At 6:00 am this morning my BG was 132 before breakfast. There were 0 carbs in my breakfast (according to MyFitnessPal). I took 14 units of Apidra and retested at 9:38 am, got an 88. I thought that the Apidra would be pretty much "gone" and I could coast to lunch. I just tested pre-lunch and got a 133.
I am trying to lose weight. Where is this "extra" BG coming from. I thought the by-products of fat metabolism (acetone, acetaldehyde and Beta-hydroxybutyrate) would not show on my meter. Could there be that much gluconeogenesis going on? Help?
You are a diabetic, beechbeard. Your blood sugar will go up without insulin even if you don't eat at all. That's what the basal is for - it provides for your background insulin needs. While 132 and 133 aren't terribly high, they show that your blood sugar is going up between meals so you need more basal. I would try raising your basal by a unit, and/or splitting the dose to get better coverage before meals. Also if I am at 132 before a meal I'll add in a correction to my meal dose to bring it down.
Finally 14 units of Apidra when there are no carbs to cover indicate you are attempting to cover your basal needs with bolus which isn't efficient. So again, you need more basal. You don't mention your I:C ratio but if that 14 units is typical you also may have a fair degree of insulin resistance. I would work on your basal first. Then when you are in range at rising, between meals and bedtime if you are still using high doses for your meals (and your basal is also high leading to a high TDD) I would consider talking with your doctor about meds for insulin resistance as well as working on losing the weight which will also help a lot with the IR.
What did you eat?...if it has calories it tuns to sugar at some point..if your starving your body can also dump sugars stored in your liver. My BG drifts up and down 30 to 40 points every day 24/7, with or without food, theres no stoping it it just happens.
I see two possible sources that could account for your pre-lunch 88-133 mg/dL rise. First of all, your liver regularly releases glucose. This is how our bodies meet the essential glucose needs (like for the brain) when we are sleeping or otherwise fasting. In a non diabetic the insulin release prompted by a meal will inhibit the liver's release of glucose. Unfortunately, as PWDs, sub-q insulin does not produce the same effect. The purpose of basal insulin is to metabolize this liver glucose release.
Secondly, if your meal did indeed have no carbs, your body will convert some of the protein and to a lesser extent the fat into glucose via gluconeogenesis. I usually deliver an extended bolus (often over three hours for me) via a pump to counteract this phenomena. The quantity of protein and fat in your meal will affect your post meal BGs and for me determines the time duration of an extended bolus. If I were not on a pump, I would be tempted to experiment using old fashioned Regular insulin to dose for protein and fat. Or you could take a second dose of rapid acting insulin some time after your meal.
Your numbers, however, are not very far off a reasonable target. Whatever you do at this point, I would recommend small adjustments and keep a written record to inform your tweaking.
Are you using low-carb to lose weight? A year ago, I lost over 20 pounds by limiting my carb consumption to 50-70 grams per day.
Am working on calculating I:C but Insulin Resistance Factor is 1 unit reduces BG by 4.8 mg/dl. I thought I was pretty sure of that but maybe my Lantus is a factor.
Do not snicker - even politely. I had three plain Burger King sausage patties. Calories but no carbs. I am trying a very low carb, high fat diet that I got from another thread here. Are you sure about that calories thing? The metabolism of fats is exothermic and does not primarily generate sugar.
I am trying to lose weight (like an extra person's worth). My most recent A1c is 6.6 - got the results last night. Have lost 15 lbs. in a month by keeping carbs very low and good. No processed flour products, no lite products where they substitute high fructose for natural fats, etc. Actually have not felt hungry.
I have upped my testing frequency to 7 times from breakfast to bedtime. I also bought a Nova Max to test ketones once a day. I like Apidra because in me it starts very fast and drops off very fast. Once I started on this self-research I noted that I was camel-humping between meals. I had gotten pretty good at meeting mealtime targets but beteen I would hump 40 = 70 mg/dl. So I am trying to emulate a pump with MDI.
I like the suggestion to look at basal. For years I have taken 40 units at dinner. I think the first thing I will try is splitting the Lantus. Then after I see what happens, I will start adjusting the Apidra.
Fat does not convert to sugar in any significant amount but a portion of protein does. So if you are ignoring the protein, then you are overlooking one of the factors that directly affects BG.
Thank you - that is probably the pathway. So far I know(think) I have a very high sensitivity to refined carbs and a very high insulin resistance. I'll spend some think-time to devise a scheme to estimate the protein contribution.
I am chasing all these factors because I had previously used NutriSystem and others that provide 40-60% as carbs and was not very successful. I was also pretty sure that I wasn't deluding myself. All the voices in my head were saying the same thing.
Having once been trained as a scientist, I finally realized that there might be more biochemistry going on than "eat less, exercise more."
It was another thread on TuD that suggested I take a look at Gary Taubes and others. I quickly realized that there was a lot of nonsense in the internet and a lot of parroting of platitudes. People drawing hard conclusions (rather than hypotheses) from epidemiological studies. When I decided to dive into the research papers, it was like being in grad school again. Some were excellent science, many were not. Some papers did not support their conclusions. I guess all the climate scientist jobs were taken, so the researchers had to settle for nutrition.
Gary Scheiner, Think Like A Pancreas (Boston: Da Capo Press, 2011)
Richard K. Bernstein, Dr. Bernstein's Diabetes Solution, 4th. ed. (New York: Little, Brown and Company, 2011)
Both of the authors are themselves T1 diabetics who live with these issues every day -- not just "experts" dispensing learned opinions.
As with any "authority" or "expert", you don't need to follow every bit of advice religiously -- you take what you can use and leave the rest. But the second book, especially, goes into quite a bit of detail about how food is digested and the various effects it has on BG.
People who low carb often have a problem with protein as it becomes a significant source of glucose for them. 58% of protein can be converted to glucose, if needed by the body. The conversion is inefficient hence the 58% figure. There is a group here called TaGers United which addresses this problem and offers solutions. Ultimately you just have to add this extra glucose into your calculations.
I see two possible issues here. The simplest is that your basals may need to be adjusted. Diabetes is the art of aiming at a moving target and your morning basals may be the moving target right now.
It is likely that your protein breakfast has a slower and more subtle effect on your BG. I encourage you to visit the TAGers group at TU as it describes some methods other MDIers use to combat a high protein/fat meal.
This is the number generally quoted around here. I believe some around here use 50% in there TAG calculations as it makes the math easier.
This article says "the liver converts an average of 58% of the protein we eat into carbohydrates". This one says "Between 50–60% of protein becomes glucose and enters the bloodstream about 3–4 hours after it's eaten"
This apparently is not a set number because protein requirements vary from day to day.
Ah, I see. I was using a very different formula because it was based on ounces of protein food, not actual grams of protein content. Just penciled it out and they pretty much agree when you account for that discrepancy. Thanx. Makes sense now.
Just for clarity, that 58% figure refers to the actual grams of protein in the food, not the total weight of the food itself. So if you are eating a piece of meat weighing 8 ounces, you don't multiply 58% by 8 ounces but rather by the actual protein content of the meat, which is considerably less.
Your weight loss experience is similar to mine. The pounds came off rather easily and I was never hungry between meals. It's been so long since I used MDI, my knowledge is minimal. I use a CGM but if I didn't and was trying to make the changes you're trying to make, I'd test as frequently as I could afford. It's the best way to learn how your body reacts to different food and insulin programs. Keeping a written record will help you spot patterns and relationships that are not immediately obvious. I also read food labels and weigh my foods that don't have labels. I use the Calorie King web site to find nutritional info.
Good luck. You're making big changes and I think you'll find big success!
For whatever it may or may not be worth, when I went low carb the weight pretty much fell off by itself. I didn't set out specifically to lose weight; once the BG started behaving itself the weight just sorta went away.
I agree with the basal issue in the scenario. I consider the breakfast short-term to be measured by the post-breakfast. I would think the 133 is showing not enough basal, since it went up despite whatever "tail" might've been lurking from the Apidra, although I gather the Apidra is supposed to have less of a tail than 'logs.
That being said, if you are trying to lose weight, I suspect that whatever is in a BK sausage probably includes quite a bit of fat in addition to various preservatives, etc. that may also throw things off.
I always use 53% for converting protein to carbs, but just fudge and use 50% because I can then do the math in my head.
This has been all good stuff, The Burger King Sausage patties appear to be all protein and fat total 780 calories).
I am going to try switching to twice daily basal. Not sure the best way to do this but I started by cutting last night's dose to 30 units and took 12 this morning. Plan to shift by 10 units a day until at 50/50 (if no negative surprises).
I was thinking about this whole project last night. I am trying to create a linear model for a complex uncontrollable multi-variant system (my diabetes) when I have no clue whether that system is first-order. Nothing wrong with that as long as I keep it in perspective. After all, Newtonian Mechanics worked well and is an approximation of relativity.
