How much insulin per day? What should HbA1c be?

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JonathanGi

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How much insulin do Type 1 diabetics have per day? I generally have 10 units of long acting a day and between 7 and 12 short acting. I weigh 53 kg. My HbA1c is 37. What should it be? I have been diabetic for 57 years. I am 66 and still learning. It's a strange condition.
 
JonathanGi said:
How much insulin do Type 1 diabetics have per day?
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Whatever works for them. You're talking a low amount compared to me (and I think lower than average), but it seems to work for you.
JonathanGi said:
My HbA1c is 37.
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That's low (and I'm sure you've at some point been told it's too low) but so long as it's not that low because you're having hypos a lot, that's great.

I don't think I've seen general statistics either on how much insulin we take or HbA1c. On HbA1c it is reported (via the discussions on the hybrid closed loop TA) that most people (around 70%, I think) with Type 1 are unable to achieve an HbA1c of under 58. And the average for people using a pump is around 64.

(Combined with your relatively low level of insulin I'd guess you may well be one of those who's still producing quite a bit of natural insulin.)
 
JonathanGi said:
I doubt very much I produce any insulin after 57 years.
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https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2901038 says
The amount of insulin produced by a lean, healthy individual is usually between 18 and 40 U/day or 0.2–0.5 U/kg/day. Because half of this amount is secreted in the basal state while the other in response to meals, the basal insulin secretion is about 0.5–1.0 U/h.​

I think it's generally accepted that injecting insulin is less efficient than insulin produced in the pancreas (just because of where it is), so I still think you're unusual. (Doesn't mean there's anything wrong, obviously. Just unusual. You haven't given your height, but 53kg is pretty light, too, though again it's probably within the healthy range. I think you'd be considered underweight (based on BMI) if you're taller than 1.69m if I calculated that correctly.)
 
Every type 1 is different and needs a different amount.
 
Article quotes a lean healthy individual and I am not as I am a Type 1 diabetic. Article also suggests that pancreas can still make some insulin up to a year after diagnosis but the study only includes up to 9 year olds.
It's a strange condition!
 
JonathanGi said:
Article quotes a lean healthy individual and I am not as I am a Type 1 diabetic. Article also suggests that pancreas can still make some insulin up to a year after diagnosis but the study only includes up to 9 year olds.
It's a strange condition!
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Do you consider yourself unhealthy just because you have Type 1 diabetes? I actually consider myself healthier than many of my friends the same age as me and in some respects my diabetes is responsible for that because I have to give more thought to what I eat and looking after myself. I don't see my diabetes as a disease or making me unhealthy. It is just a condition that I manage.

I think there was a study in the USA some time ago which tested people who had had Type 1 for many decades and most were still found to have some insulin production, so it is certainly possible that you still have some home grown insulin.

In answer to your question, I need between 20 - 25units of basal and anywhere from 7 to 20 units of bolus insulin per day. I can't get my HbA1c lower than 45 without having too many hypos (actually I have too many even at 45) and I average 90% time in range on my Libre.
 
JonathanGi said:
How much insulin do Type 1 diabetics have per day? I generally have 10 units of long acting a day and between 7 and 12 short acting. I weigh 53 kg. My HbA1c is 37. What should it be? I have been diabetic for 57 years. I am 66 and still learning. It's a strange condition.
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You sound pretty active to me @JonathanGi judging by your running and cycling achievements, so that probably reduces the amount of insulin you need. Obviously diet/carbs will also affect the amount of bolus/fast insulin you take.

Do you have a Libre or other CGM? I find looking at my Time in Range is a better measure than HbA1C.
 
As others have said, you need what you need. I weigh 55kg, I take 8 units of basal a day, though this is propped up by 2 units of fast acting in a morning, outside what I need for breakfast, to combat the dawn effect. I then have about 12-15 units of fast acting over the course of the day with meals, depending what I eat and how much exercise I take. My last HbA1c was 47, and it’s been round about that for a few years now, my time in range is normally around 85%.
But that’s me, that regime probably wouldn’t work for anyone else.
 
Article quoted above was talking about non diabetics in the lean healthy individual part. No, I am far fitter than most people my age. And after 57 years I manage my condition very well. I really dislike my Libre as it doesn't measure BG and is sometimes wildly inaccurate compared to a finger prick test. What is your Libre set to?
Thanks for answering my original question.
I have remarkably few hypos and I still have good warning signs after all these years.
 
Robin said:
As others have said, you need what you need. I weigh 55kg, I take 8 units of basal a day, though this is propped up by 2 units of fast acting in a morning, outside what I need for breakfast, to combat the dawn effect. I then have about 12-15 units of fast acting over the course of the day with meals, depending what I eat and how much exercise I take. My last HbA1c was 47, and it’s been round about that for a few years now, my time in range is normally around 85%.
But that’s me, that regime probably wouldn’t work for anyone else.
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Cortisol effect sometimes puts my BG up very rapidly!
 
I have a Dexcom G7 @JonathanGi I find it hugely more accurate than the Libre. When I had the Libre, I set my Low alarm to 5.6 because it wasn’t very accurate and that gave me a chance to ward off hypos. My Dexcom alarm is lower because it’s almost spit on with my fingerprick tests. It also has an Urgent Low alarm and a Falling/Rising Fast alarm.
 
My Libre is set to the standard 3.9-10 range. Within it's limitations, I find Libre absolutely brilliant and is usually within 1mmol of a finger prick except during the times when it struggles.... ie. when BG levels are changing direction or the rate of change is changing, so if it is going up fast but then starts to level out and Libre will continue to show (predict) it rising fast until it realises that it has stopped rising and leveled out. Same when it is dropping fast and when you treat a falling BG with fast acting carbs it will show your levels continuing to drop 15 mins after you have taken hypo treatment, but half an hour later Libre is usually back on track. This is just the algorithm which is responsible to over predicting and it usually corrects on the graph afterwards. Most of the time I can go days without needing a single finger prick as I have found it that reliable for me. I do scan a lot though to watch and understand the data it gives me and I do 2 or 3 checks on each new sensor during the first few days and I apply each new sensor a day before I activate it as this extra bedding in time helps it to be more reliable from the get go.

We have a thread about the limitations of Libre/CGM developed as a result of our own personal experiences rather than Abbott's official version which you might find helpful....
forum.diabetes.org.uk

CGM limitations and precautions

Moderator Note: This helpful reply was copied from another thread as it details some of the commonly experienced limitations of continuous glucose sensors. My blood sugar has been in perfect range for days now, but although I haven't changed anything, I'm starting to get very short periods of...
forum.diabetes.org.uk forum.diabetes.org.uk
However there are some people who find that Libre simply doesn't suit their body chemistry and they get on better with Dexcom.
 
rebrascora said:
My Libre is set to the standard 3.9-10 range. Within it's limitations, I find Libre absolutely brilliant and is usually within 1mmol of a finger prick except during the times when it struggles.... ie. when BG levels are changing direction or the rate of change is changing, so if it is going up fast but then starts to level out and Libre will continue to show (predict) it rising fast until it realises that it has stopped rising and leveled out. Same when it is dropping fast and when you treat a falling BG with fast acting carbs it will show your levels continuing to drop 15 mins after you have taken hypo treatment, but half an hour later Libre is usually back on track. This is just the algorithm which is responsible to over predicting and it usually corrects on the graph afterwards. Most of the time I can go days without needing a single finger prick as I have found it that reliable for me. I do scan a lot though to watch and understand the data it gives me and I do 2 or 3 checks on each new sensor during the first few days and I apply each new sensor a day before I activate it as this extra bedding in time helps it to be more reliable from the get go.

We have a thread about the limitations of Libre/CGM developed as a result of our own personal experiences rather than Abbott's official version which you might find helpful....
forum.diabetes.org.uk

CGM limitations and precautions

Moderator Note: This helpful reply was copied from another thread as it details some of the commonly experienced limitations of continuous glucose sensors. My blood sugar has been in perfect range for days now, but although I haven't changed anything, I'm starting to get very short periods of...
forum.diabetes.org.uk forum.diabetes.org.uk
However there are some people who find that Libre simply doesn't suit their body chemistry and they get on better with Dexcom.
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That was very helpful. Thanks very much.
 
JonathanGi said:
Article quoted above was talking about non diabetics in the lean healthy individual part.
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Yes, because it's talking about how much insulin non-diabetics produce, which seems a useful comparison to us. You seem to be comfortably in that range. I think that's unusual, but I honestly don't know that.

OK, https://www.ncbi.nlm.nih.gov/pmc/ar...ext=The starting total daily insulin,2, 8, 9]. says
The starting total daily insulin dose is typically weight based, ranging from 0.4 to 1.0 units per kilogram body weight, as recommended by various guidelines.​

(By "starting" they don't mean to include the honeymoon period, they're just saying that's a good sort of number to think about before you have any data.)

So by that measure you're close to the 0.4 (0.4*53 is about 21), and I'm pretty close to the 1.0.
 
JonathanGi said:
How much insulin do Type 1 diabetics have per day? I generally have 10 units of long acting a day and between 7 and 12 short acting. I weigh 53 kg. My HbA1c is 37. What should it be? I have been diabetic for 57 years. I am 66 and still learning. It's a strange condition.
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That looks absolutely fine, worry not what others take.
 
@JonathanGi why are you asking these questions after 57 years?
Are you concerned by your relatively low insulin requirements?
 
Because I don't, as yet, fully understand the condition. Plus I now use some tech. I think I would like a pump but, apparently, I don't fulfil NICE criteria. Diabetes further complicated by cancer treatment. And still nobody can tell me how to manage BG spike after a 24 minute Parkrun.
 
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