First diagnosed mistakenly as Type II back in Egypt in October 2015, started on sulphonylurea which probably burnt out what was left of my b-cells. moved to Australia one month after where they swapped sulphonylurea for metformin, later in the space of two months everything went out of control, had some anitbodies test. Turned out to be LADA, I was 31 at the time early 2016.
Since January 2016 i was started on insulin Lantus before bedtime and novorapid before meals. At first I wasn’t so careful with diet since i didn’t receive a really good advice on nutrition, was gaining weight really quickly with insulin. About a year into diabetes i started to read on Insulin and how Type I and Type II worked and realized that a low-carb diet is my best hope of achieving normal weight and good control on BGs.
I’m 162cm tall and about 70kgs not obese but slightly overweight and can definitely be leaner.
After i switched to a low carb diet got a really good HBA1c of 5.2 but it was really short-lived. it only lasted for almost 6 months and then blood sugars started going crazy again, i thought about adding metformin to the mix which i read a trial on online that pointed out it might be helpful with Type I diabetes so i talked to my endocrinologist and he had no problem with that and it did help me for a while but still i couldn’t get back to that HBA1c of 5.2. From there it kinda went downhill, my BGs have been climbing up and sometimes going down, till three months ago i was taking 14 units of Lantus at night and 1-3 units of Novorapid before meals but when the weather got cold (Australia) BGs started going crazy again. After losing almost 5kgs of weight during Feb-march i gained all of it back in April-may because i almost tripled my daily bolus dose from 4 to 10-12. During the same period i was also trying to cut back on Metformin since it was upsetting my stomache.
I’m really frustrated and almost depressed atm, no idea what to do. from what i read people saying 1 U of insulin for 10g of carbs which i never have in a a meal makes me crazy since i take 5-6 per meal with probably a third of these carbs.
I’m thinking insulin resistance but since i’m not obese and i’m Type I i have no idea why i would be insulin resistance.
i’m out of ideas and really depressed atm, currently in the middle of Dr Bernstein’s diabetes solution and it’s driving me even more crazy.
I’m thinking about getting a Freestyle Libre as a first step to gain more insight as to what’s happening with my BG. From there i guess i can have an idea insulin timing/dosage is off.
You don’t say whether you are doing a pre-bolus before meals or not. That could make a difference. I would guess that I inject at least 30 minutes before a meal and sometimes more. With the Libre, I can see the curve start to bend down when the insulin kicks in. But before that, I would do multiple tests before a meal using a meter. It takes much more insulin to bring you back from a high than if you would have injected in advance. Perhaps you’re already doing that?
I usually take Novorapid as i start to eat or 5 minutes before. i thought i don’t need as long a time to take it before the meal if i don’t have so much carbs which i don’t
Lots of people on a low-carb diet have to bolus for protein. That might be something to try (also, lots have good success with regular insulin instead of one of the faster-acting ones). Though personally, my strategy if I’m running high all the time in general, including fasting readings, is to increase my basal insulin.
@Jen what i notice recently is that even if my fasting BG is not that high, i still need too much insulin to cover a meal. and what’s weird is that my BG sometimes starts to rise after 2 hours when i measure after a meal. for some reason i feel it’s not consistent
Have you done any basal testing yet? Are you taking Lantus once per day or twice? This can make a huge difference in control because for some (or a lot of) people Lantus doesn’t last 24 hours.
Your graph isn’t showing any terrible BG’s IMO but I know it is frustrating when BG’s do not cooperate. I have been on a low carb diet for about 8 months and I still struggle every day to keep my BG’s in line. This disease is progressive, when your A1C was 5.2 you may have still been in a honeymoon period and now you aren’t. I’ve never had an A1c in the 5’s and unless something miraculous comes out that will just make diabetes almost child’s play then I probably never will but that’s no reason not to try.
When your BG is already on the high side it makes you more insulin resistant. Are you having issues with dawn phenomenon?
@Firenza I take 14-15 units of Lantus once a day at bedtime which is usually at 10:30 pm.
I have been struggling with morning highs the past two months.
How do you suggest I do basal testing ?
Basal testing is where you start with a stable BG (I know this can be hard sometimes) and then skip a meal (don’t eat or drink anything but water) and if you need to correct your BG in that time frame then your basal dose needs to be adjusted. If your BG goes up or down more than 30 points or so (I think that would be 1.5 mmol/l) then you either have too much or too little insulin. If you do need to correct a high BG then that means you need more basal insulin and you will need to start the test over again.
You will need to do this until you have tested all over the day and night, and it sounds like you have dawn phenomenon so what I would do is split my basal dose to once every 12 hours and see if that helps.
For basal testing on MDI, I would find a copy of Gary Scheiner’s “Think Like A Pancreas”.
Agree that higher BGs are going to make you more insulin resistant. Before I went on an insulin pump, my total daily dose of insulin (TDD) had slowly climbed to 50U/day. Once I got my numbers into a lower range, my TDD dropped significantly (around 25U/day). Having said that though, your bolus requirements are yours - don’t measure your success (or lack of) against others, since this isn’t a competition.
Also agree that having a CGM will reveal a huge trove of information to you, whether it’s a Libre or Dexcom. Seeing the trending data from 288 readings/day vs. whatever amount of fingersticks will help tremendously. You might also want to look at Stephen Ponder’s “Sugar Surfing”
Depending on your protein/fat/carb content, it’s not unusual to see a rise in BG two+ hours after a meal. You might want to check into Afrezza.
Oh, and 5.2 A1C? That would be an absolute dream for me and I would guess for many others too. These days, I am focused more on increasing my Time in Range (TiR) because 1) - it’s a more immediate feedback, and 2) - as I get a higher TiR, it logically follows that I will have a better A1C.
thank you so much @Firenza and @YogaO for the feedback, I’m fasting for the next 14 or 15 days still so i guess that’s a good time for experimentation with Basal.
@YogaO I have never heard of Afrezza before, sounds awesome though not having to have injections and fast acting as well. i’ll check “Sugar Surfing” sounds really promising
No Dr. Bernstein has that kind of control and has been able to replicate it with his patients but it is a very restrictive protocol, it’s not just a diet it’s everything from insulin dosing and timing to eating the same thing on a regular basis. I personally have a hard time eating the same breakfast or lunch everyday and as a result some of the details in Dr. Bernstein’s protocol are not attainable for me in addition he doesn’t approve of Afrezza which is my main meal time insulin so I haven’t been able to use a lot of his tip and tricks.
Btw, I love Afrezza and would probably be inconsolable if I couldn’t use it anymore since it is responsible for getting my A1C under 7 for the first time in my life.
I would not say Dr. Bernstein’s level of control is unattainable. I would say it is difficult and many of us are not willing to take on the discipline. Have a look at the “Flatliners Club” posts on this forum.
But to your earlier comments: most of us are eating some carbs although the number may be low. And those carbs will get going quickly. I would experiment to see how far in advance you can pre-bolus. Of course you will have to watch closely and be ready with glucose tabs if needed. My guess is that taking your bolus only 5 minutes before eating will not be your optimum choice. But only your personal experiments will tell you that.
While this can be done with a standard blood glucose meter, you will learn a whole lot more with a CGM.
May be your basal rate need to be adjusted more often than other people do. This is happening to me, I change it sometimes a few times a week, going from as low as 8 units to as high as 17 (not at once, by 1-2 unit increment). Usually, when my bg becomes erratic and it is less eager to respond to boluses it is a sign that the basal is too small. On the other hand if it starts going too low often it is a sign the basal is too large. In my case it is because of changes in diet and physical activity (none of them is constant unfortunately).
Also, looking at your chart it seems you have higher numbers first part of the day. Try to increase bolus for breakfast, may be this is the reason.
Neither have I, even after 26+ years. I’ve been eating low-carb for the past few years and very low-carb for the past year.
It is possible—there are many people who do it—but for some of us, particularly those of us who have had Type 1 from childhood from what I have gleaned through these forums, it is very, very, very difficult to maintain steady blood sugars. I have been trying for years to get an A1c in the 5% range, so at some point I have to make a decision about just how much effort I’m willing to put into diabetes (I have other issues like food allergies that make it more complicated). I do eat a low-carb diet, but it is not as strict as what Dr. Bernstein allows. I also deal with female hormones, which is something he doesn’t even address in his book or much of anywhere, and which creates a massive control challenge. (This is what I’ve been struggling iwth this past week, so “bad” is a matter of perspective…)
Back to your actual post… Blood sugar rising two hours after meals sounds like either a basal issue or a protein issue that needs a follow-up bolus (or use of an extended bolus on a pump, or use of regular insulin).
I found splitting Lantus (and Tresiba) made a HUGE difference to my control. Getting a CGM was also a life-changer for me (first time in over two decades I was able to keep my A1c below 7%).
Do you only test 4.5 times per day like your screenshot says? If so, I would definitely start testing more often. Even with a CGM, I test 6-8x per day so that I can correct highs or lows early.
@Jen i usually measure at least 5 times a day but i’ve been increasing that number lately due to the craziness of my BG, seeing your blood sugars made me feel like I actually have it easier than other people. keep fighting i guess
I will try splitting my basal dose as well and see what that does, i’ve read in more than one place that it really does help.
@Firenza too bad Affrezza isn’t available in Australia yet
If you are doing fingersticks, I would suggest that you should be testing at least 8X/day.
Wake-up (fasting)
Before breakfast
2-3 hours after (post prandial)
Before lunch
2-3 hours after (post prandial)
Before dinner
2-3 hours after (post prandial)
Before bed
Also a couple of points on basal and basal testing. One of the most important time periods to get right is overnight; getting a full night’s rest and waking up with your BG in range really sets up the day nicely. Therefore, you might also want to spend some time waking @ 3AM and doing a fingerstick. Again, a CGM really helps here as you get to see the trending - and you can avoid the 3AM fingersticks.
RE: Bernstein - it doesn’t work for me, but it does for others.
Almost all your bg’s are between 5 mmol/L and 11 mmol/L.
That’s between 90 and 200 mg/dL for us Americans.
That’s really excellent control and something to be quite proud of. Maybe just maybe you want to bring the whole range down an eensy bit (at the risk of having some hypos).
I see some stretches where your bg was quite constant over a whole 12 hour period. This is approaching “flatliner territory”, the best controlled of the best controlled.
Good point, basal testing. This is a must for anybody using basal insulin, injection or pump. And then there are 4 basal insulin to choose from. Each one may affect you differently.
Lantus 20-24 hrs. duration
Levemir 20-24 hrs. duration
Toujeo 24 plus hrs. duration
Tresiba 24 hrs. plus duration
