Negative for anti bodies - confused by recent lab test

I find that I can get better 2 hr readings after meals by adjusting the timing and dosing profile of my insulin. I inject at least 1/2 hour before I eat. If I have the leeway I’ll even wait until my CGM shows that my blood sugar is starting to drop. Since I also eat low carb, I’ll sometimes split my mealtime bolus, half before the meal and half after finishing. If there is too much protein I can actually be low at 1-2 hours but then have my blood sugar rise after that.

The other thing I struggle with is my morning numbers. How are your morning numbers? If I wake up high it doesn’t bode well. And if my blood sugar is high all night that can totally mess up your A1c even if your days are perfect.

About my pp BG -
My pp readings are generally taken at 2 hours after the first bite. If it’s a long meal of 1 hour or more, for example at my relatives, I check 2 hours after my last bite. Is that the right thing to do? (How do you handle “grazing”? I am wondering about Thanksgiving…???)

My pp BG for the most part can range between 130 to 160 ish. There are times that I can have pp BG pretty close to 100, 110 ish.

About Fasting BG and bedtime BG-
My fasting BG is most often GREATER than 100. It is often between 100 to high 120’s. My bedtime BG is often between 130-160.

What is perplexing to me is the following: There have been occasions where my bedtime BG is higher than usual about 170 ish (This is caused by a higher carb dinner and I likely mismatched the Novolog). The next morning fasting BG is still close to 100 to 120. Whether my bedtime BG is higher than usual or the usual, the next morning fasting BG is about the same.

I use Levemir 5 units at night and 5 units in the morning. If I have no food for about 5 to 6 hours during the day time, and then test -the lowest BG that I have tested is about 85 to 90. Would it be sensible to increase my basal by 1 unit - wait and see for 3 days?

I want to thank everyone for being so patient and helpful. Am I not “getting it” - BG management/insulin - the whole concept?

Yes, that’s pretty typically the first treatment for people dx’d with T2 (along with diet & exercise advice). More recently it’s become pretty common to prescribe it for T1 as well (I take 1000mg/day myself) but for us I don’t think it’s ever the sole medication. It just doesn’t do what insulin does, and if you’re not producing insulin it can’t substitute.

I’d say that’s actually quite decent. I know there are people here who manage to keep it below 6 but that takes a pretty extraordinary effort. Most endos generally get nervous about anything under 6 because they think you can only get there by enduring a lot of hypos (A1C is an average after all) though our members who are doing it would strongly disagree. Mine usually run between 6.1 and 6.5 (currently 6.1).

It sounds as though you are basically on the right wavelength. Minor tweaks are always possible, of course, and the idea is never to stop learning. And no matter how experienced we are, this is never an exact science. Just way too many variables in play. Perfection is a worthwhile goal, but not a practical probability. That being said . . .

2 hours is the right time to take a pp measurement. And you’re right to consider those readings somewhat high.

To obtain the best possible control, the basal needs to be dialed in correctly first. Basal testing is the way to get that right. (Gary Scheiner gives a good description of how to do it in Think Like A Pancreas and there are some old posts here that do so as well. Try doing a search.) If the basal dosage isn’t right to begin with, you’re likely to end up going in circles trying to get mealtime insulin to balance properly.

So let’s assume that you’ve done that. If your basal is what it should be and you are still high at bedtime, the balance of probability is that you are eating too late at night or just not dosing the mealtime insulin correctly. You need to know your ISF (Insulin Sensitivity Factor) and I:C (insulin-to-carb ratio) to compute the right bolus for a given meal. Those can be determined pretty easily by doing some controlled testing. And be aware that they often vary by time of day. Most people are less sensitive to insulin in the morning and more sensitive later in the day.

As for those high morning readings, the high percentage bet is that you are experiencing a Dawn Phenomenon. When that happens to me I take a unit of fast acting insulin immediately upon arising. Another way is to eat a snack of some kind before bed and ramp up the basal to compensate. But that approach carries some additional risks and I personally shy away from it.

P.S. There is another possibility I neglected to mention: gastroparesis. If food takes longer to digest than the insulin lasts, one possible result could be the kind of behavior you’re seeing.

“P.S. There is another possibility I neglected to mention: gastroparesis. If food takes longer to digest than the insulin lasts, one possible result could be the kind of behavior you’re seeing.”

I don’t think it’s gastroparesis because if I only eat fruits as my carbs with protein at mealtime, the BG/insulin matches better than if I eat protein with rice. (I don’t eat that much rice- about 1/3 cup for a meal - a half cup of rice would be alot of rice for me.). If I have a few chickpeas, the BG’s tend to stay above 140 for a bit longer. So it is the type of food that affects my BG. Of course, forget pizza. I usually don’t bother with it. If I have half a slice it’s manageable.

I do agree with the other comments here. Having residual insulin production makes dosing insulin safer. However, taking an insulin-excretion forcing drugs sounds dangerous.

Maybe additional careful basal bolus testing and adjustment of your insulin dose may help get your A1c lower. This may include adjusting dosing times relative to meals. You may also want to look into the new insulin Tresiba, which is long acting, and seems to produce great and stable blood sugar for many. Bolus dosing will still be required.

Maybe lower carb eating may help. Fruit is high sugar and could be replaced with vegetables, as carbs. Rice, in any amount (even 1/3 - 1/2 cup) in my experience can be really hard to cover accurately with insulin…

In my experience with rice, the sugar hits quickly, so bolus may need to be dosed a bit early, compared to chick peas where the sugar takes longer (and the bolus may need to be a bit later to match the peak).

Basal injection: For those who split their basal, how do you know which times are the best?

I currently use 5 units Levemir at 9pm and 5 units around 9 AM. The doctor simply stated, take it the same time everyday. He did not recommend a time.

  1. Would it make any difference if the injections were 6AM, and 6pm?
  2. If I delayed my 9 AM to 11 AM (I forgot, life got busy…etc) and nighttime is still 9pm - does it make a SIGNIFICANT difference in theory and in practice?

I have awakened at 2 am, 3 am or 4 am and checked my BG: 103, 117 thereabouts nothing unusually high or low. Dinner was around 6 or 7 pm; latest bolus around 7 pm. Bedtime BG between 130’s to 170’s. It seems to me that whether my bedtime is on the higher range >160 or lower range near 130, my next morning Fasting is between 100-130. Has this happened to anyone?

thanks in advance for your patience.

“In my experience with rice, the sugar hits quickly, so bolus may need to be dosed a bit early, compared to chick peas where the sugar takes longer (and the bolus may need to be a bit later to match the peak).”

I agree with you. The chickpeas in moderation causes my 2 hr pp to be higher than 140. BG is ok by about 4 hours.

Splitting basal is pretty forgiving it’s not a precise thing you’re just trying to level out the coverage… so no I really don’t think 6 vs 5 or 9/11 would make a bit of difference.

I’d suggest tresiba as then you don’t even have to bother with taking it the same time of day at all and 1x daily is plenty— can take it in the morning, then the next night, then the next morning, whatever— really hard to do it wrong with tresiba

Really? Are you saying 24 hours or less than 24 hours is ok with Tresiba?

Yeah it should be dosed every day but anywhere from 8-30+ hours between doses it’s all the same. Phenomenal stuff

Even with levemir just take it once in the morning and once in the evening if you need to split it… don’t get caught up in exact times–if that helps you with routine it’s fine but it’s not really necessary for it to achieve desired effect – it’s just an attempt to keep it in a steady state… so it’s not an exact timing thing like bolus is

Wow…how is it that Tresiba works from 8-30+ hours? That’s almost too weird for me to comprehend. Please don’t misunderstand me - I believe what you’re saying. It’s so incredible.
From my understanding of bolus insulins and the basal insulins and their expected duration of efficasy, Tresiba seems odd. If you were to dose and then 8 hours later, you dose again, aren’t there Tresiba in your body already and wouldn’t you be adding (stacking?) to it? For bolus, it would be stacking. Is it correct to use the term “stacking” for basal?

Thanks!

I had concerns about that “stacking” too… but it really just doesn’t work that way. as long as you just take it once a day it won’t stack…

X number of units are entering your body each day and X number are fading away, but since it lasts for more than 1 day, it’s not the insulin you took the day before that’s wearing off now. That’s how I think of it anyway…

Think of a large barrel with very a slow leak in it that leaks out 10 ounces of water every day. if you add 10 ounces of water to it every day it’s going to always have pretty much the same water level whether you do it day or night or at different times each day. That’s the tresiba example. You could add 5 ounces in the morning and 5 in the evening, but what’d be the point bc you’re changing the overall level so little it hardly matters

Here’s the lantus or levemir example. You have a 12 oz glass with a slow leak in it… every day it leaks out 10 ounces, and you’re trying to keep it st the same level so you’re adding 5 ounces in the morning and again 5 at night to keep it as level as possible because if you waited all day, it’d be almost empty… and yes in this example if you added the second dose too soon you could be “stacking” it in top of the first and overflow the glass

Don’t confuse that to mean that tresiba can be taken EVERY 8 hours… I’m just saying it needs to be taken every single day, with a minimum of 8 hours since the previous dose and a very forgiving fuzzy maximum of 36 or so (e.g. Taking it Monday morning then not til Tuesday night)

Hope that helps. I sometimes wonder if anyone can follow the bizarre way my mind works.

With levemir it I take it as soon as i wake up (smaller dose) and just before sleeping, regardless of what time i sleep our wake up.

@Sam19- LOL. Did you come to the 8-30+ hours by trial and experience or it was explained to you before you began using Tresiba?

I think the dosing instructions say take every day separated by at least 8 hours, I don’t remember all the fine print… I probably sorta arrived at that upper limit based on experience and my docs explanation— ultimately though the true measure of anything is real world observations

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@JustLookin - thanks. that’s interesting.

What I’m hearing from the group is that the timing of the basal is more flexible compared to bolusing.

I don’t pre bolus anymore because on more than a few occasions, the food did not arrive in time, or was not as much as I thought. I am not LCHF (~20g carbs/day)- I am about 60- 90 g carbs/day. Not pre bolusing and the slightly higher carbs probably could explain my a1c @ 6.5.

This disease is so FREAKING tricky to manage!