February 1, 2003
Daily Care
Question from Bismarck, North Dakota, USA:
I am a 40 year old male (6 feet 4 inches, 220 pounds) who was diagnosed originally with type 2 diabetes two years ago, but after oral agent failed to control it (approximately a year after diagnosis), I asked that antibody testing be done, and they were positive. I was then started on Lantus with Humalog, but after five months, my insulin needs decreased, and I went down to no insulin seven months ago.
Two months later, I start using NPH at bedtime because my fasting numbers were increasing (150-180 mg/dl [8.3-10 mmol/L]), now I have fasting blood sugars of 135-160 mg/dl [13.9 mmol/L], my postprandial blood sugars after breakfast increased from to 200-250 mg/dl [11.1-13.9 mmol/L], but my preprandial numbers before lunch and supper are 90-110 mg/dl [5-6.1 mmol/L], and numbers after dinner are usually 120-160 mg/dl [6.7-8.9 mmol/L]. For breakfast and lunch I eat about 15-45 grams of carb and for supper about 30-60 grams of carb.
I have been discussing this with my diabetes team, but they don’t want me going back on Lantus yet, as I had trouble with lows before meals, and for the same reason they are discouraging Humalog. I seem to be quite sensitive to fast acting insulins. My last A1c was 6.2%.
Any ideas on how to stop the roller coaster numbers? The up and down numbers make me feel buzzed and tired after meals, and if supper is late, I will go low which doesn’t feel great either. Since my team has few LADA patients, they are not sure have to handle my care.Their plan for now is to wait and see what happens. Any suggestions?
Answer:
I am glad you had the antibody test to key into the fact you may have Late-onset Autoimmune Diabetes of Adulthood (LADA). On the other hand, delayed onset of autoimmune diabetes probably represents a more protracted process of islet cell destruction. I would shoot for fasting glucose of less than 120 mg/dl [6.7 mmol/L] and a two-hour postprandial blood sugar of less than 140 mg/dl [7.8 mmol/L] all the time. I would also shoot for a normal hemoglobin A1c.
Your data suggest you can add the Humalog and increase the NPH. I would talk further with your diabetes care team about what they think are appropriate postprandial goals. There experience with you may be colored by your previous Lantus (insulin glargine) experience.
JTL
