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!

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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.

You can find my averages in my Glucosurfer log. Here you can switch to the diagram "Glucose - Profile per Hour" to see my average glucose per hour.

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.

I am using metformin and I have night sweats.

Do you have any idea why this is happening?

I follow the recommendations of Dr Richard Bernstein, and my fastingtarget bs is 80 - 85, and mostly I can hit it. I am also 'okay' with anything between 75 and 90.

I am most likely Lada. without insulin my fasting is 110+. At this point in time I am finding it pretty easy to control my diabetes with low doses of insulin, and low carb eating. I don't have lows. Long may this continue! Exercise is however a wild card and it's effects need close monitoring, particularly if it is high intensity or extra long duration (both cause my blood sugar to initially rise).

I guess it depends how agressive you and your doctor want to be in managing your diabetes.

My fasting averages about 110. My endo said she didn't think I should add basal until it's consistently over 120. For me I think that makes sense because I tend to go to the 80's between meals. With basal, I think I'd be crashing all the time or having to take glucose tabs all the time. Also, if my body is going through a rough patch (having a cold or hormones are crazy) I do have Levemir in the fridge and she said to feel free to add it for a few days if I feel it's needed to keep things in line. She also said that, before the fastings go up, at some point, I might find my bolus is no longer completely covering my meals, which could mean my pancreas isn't helping as much with meals because it's expending its power working on the basal. In that case, I would consider adding basal.

Like Parrformance, my goal these days is to try to find a way to manage the D while still relaxing & enjoying life.

My goal is always 100. No real reason, except it is a nice round number. I have a lot of lows and am more comfortable not getting up at 80 or below.

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.

The potential downside is that a person might find she has to constantly feed the basal insulin. When I was first diagnosed I was put on basal and after I added bolus, it was clear that continuing even one unit of basal meant I had to eat carbs quite a bit between meals to keep from going low. My endo suggested that constantly running too low is not good for the liver because it's constantly trying to increase the BG. I don't understand that mechanism enough to say whether it's a valid argument against basal too soon, but I don't take basal because I'd be crashing all day.




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