How do you know when you need insulin?

Your labs suggest borderline anemia. And given you borderline high RDW and normal MCV that may also suggest some sort of iron, folate or B-12 deficiency (likely not B-12 as yours is fine). Depending on the chemistry of your meter and your A1c test anemia can interfere with readings.

I will ask my doctor about that. I just assumed that my B- 12 was OK I was not anemic. So if you are anemic then the meter readings may be off.

It really depends on the chemistry of the meter, but yes. Here is one study. Hematocrit and hemoglobin are both key indicators of anemia.

Would that mean my HbA1 c is much higher than 6.6? I don’t think I like the thought of that.

Unfortunately yes, typically anemia would cause an artificially low A1c.

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This raises an interesting question for me. Perhaps my situation is the reverse of the effects of anemia and low hematocrit on the A1c number. That is, anemia can give a false low A1c. I wonder if other conditions can give a false high A1c.

I’ve found my A1c does not correspond well with the average glucose numbers shown on my CGM reports. It implies a much higher average blood glucose than my CGM measures. One possible explanation of that is that my red blood cells live longer than assumed in the standard A1c test. Because of that, I think that my actual average exposure to glucose is lower than my A1c suggests.

I can’t think of any way to prove this conclusion but I know that my meter compares well with the lab blood draw and I calibrate my CGM with this meter.

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I can only speak from my own experience, you have described yourself as , normal weight, active , vegetarian, which makes me think of my own diagnosis. My experience is that most Endo’s out there are by enlarge treating for and diagnosing what they experience most and that is type 2. Even in this forum you will find quite a number who have gone long periods of time being misdiagnosed as Type 2, when in reality they were LADA. of which being active, normal weight are not uncommon. I was fortunate to have avoided that initial misdiagnosis, but have seen thru experiences with my Endo’s their tendency to still suggest treatments for type 2 . I would suggest finding out for sure if LADA is what you really are or not. I also cannot overstate the value of my Dexcom CGM this year in helping me to actually see where I am trending no matter what my activity level, In my opinion a CGM is nearly as valuable as having insulin itself.

I would love a CGM but Medicare won’t even cover them for Type 1’s. My GAD test came back normal. At my next appointment I am going to ask for the other antibody tests. You are right doctors treat all type .2’s the same. I think my overall good control because of exercise and 9 years of low carb has worked against me. My docs see relatively normal bgs and seem to think I am not bad off. I may even try to eat higher carb the next 6 months or at least ADAM normal carb just to show what it does to my HbA1 c. My next HbA1 c is in April, so we will see what 4 months of the ADA diet does to me.

HI Jeannie:

I would definitely check your meter. The numbers you mention do not match your a1c. I am t1 and I can get a 6.3 with higher numbers than you draw on average. I have also seen the Ha1c meters at walgreens for under $40. Maybe the testing isnt accurate.

I checked my Contour USB meter against my last lab draw. And there was about a 10 point difference so within the margin of error. I actually bought a new USB meter last week. I am doing more testing especially Inmthe middle of the night. It seems I stay around 100 until 3 am or so. Then I spike 30-40 points somewhere between 3-6 am, then go back down. If I don’t eat right away, then I spike that 30-40 points again around 9-11 am. So not a big rollercoaster effect but definitely spikes when I Don’t eat. I have been experimenting with raising carbs to about 75 per day. My morning bgs have gone up from 100 to 122. I like LCHF diets and have done them for almost 9 years, but I am losing too much weight and muscle.

All: Jeannie seems to be saying her BG spikes 30-40 points during her normal sleep period, with no intake of carbs or sugar to cause the spike. Is that normal? Has anyone else experienced similar reactions?

The problem is the pattern is not always consistent. This past week I have been trying to increase my carbs because I was losing too much weight. Last night I even had a real christmas sugar cookie before bed, not LC. So I didn’t do a before bed bg and sleptmthrumthe entire night. Fasting was 94 this morning. My liver has always been my biggest source of bg spikes.

It is common for a diabetic to have the BG increase in the early morning hours, what we refer to as dawn phenomenon. I check my BG in the middle of the night periodically when I get up for a bladder call anyway. I’ve found from these checks that I’m usually able to set my Lantus at a dose that will keep my BG almost flat between the time the action of my dinner bolus is over until about 4:00 or 4:30 AM. After about that hour, my BG gradually increases until about 10 or 11 AM whether I sleep in or get up but fail to eat. By about 7:00 it will have increased about 20 points; it will increase another 20 points or so by 10:00. Mine never seems to go back down on its own, the way Jeannie’s apparently sometimes does.

Some people have a much stronger increase than mine; others far less. The exact hours it happens varies for different individuals, too.

It seems the only way Imcannstop the extended DP rise between 7 am and 11 am is to eat something around 10-15 carbs. For me the process of eating actually jumpstarts my insulin. I really don’t know if a little insulin in the background would help or not.

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