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Type 2 Diabetes
How low is too low for an HbA1c?
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<blockquote data-quote="pianoman" data-source="post: 223211" data-attributes="member: 35747"><p>I also understood phase 1 insulin (AKA first phase) to be a stored form (granules as you say) of insulin that has been saved for quick response such as when we eat... in a non-diabetic this might be released as soon as the food hits our mouth or possibly in anticipation of eating. </p><p></p><p>Also as you say: Phase 2 (AKA second phase) is secreted on demand but takes longer to respond. I recall from somewhere that it is effectively left-over" second phase insulin which is stored for the next first phase... and again as above: in Type 2 (especially with Insulin Resistance - IR) it is likely to be this first phase that fails; because (even if we are secreting large amounts to overcome IR) we barely have enough to keep up with the second phase demand let alone any "left over".</p><p></p><p>A clarification I might offer is that: I understood basal or long acting insulin to provide for our background needs for insulin; which is there whether we eat or not -- basal testing usually involves missing meals.While the fast-acting bolus insulins are to cover mealtime needs -- with the even faster-acting modern insulin analogs being developed to more closely approximate (but still not perfectly) the speed of a first phase response. Some people inject minutes before eating to try and more closely match the first phase -- in my experience it takes less insulin to keep the BG down that it does to correct it down once it has risen.</p><p></p><p>Medscape offers this on insulin secretion phases by Melissa K. Cavaghan, MD, Assistant Professor of Clinical Medicine, Division of Endocrinology and Metabolism, Indiana University School of Medicine, Indianapolis, Indiana...</p></blockquote><p></p>
[QUOTE="pianoman, post: 223211, member: 35747"] I also understood phase 1 insulin (AKA first phase) to be a stored form (granules as you say) of insulin that has been saved for quick response such as when we eat... in a non-diabetic this might be released as soon as the food hits our mouth or possibly in anticipation of eating. Also as you say: Phase 2 (AKA second phase) is secreted on demand but takes longer to respond. I recall from somewhere that it is effectively left-over" second phase insulin which is stored for the next first phase... and again as above: in Type 2 (especially with Insulin Resistance - IR) it is likely to be this first phase that fails; because (even if we are secreting large amounts to overcome IR) we barely have enough to keep up with the second phase demand let alone any "left over". A clarification I might offer is that: I understood basal or long acting insulin to provide for our background needs for insulin; which is there whether we eat or not -- basal testing usually involves missing meals.While the fast-acting bolus insulins are to cover mealtime needs -- with the even faster-acting modern insulin analogs being developed to more closely approximate (but still not perfectly) the speed of a first phase response. Some people inject minutes before eating to try and more closely match the first phase -- in my experience it takes less insulin to keep the BG down that it does to correct it down once it has risen. Medscape offers this on insulin secretion phases by Melissa K. Cavaghan, MD, Assistant Professor of Clinical Medicine, Division of Endocrinology and Metabolism, Indiana University School of Medicine, Indianapolis, Indiana... [/QUOTE]
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How low is too low for an HbA1c?
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