So–on ADA website it says the following are goals on tight bg control for T1 diabetics:
Pre-meal: 70-130
2 hrs after a meal: under 180
A1C: 7, or under
The hospital gave me the novolog when I was there, and wrote me a prescription for it, so I have some. My regular doctor said to only take it if my fasting bg was over 200 in the morning. Any advice on this would be greatly appreciated!
There are some who would argue that the ADA is seriously behind the times, but that’s an entirely different discussion.
Those numbers are pretty traditional. There are lots of reasons and plenty of history behind that fact, but a full and accurate chronicle would be way too long to set out here.
Suffice it to say that those numbers, which many authorities still use, would be totally unacceptable for a non-diabetic person. The idea that someone with diabetes can or should aim for blood sugars reasonably close to what non-diabetics experience is one that is in fact percolating through the medical community, but at a rate that can only be described as “glacial”. It wasn’t that long ago that Dr. Richard K. Bernstein, one of the genuine pioneers in this area, would stand up at medical conventions, assert that “diabetics are entitled to normal blood sugars”, and actually get booed as a result. But professional attitudes are beginning to shift; though, as mentioned, with agonizing slowness.
The point is, this is a lively and ongoing debate and you will hear impassioned defenses of both points of view. So like everything else in diabetes, you need to determine empirically what is safe and effective for you.
Thanks David–my first reaction was that 180 was a pretty high top number to be considered the ideal 2hr post meal range, and was thinking it would be more like 130-140 at most 2 hours after eating. Personally, I have been aiming for those numbers, and less than 110 fasting/morning reading. I tend to agree with the idea of aiming for non-diabetic numbers–that makes perfect sense to me.
I suppose trying to calculate and inject some mealtime insulin would not be a bad idea. In my reading, the tighter control the better it would seem when it comes to diabetes complications down the road.
If I may ask, and not that I would base my own treatment on this, but out of curiosity what numbers/ranges do you personally aim for?
I think it would be great to really get together with your endo and talk things over. while your GP might be great, diabetes wise he has probably no idea. with him/her (your endo) you can set a bg goal and get to work to find out your I:C ratio (insulin-to carb) as well as your correction factor. we can give you our BG goals, but finding out your own insulin requirement is pretty difficult and i wouldnt even want to do that myself, and i have been T1 for 12 years and study medicine. in my opinion you can’t just say i bolus for my meal, you have to have at least some idea of how much you take. (to clarify, i do dose my insulin completely on my own now, but i have that experience of how much insulin i need for what and how my body reacts to it.) until that’s done, i would keep doing what you are doing, after all it’s not working too bad, it’s just pretty bulky and leaves you not really in a good place to be proactive i think.
I must stress again that every case is individual and that what works for someone else can never be more than background information. You need to find out what produces the desired results for you.
That said, here’s the answer to your question. My fasting target is mid 80’s, say 83 to 85. I time my pre-meal bolus so that the insulin will begin working as I sit down to eat. The number of minutes depends on the type of insulin, since I use more than one type and they kick in at different speeds. My goal is to be at or below 120 two hours after eating. Most of the time I hit the target.
BTW, if you haven’t read Bernstein, you should. Some people reject his approach as too strict (in fact it’s a bit too strict for me), but whether you follow his advice to the letter or not, the book is jam packed with highly useful information and tips, including empirical data about the very numbers we’re discussing. He is one of the true pioneers in current thinking about diabetes. Here is the full citation:
Richard K. Bernstein, Dr. Bernstein’s Diabetes Solution, 4th.ed. (New York: Little, Brown and Company, 2011)
Thank you. I will definitely check that out after I finish Think Like a Pancreas. I do understand things are different for everyone, and appreciate you sharing
My doc didn’t really say anything regarding taking mealtime insulin, neither did my endo - she said to keep doing what I was doing since it seemed to be working (1000mg metformin 2xday, and 26u Levemir at night).
In the last week or two my bg has been more erratic though, with higher numbers than I had been getting. I will say we very recently had a tragic death in the family, so things have been hectic and I haven’t eaten as healthy of foods or as regular/scheduled as I was before when getting the lower numbers. I decided to start taking some mealtime insulin (Novolog) a couple days ago to correct these undesirable bg levels. Yesterday, I took 5 units before breakfast - fasting bg was 130, and I was getting ready to eat 2 scrambled eggs with some grits. BG 2 hours after eating breakfast was 95, which I thought was pretty good. Then I took it again an hour later - didn’t eat anything or drink anything besides water - and it was 120. Then 121 before eating lunch–5 hours after eating breakfast! What the heck??? Why would it go up if I’m not eating or drinking anything besides water???
Trying to get back on track now that the crazy last couple weeks have passed, but I feel like I’m doing something wrong??? In the past week or two I’ve seen readings as high as 166 and as low as 80, and while I can at times make a correlation between my numbers and eating certain things, other times the numbers just don’t make sense
That feeling is one of the most common comments you’ll see around here. I think that’s a major point of the “sugar surfing” metaphor–you’re not going to achieve perfect control, but there are a lot of things you can do to keep your BG in range. And even so there are going to be WTF??? days because that’s just the nature of the beast.
All that said, your numbers as you report them look extremely good to me. I’ve been at this 32 years, and my endo (just had my semi-annual yesterday) insists I’m her model patient, yet I see worse numbers than yours all the time.
So, a couple of things. One is that your endocrine system isn’t static; it’s dynamic, and irrespective of what carbs you’ve eaten your BG will fluctuate throughout the day (e.g., “dawn phenomenon,” where just about everyone’s BG tends to elevate toward waking time). A key reason for using a pump vs a daily basal insulin is that you can identify the most regular fluctuations and account for them by setting different basal rates throughout the 24 period. So there’s that. Another factor that can trip you up with meal bolusing is fat, which can cause a delayed post-prandial rise of the kind you’re describing. Doesn’t look like there was a lot in your meal, but things like butter if you used it to cook the eggs or put some on the grits or both could be a factor.
Trying to identify and account for all this stuff can drive you a little nuts. So many “predictions” of BG behavior only seem to work after the fact–“Oh, I see now what I should have done!”—that I’ve taken to calling it the Diabetic Nostradamus Effect (for those cryptic versus that you can only interpret as “predictions” after the event they “predicted” has already taken place).
But what I would most want you to know is that there isn’t some universe of Smart Diabetics out there who are doing this all perfectly while you’re a stumbling newbie. In fact you’re doing very well. Ultimately you’ll want to learn about determining your Insulin-Carb and correction ratios and all that good stuff and not just take “You’re doing fine let’s not change anything” as gospel. The more you know, the more you’ll feel like you have at least some kind of a handle on this thing. But as it stands, those are really quite good numbers.
DrBB’s points are right on target. I’ll add a couple more.
Stress generally creates upward pressure on blood sugar, and stress can be anything, physical or mental, e.g., not getting enough sleep, illness or injury, or the death of a loved one. You mention the last one. Now, just thinking, I wonder whether there are any other possible sources of stress in your life, like, uh, oh, I don’t know . . . being recently diagnosed with diabetes?
Given all of that plus the relative newness of your diagnosis, it would hardly be surprising if your basal needs were fluctuating, not yet dialed in perfectly, or both.
Anyway, 120 is not a very scary number. It’s slightly elevated, but the key word there is slightly. Although there is plenty of debate and disagreement about the point at which high BG levels start to cause meaningful consequences, it’s almost universally held to be higher than that. Certainly you want to work this out, but for someone still trying to make sense of this complicated new picture AND dealing with other life upheavals at the same time, it’s really not bad at all. Honest.
As well as we people with diabetes can do at times, we can never rest on our laurels. Diabetes has a way of humbling and keeping you on your toes. As soon as you get into a good groove something comes along to knock you off your course. That’s part of diabetes. How quickly you adjust and execute counteractions is up to you.
For example, up until about a week ago, I was on a very good stretch of blood glucose levels. Then my overnight BGs started creeping up. For the last five nights they’ve exceeded 180 mg/dl (10 mmol/L) for several hours. This, of course, alarms me but I have have been taking actions since the trend first appeared. The first several tactics did not move the trend much so I’m doing other things. I’m now having a good effect at moving this trend back into the zone but it’ll take me about two weeks total.
Other outlying trends are easier to turn and you may be able to return things closer to normal within a few hours or days. The important thing is to stay on it and execute a plan. Diabetes never stops teaching but you need to “listen” to learn.
Finally, I’ve learned in the last few years that there does not exist a set of perfect insulin dosing formulas for each diabetic. For many years I thought if I could just discover the exact equation, then my control would be perfect. The perfect formula to diabetes does not exist. You must react and respond to what diabetes throws at you. With persistence, knowledge, and a good attitude, you can do quite well winning your share of the BG battles.
Wow! Learning new things every day–and I feel a little better knowing this will constantly be changing and I have to adapt, rather than expecting certain actions (dosages, food/carbs, etc.) to always produce consistent results. Unfortunately, this isn’t my first rodeo with a chronic autoimmune condition, so I totally agree about not always taking the doc’s word as gospel–and to also listen to what my body is telling me.
My endo also said my Graves is acting up (causing hyperthyroidism), so maybe this is throwing it off some too? I will definitely keep that in mind about the fat content–I sure did put some butter in the grits!
And also, thank you for the encouraging words about my blood sugar levels–I have anxiety about potential future diabetes complications and it freaks me out. Hopefully the nerves will calm over time
Thanks so much for the positive encouragement David!!!
Speaking with you, and some others on here, gives me confidence that I’ll eventually get the hang of this thing and it will be ok, and not to start stressing over what I’m sure seems minor to the more experienced PWD
Welcome @kerland831! I’m so sorry that you have to join the T1 club, but happy that you’ve found this site. I was diagnosed just over a year ago and the people on this community have been more valuable than any doctor or book I have come across (Ok, Think Like a Pancreas is pretty close).
Don’t put too much pressure on yourself to get your numbers perfectly in range right away. It takes a while to re-learn how to live your life with diabetes so just take it one step at a time. Test your sugar frequently, take notes, and you’ll start to learn how different foods will affect you. As other people have mentioned, stress, lack of sleep, hormones (menstrual cycles are now twice as fun!), being sick…the list of things that affect your blood sugar is endless, it seems.
I also was determined to take as little insulin as possible in the beginning. But once I spent more time in healthy blood sugar ranges I realized that insulin is my best friend…especially when I get an unexpected 200, feel exhausted, cranky, and depressed and then as soon as that insulin kicks in, I feel like a million bucks in comparison. Once you get more comfortable using it, I think your feelings will change towards it!
That being said, there are things you can do to decrease your insulin needs (but never to completely stop taking it): regular exercise helps increase insulin sensitivity, and because insulin dosages directly correlate with how many carbs you eat, lower carb meals allow you to take a little bit less.
One last thing - it look me a long time to recover physically from DKA. My insulin needs were higher than they are now (and I’m no longer in the honeymoon phase, just to clarify), and I had 20 lbs to regain. DKA is a major disruption to your body (as you’ve already figured out) and your insulin needs and blood sugars might be a little weird while you recover.
Terry4–this is something I needed to hear. With my Graves/thyroid disease it’s always been…take a certain dose of medication, thyroid levels come back down to normal–bam, problem solved (I’ve been lucky to respond well to meds though, not all people do). Apparently this is not the case with diabetes!
Question–when you say at night…is that 2 hours after dinner, or do you check your bg right before bed? Just curious, because I don’t, and maybe should be?
I wear a continuous glucose monitor and usually do a finger-stick near bedtime. My recent highs overnight are more associated with dawn phenomena. They start to rise around 2:00 a.m. and don’t come down until I rise in the morning and take some insulin corrections. I’ve administered increasing insulin corrections during the night to little success. So, I’ve concluded that my basal rates need to be elevated to counteract this rise. I’ve done this before and I end up increasing my basal rates until I start to experience some lows and then I need to pare back on the basals, often returning to where I started!
I think it’s good practice to be aware of your current BG level and trend, especially at bedtime. I also consider whether there’s any active insulin at bedtime to help make my decision that increases my odds to sleep safely. I’ve always been a big fan of testing a lot. I am in a minority but there many of us. I typically test more than 10 times per day. I don’t consider it a nuisance. It adds information to the mix and it’s taught me a lot about my metabolism.
You will discover what’s right for you as to BG checking frequency and timing. I’ve always thought more is better but I hope you’re learning that one size doesn’t fit all. I’ve been at this for 32 years and my best habits weren’t adopted till year 28, mostly due to my interaction here at TuD. I hope you arrive a suitable regimen more quickly than I did!
and as low as 80, and while I can at times make a correlation between my numbers and eating certain things, other times the numbers just don’t make sense 
