I was diagnosed with Type 2 diabetes in October 2006, and started insulin therapy several years later. I have just been seeing my primary care doctor to manage my diabetes. That included quarterly office visits to review my A1C lab test for my 3-month glucose average. Also I had annual comprehensive, metabolic, and lipid blood and urine tests to check my cholesterol, liver and kidney function, etc.
My hemoglobin A1C had been increasing over the last year (6.9, 7.5, 8.0, 8.4%). My PCP wanted me to try Trulicity, which is a GLP-1 agonist weekly injection (non-insulin). That works in the small intestine when food is detected, and the hormone works three ways: it signals the pancreas to release more insulin, liver to produce less glucose, and stomach to slow digestion.
My PCP said Trulicity should lower my A1C from 1.4 – 1.8%, and wanted me to stop both my Lantus long-acting basal insulin at bedtime, as well as my NovoLog fast-acting bolus insulin for meals. So I stopped all my insulin “cold turkey” and started my first Trulicity injection, and my glucose sky-rocketed immediately to over 600 mg/dL with highs constantly in the 300-500 range. I was really worried about the hyperglycemia (high glucose) because of potential long-term complications, and even thought I might need an ER visit.
I sent messages to my doctor about my readings during the first few days, and he suggested trying the NovoLog at meals because it might take a while for the Trulicity to kick in. I’ve read that it might be several weeks (or months) before it becomes effective. So I did that, but it still didn’t help much. Then I told him about that, and he said maybe it would be more beneficial to use the Lantus at bedtime instead of the NovoLog. So I tried that for a while without any improvement. So I resumed taking my NovoLog at meals also, and did 30 minutes on a treadmil at the fitness center daily to see if that might help get it down.
I checked my blood for ketones that are produced when your body burns fat for energy when there isn’t enough insulin to get the glucose into your cells; it ranged from trace to small, rather than negative, but at least it was not in the moderate to high range which would indicate diabetic ketoacidosis (DKA) that is very serious.
I was starting to lose confidence that my PCP could really help me manage my diabetes. So two weeks ago, I decided that I finally needed to see an endocrinologist, and I am so glad that I did. He increased my Lantus insulin from 10 to 16 units, although it has since been reduced to 12 units now since I was having some lows during the night. He also discontinued the daily Metformin pills that I had been taking because he said they wouldn’t help me any more. Recently my glucose has stabilized quite a bit.
Type 1 LADA?
He thinks that I might actually be Type 1 LADA (Latent Autoimmune Diabetes for Adults), rather than Type 2. He ordered blood tests to measure my antibodies to determine whether I have Type 1: C-peptide, GDA 65 Ab, Islet Cell Ab, Insulin Ab, and Zinc Transporter Ab, along with a TSH thyroid test. I will review the results at my return visit tomorrow.
He also ordered a Dexcom G6 CGM (continuous glucose monitor) for me that I received a few days ago and will activate tomorrow as well. This uses an applicator that inserts a sensor in your abdomen that samples your blood glucose every 5 minutes and transmits the results to an iPhone app; a Dexcom receiver is also provided as a backup. It shows the current G6 reading with a history graph and up/down arrows that show trends, and also provides alerts and alarms for lows and highs that will be especially important while I sleep. And I won’t be checking my glucose with fingetsticks 10 times a day.
I have included some photos of the Dexcom G6 that I received, which includes a user guide, transmitter, receiver, and 3-month supply of sensors with applicators. I will let you know how my visit goes tomorrow.