happy valentines day peeps! a question for all of you on mdi-im on mdi and there is no chance in hell of getting a pump or cgm. none. is it a realistic goal to want to have morning fasting numbers below 100 on a regular basis?
That's a good goal. I never really managed to hit it very regularly on MDI. Oddly, the only times I seemed to reliably have normal/ good BG in the AM were when I drank *a lot* the night before. I only used NPH though so I can't really speculate on Lantus/ Levemir.
I am not a diabetic-hero type who carries around Dr. Bernstein's book but I finally got close to your goal with a regular fasting range from 85 to 110. I am MDI with Lantus and Apidra. The trick for me was not adjusting the insulin but rather becoming totally boring with respect to my lunches (at work) and dinners. By that I mean, I eat basically the same amount of the same foods daily. At lunch, I eat a half sandwich on homemade wheat with the same amount of protein (chicken, ham, etc.)and an apple. This is a "brown bag" deal because we have a great cafeteria here at work but the portions are too large and I have too little will power. This regimen usually gets me a bg of 70 to 100 by dinnertime (6 pm). From that foundation, dosing for dinner is pretty simple. I then test at 10 PM (bedtime) looking for a 120-130. If I pigged-out at dinner and am higher than my target, I will shoot 2-5 units of Apidra.
This may all be imaginary but my motivation is I feel like I sleep better when I stay on target. If business has me travelling or eating restaurant meals, then my numbers are all different and I start to chase them. I know it is silly, but when I get exactly 100 at my 5:30 AM test, I feel like I won the daily lottery - my first smile of the day.
I have a sizeable and ever changing dawn phenomena. My morning reading may be my most inconsistent of the day. On MDI it was very challenging to get a number in my target range. My BG may have been under 120 2-3 days out of the week. It was always a guess? Pumping and a CGM have made morning much more managable and predictable. Aiming for a BG between 75-100 is a too narow range for me to consistently hit. Just too many variables.
I think this is a very individual thing. I am unable to attain morning numbers under 100 mg/dl with my MDI regime. I increased overnight basal, used NPH overnight tried all sorts of differences in before bed practices (food, no food, wine). It hasn't worked to further reduce my morning numbers. Part of my problem is that I have sleep problems. When I have disturbed sleep in the early morning hours, my DP is much worse. Dr. B suggests that you can wake up in the middle of the night and inject R to address DP, but I already have sleep problems. So I have loosened my goals. Now, I just want my average to be below 120 mg/dl and even that at times seems hard to achieve.
I'd guess that mine are below 100 half the time, and below 150 about the other half. I'm satisfied with that.
Oddly? The liver has invested itself in saving your life. Thus it will restore and rebuild itself after a some hours. After drinking at night this usually happens in the morning hours and this will supress the dawn phenomenon.
Have you tested your BG from 3 to 4 am? With a target of 80 you might have overslept many lows. When do you inject your NPH?
As a pumper you could program the pump to release more basal insulin. If the DP is happening regularly of course. As a pener (or MDIer) you have modern insulins at hand with a more even reaction profile. You can try to inject later at night. To increase the dosage is another approach. But this will increase the risk of lows at night. I found a way for me and this is a bit like gene's approach. I eat something before I go to bed (but I would never go to bed lowish). The point is that for me the DP depends on the blood glucose at 4 am. By eating something like one Wasa Bread I will increase my blood glucose above the magic treshold. It is a balancing act: My basal will pull my BG down evenly all night. My liver will reduce its glucose output from 2 to 3 am (highest risk of lows). In this phase the Wasa helps by increasing the BG. Most likely the BG is elevated by the Wasa till 1 am. But then the reduced output of the liver will show and the BG will normalize above fasting numbers. This slight elevation above fasting is the trick for me to prevent that the DP will be triggered. Of course this does not work every day. It needs experience and attention to details. With physical activity on that day I need to eat more to feed the refueling muscles. If you can achieve that the likelyhood is spread like a normal distribution (mathmatic Gauss) around your target this is good in my opinion.
Happy Valentines Day to you as well. If you do not experience Dawn Phenomenon then a realistic goal for fasting numbers is below 100. If you do in fact have DP then achieving these goal numbers without a pump is far more difficult. I tend to get low at night and I am very lucky in that I have a CGM and do not have DP. I am on MDI and my average morning fasting blood sugar is 104. But it isn't a number I focus too much on because if I have been hypo during the night I'll have some skittles to stop the dex from buzzing and that can tend to bump me up in the morning.
I want Sally's Diabetes!
Nope, then you'd be stuck with mine! Even with a pump, with working my butt off, I couldn't possible stay between 80-100. Oh well, could be worse!
You must be still honeymooning, Sally. Your residual beta cells are still acting as a buffer. If the NPH is overly active your beta cells will compensate that by reducing their output. Thus you do not see the profile of the NPH activity in your numbers yet. Hopefully you are LADA for life (high level of residual beta cells).
My understanding, Holger, is that there is no reason to believe that LADA's have a high level of residual beta cells for life, but simply that it takes longer for them to get destroyed. LADA just refers to the slower onset (destruction of beta cells) which occurs over a few months or a few years rather than all at once.
Bernstein definitely helps all around. I'm sure I'd have a lot better profile if I did it, but would find it hard to stay vegetarian which is important to me. Life is all about choices.
I didn't realize it's been five years for you, Sally (though that's still within the range of LADA). Have you had a c-peptide recently?
I'm on MDI using Levemir & Apridra. Quite an attainable goal. My fasting is under 100 90% of the time & it took a good bit of tweaking. I don't want a pump or CGM.
We all vary in our stability, Clare. I don't have DP and yet I am not always below 100 fasting. For some with Type 1, our numbers vary a lot more than that.
I am like you Gerri. I wonder by tweaking what things you have done to find success for your good morning numbers? I know for me cutting off all food after 9;00 pm is a must unless for some odd reason I eat dinner late (like on vacation) and then I bolus.
I do the same. No food after 9. Necessary with gastroparesis, but that helps most everyone. Also, though not always possible, I steer clear of protein & fat heavy dinners. They take too long to digest. The lighter the meal, the better my fasting. In my case, what I thought was horrendous dawn phenomenon turned out to be gastroparesis.
I've taken a small correction before bed, half the usual dose. Know people freak at that, but I have to with delayed stomach emptying.
The other tweaking was the usual overnight basal fine tuning. I went up & down in half units. Kept the dose change the same for 3-4 days before making another adjustment. What works best for me is injecting basal right before bed. I take another Levemir dose 11 hours later. The worst fasting I had was using Lantus. Woke up either high or low.
i know! i have a couple of glasses of wine and i wake up in the 80s! thats even eating a snack before bed! i joke ill have to become an alcoholic to get good am numbers, but maybe theres something to it...