I go from .225 to .9 for DP. The .9 goes from 9am to 3 pm.
Mine gets worse if I don’t eat after I wake up, so I eat!
That sounds like “day phenomenon”! I almost wonder if you might be under bolusing (ratio wise, except a lower numerator= more insulin…) but sort of resting on a cushion of basal? I like a big, fluffy basal cushion but that might be something to explore?
I have a morning, not dawn peak, too. Over the last six months this profile has migrated from a 5:00 a.m. peak to a 10:00 a.m. peak. My peak ends at 2:00 p.m.
One thing I love about TuD is how refreshing it is to find other people who think like I do. I went searching for a community when I started the pump, because I knew I was going to want help navigating the issues I'd confront, but this has turned out to be so much more than that. And for that I'm grateful.
I thought I needed extra insulin to cover the same carbs in the morning, but a prior endo suggested just giving the bolus earlier and waiting longer before eating, and that turned out to be spot on for me.
During the rest of the day I find 20-25 minutes is about the right time interval between bolus and starting to eat, in the morning it's more like 45 minutes.
I've also been experimenting with a super bolus on top of that, and it seems to work well, with the caveat that it makes it more crucial not to wait too long, or I risk a hypo.
I think my endo went into practice because she has thyroid probs in her family. She had some thyroid probs this year, and I couldn't figure out what was wrong with her until she was better and spilled the beans. Has nothing to do with diabetics. I like you TIR measurement.
I go from .225 to .9 for DP
<chuckle>T1 vs. T2 -- I go from 0.05 to 3U at 5am, back to 0.05 at 8am to cover DP.
Dangnabbit, IR's a biotch.
Keep in mind that excess protein is converted to glucose too -- so high protein diets will result in some gluconeogenesis even if not operating in a ketotic metabolic state.
This is why, as a rough rule of thumb TAGgers bolus for about 50% carb equivalent by weight for protein in a LCHFP diet.
We always have a choice.
Did you express your concern, and have the discussion(s) directly? Consider, unless someone in their office is reading your data intimately (roflmao) they have no way to tell what any of us are ever doing. And that much data... very unlikely.
Experiment for a brief time with the new formula, see how that turns out? Or you can always ignore the order entirely, if that feels better to you. If the real fear is beheading you as a patient, do what they say, get the script(s) refilled.
How many get filled at one time? How long does that typically cover?
Had most white coats play all kinds of entirely deliberate and completely malevolent games over the years. I trust none of them myself for excellent reasons.
The numbers you provided are NOT "high" ones at all. They are higher than you are used to perhaps, but that doesn't make them high in the least. The 5.5 A1C is whats causing the problem for them. Get the number up by a point, and they won't squirm at all.
How many LOWS did you get with the 5.5 number?
Did you catch them all?
A 5.5 A1C number is very aggressive to them. Likely its CYA medicine, unless there were/are a bunch of lows which demand this change. Sorry you're having the trouble... been there (though the numbers were different).
TIR ? Not familiar with the concept... hows it work? Where is it from?
Time In Range: You determine a range within which you'd like to be, like 80-140. Your Dexcom or other devices then automatically calculate how much time you spend in this range, and how much below and above it.
David...
Point of clarification please.
Are you saying that readings of 150-160 are TOO high??? Just want to make sure... I understand your words correctly.
David referred to "living in the 150-160 range," which seems to mean, well, living (i.e. staying for long periods of time) in the 150-160 range. And yes, being consistently at those numbers is high, not as bad as it could be, but far from optimal.
Occasional spikes to those sorts of numbers are probably inevitable for all but severe low carb folks, and how harmful modest spikes like that are is a matter of debate.
Like to see the proof of this one. Long term study double blind, 150 harms... prove it... absolutely nothing wrong with numbers in the 150 range long or short term.
Double blind? As in neither the people nor the experimenter knows who has higher or lower blood sugars? Does that seem necessary to you to explore the relationship between blood sugar and complications?
A blood sugar stable in the 150-160 range, which would also entail post-prandial excursions meaningfully above that, would translate into an A1C no lower than mid-7s and more likely at least in the 8s, depending on those excursions. I personally would fear complications at those sorts of numbers, and an awful lot of studies support that at this point.
Whether short-term excursions to relatively modest levels like 150-160 harm is more contentious. On the one hand, it's considered medically ethical to conduct experiments where healthy people get their BGs temporarily jacked way up to levels like 500. On the other hand, damage from excursions is thought to be part of what impairs beta cells, which are particularly sensitive to elevated BGs, and reduces endogenous insulin production in T2s.
Personally, I tend to think the tighter the control, the better, but I also haven't taken that to the logical extreme of a Dr. Bernstein approach. To each his own, I guess.
As a steady diet? Yes, absolutely. Too high. That's getting very close to the renal threshold, which the body definitely considers too high.
. . . and as someone noted, that equates to an A1c in the 7s or 8s. To each his own, I guess. Not for me, that's for sure.
See, this is one of the things that drives me absolutely nuts about the profession: the one-size-fits-all mentality. Each case of diabetes is different. We know this. Why don't they?I with you 100%.
Got me thinking about the issue, though... The wide variability in diabetes is something we all know well about. However, how many other chronic, serious health conditions are similar in this respect?
As I sat here and thought about it, I realized that "one-size-fits-all" is what doctors do 99% of the time, because it works. Works for most ailments. Diabetes is a bit exceptional in this regard.
Also, diabetes has other somewhat unique aspects to it. It requires constant vigilance. Treatment action can occur at any time, and is completely variable. Treating the disease well means taking some serious risks, and having to be on top of them. Successful treatment requires some compliance (there's that word!) on the part of the patient dealing with complex protocols, and many just won't follow them.
Even some T1's. I had this temp admin assistant about 10 years ago that was a T1. Stunningly beautiful young lady, Victoria's Secret body.
She played the "diabulemic" game. Skipping insulin to ■■■■ out carbs and keep her awesome figure. I told her over and over what she was doing to herself, but at 23, she was invincible and didn't care. Smoked too.
Point is, people like many of us here on TuD are a tiny group of exceptional patients. Our doctors probably only see a diabetic like us every week or two. Every time you go in for an appointment, it's probably on the heels of 25 "don't cares" over the previous few days. Doctors, being human, get chastened.
So, the burden is really on us to find a doctor that will listen and trust. I'm blessed beyond words to have just such an endo myself.
My friend Miriam Tucker wrote an interesting article about a study, updating the DCCT as researchers have continued following patients and found that people with tight control have been found to have reduced risk of death, the ultimate complication....
Article: "Tight Control Saves Lives but it's tough"
As TR said, "When the going gets tough, the tough get going!"
150 is not a spike...why wouldn't a low carb folk hit that too, protein turns to glucose too especially in very little carb. bolus is only 1/2 of equation, basal highs and lows happen all the time, too.