Glycemic variance

[achyut1939]

I am 80 years old. I am having type 2 diabetes from 30 years. I am taking 30/70 biphasic isophane insulin injections 40 units before breakfast, and 20 units before dinner. My post dinner blood glucose level is 268 mg/dl, and it gets reduced to a fasting blood glucose level of 91 mg/dl after about 12 hours. Does this variation causes diabetes complications in future. However, I do not have any diabetes complications till now.

 

[LooperCat]

Hi - just answering to bump you question to the top of the pile, but I cant really comment as a T1 - but levels that high aren't ideal, I'm afraid. Hopefully someone will be along soon who can advise. Tagging @JoKalsbeek

 

[Rachox]

I don’t take insulin so I can’t comment too much. Your fasting reading of 91 (5.01 in units used in the U.K.) is well with in the desired range of under 5.5. However 268 (14.8 in U.K.) is above the recommended limit of 149 (8.3).
This, with my limited knowledge of insulin use in Type 2 would indicate you have eaten too many carbs in your dinner or your insulin dose is too low. I can’t recommend what to do, but I think a Drs visit would be wise.

 

[catinahat]

This is copied from the blood sugar 101 website https://www.bloodsugar101.com/healthy-blood-sugar-targets

Research conducted with human patients, mice, and pancreas beta cell cultures all point to a single threshold at which elevated blood sugars cause permanent damage to your body. What is that level?
140 mg/dl (7.8 mmol/L) after meals

 

[achyut1939]

Fortunately, I do not have any diabetes complications till now, eventhough my ppbg levels are far higher than 140 mg/dl on several days eventhough I am having type 2 diabetes from the past 30 years. This may be due to my genes. Also, I think if diabetes complications appear if the bg level is higher than 140 mg/dl, and the high bg levels are persistent, continuous, and prolonged. In my case the bg levels get reduced to near fbg level in about 12 hours. If that is not true many persons would have got diabetes complications, which is not the real situation.

 

[JoKalsbeek]

Fortunately, I do not have any diabetes complications till now.

Your numbers do fluctuate a little more and higher than one would wish to see them do. I'd say, cut the carbohydrates some, but with your insulin/medical regime, I don't think it's safe to do so without an okay from your doc on how to proceed. https://www.diabetes.co.uk/forum/blog-entry/the-nutritional-thingy.2330/ could help a little to get you started?

 

[achyut1939]

I get Hyperglycemia on some days. To reduce the hypers if I reduce the diet, or increase the insulin dosage, I get into hypos. So I have to live with my bg fluctuations.

 

[Rachox]

I get Hyperglycemia on some days. To reduce the hypers if I reduce the diet, or increase the insulin dosage, I get into hypos. So I have to live with my bg fluctuations.

Why do you feel you have to live with the fluctuations? As I said above you need to visit your Dr. A change of insulin type or change in dosage might help even your readings out.

 

[achyut1939]

My doctor is not concerned with the ppbg levels. My HbA1c is 6.1%. My fbg is in normal range (less than 100 mg/dl). My ppbg is higher than 140 mg/dl. I do not have any diabetes complications till now. It may be also quite certainly possible that these nasty complications appear if the high bg levels are consistent, persistent, continuous, and prolonged for a long peroid of time. Further, it takes months or years for the complications appear. Hence, temporary, and transient high ppbg levels that get reduced to near fbg levels in a few hours do not cause complications. As I have already mentioned earlier, I have not got any diabetes complications till now, eventhough I have type 2 diabetes from the past 30 years. I very much like to know the experience of the other members.(My fbg varies from 60 mg/dl to 120 mg/dl. My ppbg varies from 130 mg/dl to 270 mg/dl).

 

[achyut1939]

On 18 July 2019 at 03-30 AM I got a hypo of 57 mg/dl. That is the problem, I get hypos of 57 mg/dl to 70 mg/dl, and hypers of 140 mg/dl to 270 mg/dl, on some days for the same insulin dosage and diet carbs. However, I do not have any diabetic complications till now, eventhough I am having type 2 diabetes from the past 30 years. I would like to know the experience of other members on this subject.

 

[achyut1939]

I would like to get the opinion of the other members about my problem.

 

[Brunneria]

Hi @achyut1939

I don't take insulin myself, but over time I have seen insulin users discuss things like this, so I have a few suggestions you could look into, to see if they apply to your situation.

Firstly, is your insulin fresh? Sometimes heat, or time out of the fridge, or expiry dates can affect its effect.
Secondly, are you injecting into the same place every day? Or do you rotate your sites? This link may be interesting to you, since the presence of lipotrophy can affect absorption rates.
https://bjd-abcd.com/index.php/bjd/article/view/37/88
Thirdly, you maybe eating the same things and injecting the same amount every day, but there are other factors that affect blood glucose level - stress, activity, amount of sleep, etc.
Fourthly, there is a condition called gastropareisis which is can affect the length of time it takes to digest food, which therefore affects the length of time it takes for the blood glucose to rise after food. Gastropareisis is something that may be diabetes related, or may not. There are tests which can be done to assess gut transit time.

Obviously, these are just suggestions of things for you to look into, since none of us here can give you clear answers.
Have you discussed the problem with your doctor?

 

[MeiChanski]

Hello, I would have to second that you need to see your consultant/endo/doctor for more advice. Since you are on a mixed insulin regime, I was wondering if you may or may not benefit from a basal/bolus regime where you have more control and possibly a carb counting course to give you that knowledge to adjust your insulin for meals to reduce hypos and correct accordingly for your hypers. But it is more than 2 injections a day, but it gives you that flexibility. I was also wondering whether you would benefit from a CGM or libre sensor to show you what's been happening in between tests. If your doctor isn't concerned, you have to be firm to show your blood glucose log book to say I've been having erratic readings and thats what is averaging out your HBA1c.
Before the libre, I didn't know when I spiked or fluctuated. Each time I tested, it was fine, low and mildly high, no complications, my gum health is at bay - I use to suffer gum problems when my bg was much higher for longer periods of time. Since I have the libre, I've been able to spot the spikes and I have learned to time my insulin better to reduce the spikes. Of course If I ate low carb, the spikes are very mild but with high carb meals, I will spike badly but with prebolus injection timed properly, it's not too bad. However it's better to keep levels in range, running that high isn't ideal.

 

[achyut1939]

Thank you all for your replies. I am not having any diabetes complications till now, eventhough I am having type 2 diabetes from 30 years. I take 30/70 premixed insulin 40 units before breakfast, and 20 units before dinner. I eat rice, and vegetables diet 120 carbs per day. Considering my age of 80 years, I propose to continue with the same diet, and medication, even though I get after meal blood sugar spikes upto 250 mg/dl. However, my HbA1c is 6.1% which is normal, and the high blood sugar spikes get reduced to near fasting level in about 12 hours. Even if some diabetes complications appear in future I may not live that long to suffer from them.

 

[achyut1939]

Thank you all for your replies. I am not having any diabetes complications till now, eventhough I am having type 2 diabetes from 30 years. I take 30/70 premixed insulin 40 units before breakfast, and 20 units before dinner. I eat rice, and vegetables diet 120 carbs per day. Considering my age of 80 years, I propose to continue with the same diet, and medication, even though I get after meal blood sugar spikes upto 250 mg/dl. However, my HbA1c is 6.1% which is normal, and the high blood sugar spikes get reduced to near fasting level in about 12 hours. Even if some diabetes complications appear in future I may not live that long to suffer from them.

On 21 August 2019 at 04-30 hrs, I had a hypo of 57 mg/dl. Again on 22 August 2019 at 03-39 hrs, l had another hypo of 61 mg/ dl. I do not understand what ever is happening. I am suffering from hyperglycaemia, hypoglycemia, and wild blood glucose fluctuations, on several days, for the same diet, and insulin dosage. I do not know what I should do.

 

[Walking Girl]

On 21 August 2019 at 04-30 hrs, I had a hypo of 57 mg/dl. Again on 22 August 2019 at 03-39 hrs, l had another hypo of 61 mg/ dl. I do not understand what ever is happening. I am suffering from hyperglycaemia, hypoglycemia, and wild blood glucose fluctuations, on several days, for the same diet, and insulin dosage. I do not know what I should do.

Stoping the mixed insulin and going on basal/bolus so you can actually time food with meals would probably help significantly.

 

[Tophat1900]

On 21 August 2019 at 04-30 hrs, I had a hypo of 57 mg/dl. Again on 22 August 2019 at 03-39 hrs, l had another hypo of 61 mg/ dl. I do not understand what ever is happening. I am suffering from hyperglycaemia, hypoglycemia, and wild blood glucose fluctuations, on several days, for the same diet, and insulin dosage. I do not know what I should do.

You need to discuss these problems with your doctor.

 

[Alexandra100]

On 21 August 2019 at 04-30 hrs, I had a hypo of 57 mg/dl. Again on 22 August 2019 at 03-39 hrs, l had another hypo of 61 mg/ dl. I do not understand what ever is happening. I am suffering from hyperglycaemia, hypoglycemia, and wild blood glucose fluctuations, on several days, for the same diet, and insulin dosage. I do not know what I should do.

I agree with everyone else that as you are on insulin it is vital that any changes you make, even to your diet, must be with the knowledge and guidance of your doctor.
From the title of your thread I see that you are aware of Glycaemic Variability. When I Google this I see that too much GV ie swinging between high highs and low lows, is likely to cause hypos. One of the drawbacks of the A1c test is that even a seemingly excellent result can hide big bg swings. I have seen it suggested that the ideal is to keep GV down below 2 / 36 and that is what I personally am currently aiming for by eating very low carb. However, once again, to attempt that without your doctor's help to modify your insulin regime could/would be catastrophic.
I have the impression that you really don't want to change anything. That is absolutely your right, but then I'm afraid you will have to live with the hypos and hope for the best.

 

[achyut1939]

I am 80 years old. I am having type 2 diabetes from 30 years. I am taking 30/70 premixed insulin 40 units before breakfast, and 20 units before dinner. I eat one cup cooked rice-vegetables diet. My fbg varies from 70 mg/dl to 120 mg/dl. My ppbg varies from 140 mg/dl to 250 mg/dl. My ppbg value gets reduced to near fbg value in about 12 hours. However, I am very much worried about my wild bg fluctuations. I get hypoglycaemia of 60 mg/dl to 70 mg/dl on some days. Many persons here have suggested to change my insulin type from premixed insulin to bolus/basal type of insulin. As I have already stated, I do not propose to change my insulin type, and cooked rice- vegetable diet. This is because I am suffering from gastroparesis. I can not decide upon the bolus insulin dosage 3 times every day, before my every meal, to keep my bg levels in good control. BG levels are also caused by, stress, exercise, hormones, insulin resistance, insulin produced by pancreas, and glucose produced by lever. At my advanced age of 80 years, I am resigned to the fate, and face the diabetes problems, as and when they strike. I do not have any diabetes complications till now even though I am having diabetes from 30 years. However, I may get diabetes complications any time in future due to my wild bg fluctuations that I am experiencing presently. Even if I get complications in future I may not live that long to suffer from them due to my advanced age of 80 years.