What is a 'normal' daily blood glucose pattern?

Simon Grey said:

Hello everyone!
I am a T1, fit and healthy and apart from pesky hypos feel pretty well with my diabetes. However, when I look at my daily patterns, they are all over the place, from being in target range for some of the time to being in high teens after meals and randomly at night. If i take 'enough' insulin to avoid highs after meals then i will always hypo (even on low GI foods, which is mostly what i eat). Injecting half an hour before meals helps, but only a bit. I have concluded this is OK because I feel well, but wonder if actually my control is really poor compared to others or just 'normal'. Any comments?
Thanks
Simon

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That pretty much reflects what I experience, which is why I find it easier to manage my glucose levels with a lower carb diet than other T1's. Very seldom that I eat more than 50g at any one time and therefore only eating about 120g to 150g per day. I don't think the text book method of eat whatever you want and bolus for it works for everybody.

But what insulins are you actually using?

The type of basal insulin you are using will have a significant effect. Levemir works better than Lantus, (Tresiba better still) at keeping your background glucose levels flat. You need to get the basal right before you can really work on the bolus, have you tried basal testing?

Simon Grey said:

Hello everyone!
I am a T1, fit and healthy and apart from pesky hypos feel pretty well with my diabetes. However, when I look at my daily patterns, they are all over the place, from being in target range for some of the time to being in high teens after meals and randomly at night. If i take 'enough' insulin to avoid highs after meals then i will always hypo (even on low GI foods, which is mostly what i eat). Injecting half an hour before meals helps, but only a bit. I have concluded this is OK because I feel well, but wonder if actually my control is really poor compared to others or just 'normal'. Any comments?
Thanks
Simon

Click to expand...

I tend to 'eat what I want' and take the correct amount of insulin. Usually somewhere between 150 - 250g a day depending on what I'm eating and this is my current 14 day daily pattern. Like previously mentioned, I think background insulin is key with these graphs.

Simon Grey said:

Thanks for the reply!
I am using Lantus and Humalog. I agree re low carb diet, but I tend to burn a lot of energy (outdoor farm work, mountaineering, ski touring, etc.) and laws of physics say that energy has to come from somewhere! having said that, the more I exercise, the flatter my BG, though not always!
I guess back to the original question - does my pattern look scarily unstable or just pretty normal for a T1? If it is unstable, then I need to try more things! Seems to be no use talking to the doctors!

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It appears from your screenshot as though you're going from 4mmol to 15mmol on a fairly regular basis. At what time do you inject your basal, before bed?

It would be beneficial to longer term health if you could do something to reduce the peaks and troughs.

I was on a Lantus biosimilar product (Abasaglar) for a while and didn't get on with it at all. I'm no expert but I understand that Glargine based insulin can pool under the skin and then release suddenly sending the user into a hypo. Not great when you're active.

I believe that this is one of the main reasons why NICE changed the recommended basal from Glargine to Detemir (branded Levemir) in 2015. Use the following link to read more about it.

https://www.nice.org.uk/guidance/ng17/chapter/1-Recommendations#insulin-therapy-2

I am using this now and have a lot less hypo's these days. Having a flatter baseline makes bolusing for meals easier too. It's definitely worth a phone call to your doc' or endo' to see if you can get changed over or even have a trial.