I have been type1 for 47 years, with no complications. HbA1c usually pretty good and has ranged from 40-46 in the past 5 years. I take Humalog bolus and Tresiba basal and have been using the Libre since it was first launched. I do not use insulin/carb ratios. My maths is hopeless and I've always got by with guesswork, which has served me well.
Most of my life I have suffered with an eating disorder (food craving) and developed a serious weight problem. At my worst I weighed 19 stone (120.5kg). How I continued to control my blood sugars during that time, I will never know. Approx 4 years ago I discovered low carb eating and have never looked back. How I wish I had known about this in my teens. I have lost 4.5st (28.5kg), have managed to keep the weight off for 3 years and have never felt better, although I do still need to lose another stone (6.3kg).
Over the past year I’ve developed a bit of carb creep. I decided to cut back and at the same time try to lose the next stone. I am seeking advice because my blood sugars have started rising in the late evenings, anywhere between 7-10. By this time my Humalog will be spent, so it's not covering me for the whole evening. I usually take an adjustment dose of 1-2 units between 10-12pm. The adjustment usually brings me back down to 5-6. I don’t think my basal is at fault. I take 7 units of Tresiba at bedtime and have a very steady line throughout the night. If I increase it by 1 unit I go too low in the night, so that isn’t the answer.
I may be wrong, but I’m pretty sure my problem is due to the low carb and my body converting protein into glucose. I eat approximately 50 grams of carbs per day. My evening meal is between 15-20 grams. I do not want to increase carbs because I want to lose weight. I did try strict keto when I first started low carb eating. I managed for two months, but when I discovered I couldn’t control my blood sugars, I changed to low carb. At that time I had no idea the body can convert protein to sugar. Not being able to control my blood sugars properly at that time made me change from keto to low carb. That has worked well for 3-4 years.
With my current problem I thought maybe the answer would be that I needed a longer acting bolus insulin with my evening meal. I discussed this with the DSN at the hospital clinic. To my amazement she told me my figures are nothing to worry about and are in line with guidelines for someone of my age (I am 72). Having spent 47 years trying to keep my blood sugars within the 4-7 range I was appalled to be told that a reading of 8 or 9 was perfectly acceptable and I didn’t need to make any changes. She said there is no reason to change insulin.
I was also told that my HbA1c was too low and for my age the guideline is 58 and that is what I should be aiming at. I have always understood the guideline to be 48 and have worked hard to keep to, or below that level. After 47 years I am finding this extremely stressful and I really don’t understand why being in the “70”s age bracket should make a difference. I can’t seem to find any evidence as to why an older person should change daily and long term targets. I’ve been told it’s to do with preventing falls from hypos. Well surely one cap doesn’t fit all? I am fit and able and no more likely to fall now than when I was 69. If I were feeble and less mobile then I would accept this as a concern, but I cannot see how this applies to me or others of my age group who live healthy and active lives.
I really am feeling stressed by what the DSN has told me. I would so appreciate some advice on any of the above. Apologies for the lengthy post.
To summarise:
1) Is a blood sugar level of 7-9 (sometimes 10) late evening, acceptable?
2) I would appreciate some advice about why my blood sugars are rising late evening. Is this down to protein and if so, how do I cover for the unknown? (I have looked at Richard Benstein on youtube. All he says is “you need to cover for protein”. Not very helpful!).
3) Is an HbA1C of 58 really acceptable? Am I making a fuss unnecessarily?
I also apologise if I have more than one thread here, but as they are interlinked I hope I’m not breaking forum rules.
Thankyou in advance.
Most of my life I have suffered with an eating disorder (food craving) and developed a serious weight problem. At my worst I weighed 19 stone (120.5kg). How I continued to control my blood sugars during that time, I will never know. Approx 4 years ago I discovered low carb eating and have never looked back. How I wish I had known about this in my teens. I have lost 4.5st (28.5kg), have managed to keep the weight off for 3 years and have never felt better, although I do still need to lose another stone (6.3kg).
Over the past year I’ve developed a bit of carb creep. I decided to cut back and at the same time try to lose the next stone. I am seeking advice because my blood sugars have started rising in the late evenings, anywhere between 7-10. By this time my Humalog will be spent, so it's not covering me for the whole evening. I usually take an adjustment dose of 1-2 units between 10-12pm. The adjustment usually brings me back down to 5-6. I don’t think my basal is at fault. I take 7 units of Tresiba at bedtime and have a very steady line throughout the night. If I increase it by 1 unit I go too low in the night, so that isn’t the answer.
I may be wrong, but I’m pretty sure my problem is due to the low carb and my body converting protein into glucose. I eat approximately 50 grams of carbs per day. My evening meal is between 15-20 grams. I do not want to increase carbs because I want to lose weight. I did try strict keto when I first started low carb eating. I managed for two months, but when I discovered I couldn’t control my blood sugars, I changed to low carb. At that time I had no idea the body can convert protein to sugar. Not being able to control my blood sugars properly at that time made me change from keto to low carb. That has worked well for 3-4 years.
With my current problem I thought maybe the answer would be that I needed a longer acting bolus insulin with my evening meal. I discussed this with the DSN at the hospital clinic. To my amazement she told me my figures are nothing to worry about and are in line with guidelines for someone of my age (I am 72). Having spent 47 years trying to keep my blood sugars within the 4-7 range I was appalled to be told that a reading of 8 or 9 was perfectly acceptable and I didn’t need to make any changes. She said there is no reason to change insulin.
I was also told that my HbA1c was too low and for my age the guideline is 58 and that is what I should be aiming at. I have always understood the guideline to be 48 and have worked hard to keep to, or below that level. After 47 years I am finding this extremely stressful and I really don’t understand why being in the “70”s age bracket should make a difference. I can’t seem to find any evidence as to why an older person should change daily and long term targets. I’ve been told it’s to do with preventing falls from hypos. Well surely one cap doesn’t fit all? I am fit and able and no more likely to fall now than when I was 69. If I were feeble and less mobile then I would accept this as a concern, but I cannot see how this applies to me or others of my age group who live healthy and active lives.
I really am feeling stressed by what the DSN has told me. I would so appreciate some advice on any of the above. Apologies for the lengthy post.
To summarise:
1) Is a blood sugar level of 7-9 (sometimes 10) late evening, acceptable?
2) I would appreciate some advice about why my blood sugars are rising late evening. Is this down to protein and if so, how do I cover for the unknown? (I have looked at Richard Benstein on youtube. All he says is “you need to cover for protein”. Not very helpful!).
3) Is an HbA1C of 58 really acceptable? Am I making a fuss unnecessarily?
I also apologise if I have more than one thread here, but as they are interlinked I hope I’m not breaking forum rules.
Thankyou in advance.
