks in the fall when I was really sick with DKA (I think that’s what the condition with the high ketones is called) really took off my ‘winter layer’ so to speak.