Replies to This Discussion

Permalink Reply by Zoe on February 14, 2013 at 3:59pm

My understanding, Holger, is that there is no reason to believe that LADA's have a high level of residual beta cells for life, but simply that it takes longer for them to get destroyed. LADA just refers to the slower onset (destruction of beta cells) which occurs over a few months or a few years rather than all at once.

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Permalink Reply by Super_sally on February 14, 2013 at 5:08pm

I sure hope so. That's why I am working to keep excellent control.

I am going on 5 years now since diagnosis and despite massive insulin requirements during pregnancy, have returned close to baseline after with only a very slight increase in insulin requirements over time. I am a Berstein follower. He seems to think that at least some people can maintain some beta cell function indefinitely if blood sugar numbers are kept normal.

I am still breastfeeding no. 2 and it will be interesting to see what happens with bs numbers when I finally stop.

I do have a mild dawn phenomenon, with a rise overnight (without basal) of 30 - 50 points over my bedtime numbers. So I think the profile of NPH probably works well for that.

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Permalink Reply by Zoe on February 14, 2013 at 5:43pm

Bernstein definitely helps all around. I'm sure I'd have a lot better profile if I did it, but would find it hard to stay vegetarian which is important to me. Life is all about choices.

I didn't realize it's been five years for you, Sally (though that's still within the range of LADA). Have you had a c-peptide recently?

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Permalink Reply by Sweet Fur on February 17, 2013 at 8:44am

I just wanted to say thank you for this brilliant idea for NPH injection schedule.

Let me ask you - do you find you need significantly less insulin around 2-6 pm? As in, if you were to exercise or do something different, do you tend to go low then?

I would go off my pump if I could figure out a way to cover all the times around 2-6 and not go low during that time frame. I've been experimenting with NPH because (in theory) I'm hoping it will be mostly out of my system around that time.

Thank you!! And I'm open to any ideas you may have if you are in a similar situation.

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Permalink Reply by beechbeard on February 14, 2013 at 6:23am

I am not a diabetic-hero type who carries around Dr. Bernstein's book but I finally got close to your goal with a regular fasting range from 85 to 110. I am MDI with Lantus and Apidra. The trick for me was not adjusting the insulin but rather becoming totally boring with respect to my lunches (at work) and dinners. By that I mean, I eat basically the same amount of the same foods daily. At lunch, I eat a half sandwich on homemade wheat with the same amount of protein (chicken, ham, etc.)and an apple. This is a "brown bag" deal because we have a great cafeteria here at work but the portions are too large and I have too little will power. This regimen usually gets me a bg of 70 to 100 by dinnertime (6 pm). From that foundation, dosing for dinner is pretty simple. I then test at 10 PM (bedtime) looking for a 120-130. If I pigged-out at dinner and am higher than my target, I will shoot 2-5 units of Apidra.

This may all be imaginary but my motivation is I feel like I sleep better when I stay on target. If business has me travelling or eating restaurant meals, then my numbers are all different and I start to chase them. I know it is silly, but when I get exactly 100 at my 5:30 AM test, I feel like I won the daily lottery - my first smile of the day.

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Permalink Reply by Capin101 on February 14, 2013 at 6:24am

I have a sizeable and ever changing dawn phenomena. My morning reading may be my most inconsistent of the day. On MDI it was very challenging to get a number in my target range. My BG may have been under 120 2-3 days out of the week. It was always a guess? Pumping and a CGM have made morning much more managable and predictable. Aiming for a BG between 75-100 is a too narow range for me to consistently hit. Just too many variables.

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Permalink Reply by Brian (bsc) on February 14, 2013 at 8:42am

I think this is a very individual thing. I am unable to attain morning numbers under 100 mg/dl with my MDI regime. I increased overnight basal, used NPH overnight tried all sorts of differences in before bed practices (food, no food, wine). It hasn't worked to further reduce my morning numbers. Part of my problem is that I have sleep problems. When I have disturbed sleep in the early morning hours, my DP is much worse. Dr. B suggests that you can wake up in the middle of the night and inject R to address DP, but I already have sleep problems. So I have loosened my goals. Now, I just want my average to be below 120 mg/dl and even that at times seems hard to achieve.

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Permalink Reply by Kathy on February 14, 2013 at 9:09am

I'd guess that mine are below 100 half the time, and below 150 about the other half. I'm satisfied with that.

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Permalink Reply by gene on February 14, 2013 at 9:32am

It's like a rube goldberg machine, that makes good waking numbers, going off at night. Back on Lantus my system was lantus at night(a heavier dose than what would seem normal), little or no bolus and the ritualistic consumption of plain yogurt. Going to sleep with a lowish BG made me a little paranoid at first. Magic Yogurt?
I'm still hopeful it can be achieved as it's a worthwhile target to aim for.

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Permalink Reply by Holger Schmeken on February 14, 2013 at 12:53pm

As a pumper you could program the pump to release more basal insulin. If the DP is happening regularly of course. As a pener (or MDIer) you have modern insulins at hand with a more even reaction profile. You can try to inject later at night. To increase the dosage is another approach. But this will increase the risk of lows at night. I found a way for me and this is a bit like gene's approach. I eat something before I go to bed (but I would never go to bed lowish). The point is that for me the DP depends on the blood glucose at 4 am. By eating something like one Wasa Bread I will increase my blood glucose above the magic treshold. It is a balancing act: My basal will pull my BG down evenly all night. My liver will reduce its glucose output from 2 to 3 am (highest risk of lows). In this phase the Wasa helps by increasing the BG. Most likely the BG is elevated by the Wasa till 1 am. But then the reduced output of the liver will show and the BG will normalize above fasting numbers. This slight elevation above fasting is the trick for me to prevent that the DP will be triggered. Of course this does not work every day. It needs experience and attention to details. With physical activity on that day I need to eat more to feed the refueling muscles. If you can achieve that the likelyhood is spread like a normal distribution (mathmatic Gauss) around your target this is good in my opinion.

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Permalink Reply by Clare on February 14, 2013 at 1:27pm

Happy Valentines Day to you as well. If you do not experience Dawn Phenomenon then a realistic goal for fasting numbers is below 100. If you do in fact have DP then achieving these goal numbers without a pump is far more difficult. I tend to get low at night and I am very lucky in that I have a CGM and do not have DP. I am on MDI and my average morning fasting blood sugar is 104. But it isn't a number I focus too much on because if I have been hypo during the night I'll have some skittles to stop the dex from buzzing and that can tend to bump me up in the morning.

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Permalink Reply by Zoe on February 14, 2013 at 7:37pm

We all vary in our stability, Clare. I don't have DP and yet I am not always below 100 fasting. For some with Type 1, our numbers vary a lot more than that.

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