Hello it is me again with a related question to my last "survey– this time regarding fasting numbers though.
I m a recently diagnosed LADA and so far I m just injecting Bolus-Insulin whenever I eat a carby meal. But since I seem to still be producing some of my own insulin, I am not on any Basal. MY fasting numbers vary between 80-110, very sometimes I would see a number like 116 or something, on a very lucky day I will wake up with a 75. I would say if I averaged it all out (lately) I would be a "solid 100".
My Endo said he would not consider basal until there is a significant rise in fasting BG overall.
I am wondering if he is correct? I m sure many of you would probably wake up with numbers quite a bit lower than that?
I have to admit trying to postpone basal for as long as possible sounds very tempting to me, on the other hand I wonder if maybe getting into the basal regime some time soon would maybe be good– would that even be possible with very small insulin requirements like I have?
I appreciate any feedback!
Basal insulin will require you to be more regimented in you intake and exercise. I am coming up on my two year anniversary of DX (age 42, LADA). I can keep my fasting numbers below 100 so long as I consistantly exercise. When I miss a couple of days of riding, I start to see the fasting #'s rise. My current Endo gave me some great advice at my last visit, "relax, enjoy life a little". This advice has been a game changer for me, I think some of my bg spikes were related to stressing about the number on the meter.
Scientists use 110 mg/dl as the golden average for the blood glucose of healthy people. It is known that the blood glucose after fasting in the morning is usually the lowest of the day. It is typical for T2 diabetes that this average will change to 140 mg/dl and more (with smaller deviation) and this change will have long term consequences like complications. It is also known that numbers above 160 mg/dl will put pressure on the kidneys because they then start to filter blood glucose out of the blood stream. If you take the 130 mark you have room and time to act about it.
Healthy beta cells are used to produce insulin all the time. If they are being forced to produce higher amounts of insulin for longer periods of time they will burn out. This is what typically happens to T2 diabetics when the average is elevated to 140 mg/dl or higher. This is why they often need insulin because the production pressure has killed more than 70% of their beta cells. Your beta cells manage to keep good averages. The stress will be to cover the carb load from the meals. For this you are already using bolus insulin. Seen from this perspective I think your endo is right.
With additional basal insulin. Your beta cells would need to regulate their production down. If you have many residual beta cells the question is if their lowest production rate combined with your basal might be higher than what your basal needs are. If so you might have unwanted lows with addional basal on board.
Finally I would like to point out that meters are not accurate. They are often off by around 20%. The same blood glucose of 110 can give you numbers in the range of 88 to 132. So do not stress out about single elevated numbers. Take the average as your guideline and enjoy the ride.
I am ok with anything between 70 and 110. Before my pump, dawn phenomenon meant I was constantly waking up close to 200, which is not cool. Thankfully, my pump has helped me correct that and I am almost always below 130 and fairly frequently within my preferred fasting range of 70-110.
Basal insulin doesn't just affect your fasting blood sugar. It is background insulin that is supposed to keep you level 24/7, so that you can, fore instance eat late and not go too low. It is reflected in all the numbers that are not 2-3 hours after a meal.
To answer your question, I'm happy with anything between 70 and 120. I don't have dawn phenomenon so I don't need to worry about going up higher before eating.
I'm happy if I see 70-90 for fasting numbers, which I will see around 80% of the time. Anything above 60 and below 110 is probably more realistic for 90% of my readings. I'll occasionally see between 110 and 140. Once or twice a month I might see a number higher than 140.
I normally won't start messing with my basal, either way, unless the number I see starts to fall outside of 60-110 more than 10% of the time over the course of a week or so.
Adding basal definitely changes everything though. Your entire profile throughout the entire day has to be accounted for and you will most likely see changes to your bolus routine too.
My target fasting is 75-95, and I land there pretty consistently.
I would start with a low dose of basal and adjust your bolus doses accordingly. Ideal fasting numbers should be between 80-90. If your frequently landing higher than that, it would suggest your remaining beta cells are trying as hard as they can but not getting you there. Why put them under any additional unnecessary strain and risk more irreversible damage? I'm also a T1 LADA, and I do both basal and bolus. My objective is to preserve what little beta function I have left. Dr. Bernstein believes that this approach will allow you to preserve them indefinitely. In fact, your symptoms sound a lot like what Jenny Ruhl writes about in her book Bloodsugar 101, where it is first phase insulin that goes first, and basal last once your beta cells burn out trying to cover your meals and fasting. In fact, she also presents convincing evidence that if you've lost your first phase insulin, your second phase can over compensate, giving you unexpected lows. Hence, you might actually find yourself enjoying improved post meal control precisely because you're assisting your pancreas with basal. There is no downside in giving them some help, provided you carefully adjust your doses. The risk in following your endo's advice is that by the time your fasting completely deteriorates, you might not have much left to save.
You are really asking two questions, at what point should you initiate basal insulin therapy and then once you are on basal therapy, what should your target be?
In my view, the two reasons for starting basal insulin therapy is when your fasting gets above a normal range (70-110 mg/dl) between meals or when your morning numbers get above say 140 mg/dl.
Now that I am on insulin therapy, my targets are 90 mg/dl between meals and 100 mg/dl in the morning. However I still struggle, and really only average 100 mg/dl between meals and about 130 mg/dl in the morning.
I understand your question but would urge you to give up on the idea that numbers are acceptable. With any luck you age going to have this diseae for a very long time. There are mornings you are going to wake up high. Not 116 high but HIGH and there are mornings you are going to wake up low. All numbers are acceptable because you in fact wake up and have a chance to deal with them.
Insulin is a treatment to maintain reasonable blood glucose levels. Waking up between 80 and 110 seems reasonable and taking a basal insulin to try to get the range down to 70 to 95 seems to me a fools errand. In the best case, you might trade the occassional 116 for an occassional 60. I for one wouldn't see the point.
It's very true what they say - everyone's Diabetes is different. I'm not suggesting a dose, just an approach using a process of elimination and adjusting one thing at a time. You're right in stating your dose is too high if you continually have to counteract it with carb consumption. I've been there too. The trick is getting the right equilibrium with basal as well as with bolus. Here is also where I find consistency in diet to be key. By keeping carb and protein consumption consistent from one day to the next, I remove the variability that food can play on BG in establishing the best basal/bolus doses. I then fine tune my insulin doses accordingly. You might be going low for any number of reasons that can be driven by variability in meals and/or bolus. A too high basal dose can then compound the effect. Another thing to consider is 1/2 unit doses. BD sells syringes with 1/2 unit markings that I find very useful.
But at the end of the day, as several people have stated, BG targets should be what the individual is happy with and feels they can reasonably achieve.
why am i taking only basal, 2 units at nigt, 1 in the am and no bolus if i eat low carb? could a honeymooning lada just do either one, choose between taking bolus or basal? which would be better? is there a definite one thats better for everyone or are you all just going to say ydmv? my doctors didnt advise me to do this, it was just a gradual turning down of the insulin because i woud have lts of lows and would have to eat lots. im still eating between meals but dont want to lower it anymore...
I have a pediatric Insulin Pen, and only use it for correction now(no basal thus far) if I exceed 200 on my glucose meter. I exercise intensely and am keeping my carb intake around 150g a day. I beleive so long as I keep myself hyper sensitive to Insulin, I can avoid the exogenous Insulin which makes it own priblems, like chasing lows and so on. When I miss two or three days of riding I see spikes in glucose. Whenever possible, I try to at least go for a walk after meals to temper the spike. I hope I can keep this honeymoon going, I am at 23 months and counting.:)
As for the liver, think of it as a power house(stores a lot of glucose and other things ,wish I’d write it but it’s a long list).when your getting low your body does a response system to the low blood suger and commences gluconeogeneses.(another mechanism is glycolysis).but keep in mind both systems have limits in there respons time,a study hypotheses suggested that to much activation of these pathway system tends to make the body adapt to lows and don’t respond to it any more(at least that what my endo says happened to me)
If your interested I suggest reading about gluconeogenesis and glycosis.
Hope these helps ,good luck.
It is not only that the liver will adapt to lows. The liver will not increase its release rate in case of a low if the low was caused by too much insulin. It is the insulin level itself that prevents the liver from helping with glucose. This has to do with the signalling role of the insulin. In a healthy body increased insulin levels are signalling that carbs are digested and will be entering the blood stream soon. Thus the liver will not release additional glucose. Only with very low insulin levels the liver will help us out to fight the low. To my knowledge most basal rates and basal dosages are already above this signalling level. Thus it can be said that the liver response is broken by design in insulin dependend diabetics.
Holger my fasting BS is one of my highest numbers during the day. This morning my fasting BS was 100 (5.5), the lowest it's been since I was diagnosed.
