Do you know any secrets to decreasing fasting BG – apart from taking basal?

I m a honeymooner just on meal time insulin as of yet. I can keep pretty tight control,although just recently I have seen a rise in my fasting numbers. I range between 100 and 120 now.
I would like to keep staying off basal for a while longer if I can, are there any tips or "secrets" out there that might make a difference to fasting numbers? More exercising in the evening, certain time of eating dinner etc...? Would love to hear any suggestions! Thank you!

Low carb and exercising is your best hope but your body needs insulin for basic services like breathing so there will be a line at some point that you will not be able to cross. Some individuals believe that it is better to start insulin before losing the ability to produce small amounts, I believe that it would just be another road to the same destination.

I have to be honest with you. It often doesn't take much insulin production to maintain a fasting blood sugar, it is meals that really challenge us. So when your fasting numbers start to rise, that can be a sign that your remaining insulin level has just dropped too low to even control your fasting. As JohnG has suggested, you could do certain things to drop your blood sugar in a transient way. And I would add to the list that you could also overbolus for meals to target a blood sugar of 70-80 mg/dl 3-4 hours after your meal. During the day, this would essentially add in your basal into your carb bolus for meals. But this does nothing for night.

I firmly believe that it is important to preserve any remaining beta cells, and I think almost everyone, T1 and T2 alike retain a certain small reserve throughout their career. And a big thing to helping preserve beta cells is to not sustain high blood sugars. So while you might bide some time, I would recommend you think about starting a basal. At least think about it.

i did the opposite to you, took only the basal and not the basal. you think that migt work for you?

A third vote for starting basal. It takes time to learn to use insulin well and it is usually easier to do if you still have some insulin production. I'm 6 years in and have a hunch a pocket of helpful beta cells have just bitten the dust which is making everything harder. Why risk your existing insulin production for a few months of going without one or two shots a day?

meant to say i only took basal and not bolus. doh.

sorry but in my case it is just not as simple as that....I go extremely low during the day in between meals (down to the 60s) and that is WITHOUT any basal or bolus, if I was on slow acting insulin I think I would constantly have to watch not to crash. I don't want to do that, I find that would be stressing me constantly.

Unfortunately I frequently go really quite low in between meals, without any bolus or basal..I fear I d be crashing constantly – how did or do you manage to avoid that? And: Are you on both now?

A bit off Julez' topic, Maurie, but you and I frequently have similar numbers/progress, so I was curious about your statement. I recently posted about a definite increase in my basal needs across the board and explored several possible causes, none of which ended up accurate. I've been assuming I was "running on empty" as my c-peptide in 2009 was only .38 but maybe I just also had a bunch of beta cells give out on me and that's why I need more insulin. I can't remember did you have a c-peptide test at one point and what it was? I'm also why it is "making everything harder" as I would assume once we account for the increased insulin needs it would be the same and maybe a bit easier as our needs stay steady. Just curious.

I had a C-peptide when I started out but haven't had one since. When I asked my endo about it at the time he just said "it's very low" and I wasn't curious or with it enough to ask for the exact number.

Holger said in a post somewhere that if you have a small insulin response maybe even 10% of what's required then that little bit can reduce spikes - maybe from 180 to 160 since the insulin response is in real time. That change is consistent with what I'm going through right now. I used to get an occassional 150 or 160. My current goal is to not see the 170s and to gradually get back to seeing 160 or above no more than a couple of times a week. I've upped my basal by 30% during the day and ~15% overnight; most of my numbers are still pretty good but my standard deviation has gone from around 23 to around 30. A much higher scatter.

I've never been a fan of the "my beta cells aren't all dead and that's messing up my calculations" theory. I'd rather think that I've been lucky the last six years :-)

Hope you've been well.

Maurie

Well the 60s aren't extremely low but I get your point :-). Type 2s sometimes have lows which are caused by a late insulin response - reactive hypoglycemia. Could it be that you're getting hit with something similar? If that's the case, having a little bit more insulin on board when you need it might actually prevent lows. I'm not an endo but you might want to discuss this with your medical team.

Thanks for the update; does sound like maybe we are still following each other around. I just did a quick/very approximate estimate and I'm probably somewhere around 20% higher in my basals now. My I:C ratios and ISF have only moved a tad. I don't know which theory I believe, I'm sort of for anything that makes for consistency, but also obsessive about my weight so would rather have a lower insulin use. It's not like we have a choice either way! You still sound like you are doing pretty good, and fine-tuning it to back to where you like it, so beta cells or no beta cells, good job!

Me, I've been playing around with these higher numbers since late September because first I thought it was the steroid shot, then I thought it was expired insulin, then I decided it must be colder weather though that didn't make a lot of sense, so I've been a bit slow to just increase the insulin thinking it would go away. I think your "theory" probably relates to me as well, so thanks for sharing it.

Going to sleep on an empty stomach helps, not eating 4-5 hours before bed. Also, not eating protein/fat heavy dinners that are slow to digest.

The dawn phenomenon (DP) is a natural reaction. If certain criteria are met the liver WILL start a process that will release glucose. This is our heritage from millions of years of evolution. Times when we had no breakfast and no storage for food. In these times we woke up hungry and thirsty. To prepare us for the hunt for new food the liver dumps some of its deposits in the morning.

In contrast to other advice you have been given: the DP can be stronger the lower the blood glucose has been. With 80 all night I would see a nice DP reaction. With 115 all night the DP will very likely not trigger at all. To elevate my blood glucose to this threshold I do eat somethink before going to bed. Something that takes longer to digest: one WASA crisp original. Right now I have big trouble with DP and this does not work as usual. But for me this is due to my recent switch to Lantus. It will take some time until I have sorted that out. BTW: a real spike from DP is more around 160mg/dl and higher. This shows that your beta cells can still counter-regulate down to 120mg/dl (if you want to see the positive side).

Now the DP is a negative reaction for people with limited insulin production like we are. So in one way or the other you will need additional insulin to cover the DP. I still want to remind you that 100 to 120 can still mean that for both measurements the REAL blood glucose was 110. The standard deviation of our meters allows these tolerances. It takes longer periods of thorough collection of data to determine if the average in the morning is really elevated to 120 or higher.

Let us assume for a moment that the average is 120. This is above the norm but I still think it does no harm. I mean in the final T1 business you will be happy with any 120 in the morning - at least this is my opinion. If the average climbs above 120 then you should react with adding more basal insulin. Or if you do not mind some experimentation then increase your basal dosage slowly. But if the number of lows increases then you should better reduce your dosage.

You might be low between meals specifically because you're only on mealtime, not basal. Right now you're covering all your needs with something more likely to cause a crash. Perhaps a low dose of basal covering you throughout the day would allow you to lower your mealtime doses.

For example, I was going low before lunch. So I only take 2-3u of basal (which isn't much) and then take 1.5u of rapid at lunchtime. It helps me get through that dip in the day. Usually take about 3u of rapid for the other meals.

I find that if I have a snack before bedtime, I'm not as high in the morning. Say a couple of crackers with cheese. No more than the equivalent of 5 to 10 grams of carbs (depends from person to person).