I see this thread is a bit older, but if anyone is still looking at it, I am very curious about the amount of insulin per day that those with ~5.0 A1C take.
I generally average 12.1 for basal and 12.6 for bolus per day (total insulin ~24-25 units via pump), and still get crazy low blood sugars which cause rebounding highs… my last A1C was 6.9 and I hover around an intake of 80 carbs a day and exercise regularly. I’m trying to get my A1C down more, but also worry about more lows.
It varies widely for me. I take 14u of tresiba lately and bolus with novolog and Afrezza. The amount of bolus varies hugely with what I eat-- anywhere from just a few units in a day to probably upwards of 30. If you’re going for a tight A1C I think mild lows in the 60s and such are probably essentially unavoidable and the name of the game is just to avoid serious lows and prevent them from causing any problems in your life…
I’ve been using between 35-45 units/day, with 75% of that being basal and temp basals (my current basal is 26 u/day). I’m also pregnant and have found temp basals to work better at keeping my bg steady, especially while eating LCHF.
My a1c is currently 5.6 I’ve been 5.4 - 5.9 for over 10 years. A soon as I got to 5.4 my doctor pleaded with me to lessen the reins. She was afraid i would have hypoglycemic unawareness cause I felt so great at 60 then suddenly 50 I’m beyond low.
I never write my blood sugars cause my doctor knows I will not tolerate BS over 150 (if I can help it life happens!) I eat moderately low carb.
What does moderately low carb mean? Could you share what a day of consumption would look like?
today I ate a large omelet with hot link sausages on the side, with about a cup of cottage cheese and maybe half a cup of blueberries in it for breakfast-- for lunch a sandwhich and a small cup of clam chowder, and for dinner 2 pork chops, some sort of vegetables, mashed potatoes, a glass of milk. That’s pretty typical for me while I’m at work except usually I also have a salad instead of soup at lunch.
I eat generally the same sorts if meals almost every day in terms of general composition… really all I’ve had to do is kind-of master dosing for about a dozen or so different basic meal composition categories that have very little differences in carbohydrates within those groups
My day is definitely lower than Sam19 and I probably eat more.Every meal is like a mini meal so my blood might rise 10 - 30 points.
Egg white plus 1 whole egg with spinach, 2 coconut flour pancakes (made up recipe) will spread dairy free cream cheese and monk fruit on there with cinnamon
Sun warrior protein shake with almond milk
Sliced zucchini with dressing, 2 hard boiled eggs
Dark chocolate bar (this has about 8 carb)
2 coconut flour pancakes (my go to item clearly)
Salad with a piece of broiled fish, any left over low carb veggies sauteed up, 1 macaroon (6 carb)
Sun warrior shake with almond milk, 2 TBS stevia chocolate chips
Low carb tofu noodles with coconut butter
I am gluten and dairy free
I eat almost the same things everyday but try to rotate for variety and use powdered greens and high antioxidant supplements, turmeric powders for the lack of fruit!
I don’t have a 5% A1c (though I think my next one will hopefully be below 6.5%) and my blood sugar does not stay entirely in range most days. But I do eat low carb, so thought I’d provide examples of my meals. In the morning I have one to three eggs and sometimes low-carb toast (made with homemade almond-flax bread) with nut butter. For lunch I have a sandwich on the same bread with nut butter, some raw celery and cucumber, raw nuts, a hard boiled egg, and low-carb yogurt with homemade granola (made with nuts and seeds). For dinner it’s usually chicken or salmon, zucchini noodles or spaghetti squash or sometimes baked butternut squash, bread on low-carb bread with coconut butter, and at night is my one time of weakness when I eat a square or two of semi-sweet chocolate, which spikes me. I need to make some low-carb yet sweet-tasting chocolate that I can eat instead!
I’m also low-carb, gluten-free and dairy-free! We should share recipes and strategies. So many of the low-carb groups out there are hyper-focused on cheese!
I also use this strategy. I even try to avoid eating after 6 pm since my blood sugar wants to spike around 3-4 hours after eating and this gives me time to address the spike before I fall asleep.
what do you mean by non-injectable insulin?
I think @Dragan1 is talking about Afrezza, the relatively new inhaled ultra-fast acting insulin: https://www.afrezza.com/
I’ve been working hard with a goal of below 6 on A1c. So far so good. I’m a diligent carb counter on MDI, not low carb. My daily carbs range from 185g to 225g depending on activity level, definitely not low carb but I think I have my I:C pretty well dialed in most of the time.
My only concern is similar to Ali4’s doc, hypo unawareness. I’m in the 60’s fairly often but feel pretty confident that I can correct before I get too low and (knock on wood) have not had any untreatable lows requiring outside intervention. Basically, I have become pretty aggressive about correcting high trending BG, because I have confidence I can catch a low before it gets serious.
The whole topic of hypo unawareness is my main concern. I only know if I’m in the 60’s from my CGM, I don’t experience any symptoms. Does that sound like a reasonably safe approach or am I kidding myself and asking for trouble?
I don’t consider 60s truly hypoglycemic… most people feel nothing in the 60s I believe. I certainly dont myself on my own meter (though I believe it reads lower than reality) Healthy non diabetics spend a fair bit of time in the 60s. If you start feeling symptoms in the 50s I think you’re doing great and don’t have any significant hypo unawareness.
When I was on a pump I would never be able to get my A1c below 5.4 but I think on Tresida I could. I was always low some days I would see 40-60 several times. I would be checking 1 -1 times during hte night never sleeping or before I drove cause of fear. I haven’t experienced that once yet since I switched. But when talking to my eye doctor she said what’s more important is the stability. For example you could be 130 for most of the day and your a1C would prob be something like 5.6 (guessing I don’t have the conversion memorized). OR have sugars jumping from 60 - 250 throughout the day and still have an a1c of 5.6. The amount of pressure on eyes and organs would too much and start to cause damage. Ya know!?! Sometimes I have to step back and look at the big picture a1c doesn’t tell the whole story.
Anything below 70 mg/dl is “truly hypoglycemic.” It is strategically a serious mistake to deliberately walk around with your blood sugar below 70 mg/dl because it will lead to hypo unawareness. Walk around too long with your blood sugar in the 60s and then you won’t fell hypo when your blood sugar is in the 50s. Then keep walking around in the 50s feeling hunky dorry (sorry for the technical term) and then the next thing you know you only find out you are having a hypo when you have a serious event.
Everyone taking insulin (or a drug driving insulin secretion) should seek to identify hypos below 70 mg/dl and treat them promptly. We are not healthy non-diabetics with fully functional counterregulatory systems to protect us.
And a key part of actually achieving an A1c of 5% that is a good goal is minimizing hypos. One should not seek an A1c of < 6% unless you can develop a significant assurance that you are not going to suffer bad hypos. A key to doing this is to minimize variations, bring your standard deviation down and maximize your time in range.
The lab at my hospital defines “normal” glucose as 65-126… not that 65 vs 70 is within the margin of accuracy of home testing (it’s not). I just think it’s unnecessary to immediately redesign ones treatment plan as if it’s not working if you see some numbers in the 60s on your home meter. I consider hypoglycemia to be symptomatic and with low blood sugar-- sure it’s not a good thing to reach a point where one doesn’t recognize those symptoms when they should— but to treat a condition before it exists isn’t part of my plan either-- like if I see a 68 on a home glucose meter (that I have pretty good evidence reads low) and have no bolus on board
Personally, I feel much more comfortable aiming for a “normal” bg when two factors are in place: (1) I have the CGM that can alert me to lows and trends, and (2) I have a handle on carb counting so I feel relatively confident that my boluses are matching what I’m eating.
Up to the beginning of this year, my A1C was consistently in the 8s because I preferred to run my bg a bit higher…I was terrified of lows impacting me at work or while driving. My carb counting was very average and I barely wore the CGM because I could never get it to work right.
This year, I vowed to renew my focus on my health, got the Dexcom, and started LCHF. I don’t think the switch to LCHF is a necessary component, but what it did for me is simplify the carb counting. Once I did that and had steady trend bars (rarely and downward or upward trending arrows), I felt more comfortable having bgs that were steady in the 70s and 80s, because I was no longer uncertain that they could suddenly start rapidly trending downward.
I also check my CGM constantly, do not ignore any pump alarms, and always have glucose tabs on me. I check the CGM before driving and I’m pretty confident with my overnight basal, the two times when I would be most concerned about hypo unawareness.
Yikes. Yuuuge misunderstanding. The lab reference range has absolutely nothing to do with what is considered a hypo and when you should treat. In fact the reference range doesn’t apply to you. It is the observed range of blood sugars for non-diabetic patients. The lab test has a range defined to screen and identify potential patients with diabetes (or other problems). I’m sorry to tell you that you have diabetes. In your case the test is simply a weak way of assessing your level of control.
I understand lab reference ranges. And as they are exactly as you describe, the ranges for non diabetics adults, they seem like a good starting point for my own targets-- as my ultimate goal is to have the exact same blood sugar profile as a non diabetic adult… actually I like to keep my blood sugar in even tighther ranges than most non-diabetics most of the time…