BASAL/ BOLUS THERAPY

[billyblue]

I'm a massive fan of Bernstein and his low carb magic.

If your glucose levels shows 5 mmol for the 18 hours you are awake each day, then your basal is almost perfect.
As long as you are not having hypos during sleep I would call that a win.
Can I ask what your last HbA1c result was?

Hello Benny,

I started as T2 and it was perfect with A1c 6.2 all the time till Sept 2019 things started to change and discovered that I am Lada, my A1c was 7.8 in Sept, till last month with injecting insulin instead of metformin pills went down to 6.6, I just need to bring down my fasting readings a bit by controlling the Dawn phenomenon if this the cause of morning highs

 

[everydayupsanddowns]

@everydayupsanddowns thanks for this, very helpful.
I am trying to find a away to manage my dawn phenomenon by experimenting a bit with insulin timings and doses, do you know by any chance a good way to tackle the morning highs? bedtime readings are 5 to 5.5mmol but the morning readings are up to 7 to 7.8mmol,
I am aware that the numbers are not very high but it is always good to manage better
thank you

Some people are more affected by Dawn Phenomenon than others, and some people (like me) find it comes in phases and waves, mine has currently almost completely disappeared after many years of needing much more insulin around breakfast time.

For classic DP some people find that a late night snack with a mixture of carbs and fat/protein helps keep their liver happy overnight. Mine was always Feet Hit The Floor rather that DP, with a similar hormone-based rise, but which only kicked in when I actually got out of bed.

Personally if your other levels are so stable and in range, I wouldn’t worry about a small rise into the 8s. You can have a perfectly on target A1c, which offers good chances of avoiding long term complications, while also having a quarter of Libre ‘time in range’ above 9 or 10.

Perfectly flat BG traces are not normal in the non-d population, so they aren’t something we need to aim for.

You might find this link to the international expert consensus on Time In Range helpful.

https://forum.diabetes.org.uk/boards/threads/time-in-range-useful-for-libre-cgm-wearers.82080/

I think you need to be a little cautious about some things you might read in keto/very low carb forums - I’ve seen people in those communities suggesting immediate prophesies of doom for anyone venturing above 7.5mmol/L at any time, where in reality the risk of long term complications just don’t work like that. It’s about reducing risk over an extended period and a proportion of time above range readings are perfectly acceptable within that reduced risk. Conversely, even with a ‘non diabetic’ A1c, a degree of risk still exists.