What to do about overnight readings? Hba1c vs BG readings

[Binky21]

Type 2 10 years, managed by diet then metformin and now need something else. Have always had a problem with the dawn effect. About 18 months ago, my HBA1C rose to about 60 when I had had fairly good control for a long while. I had let my lo carb diet go about 6 months previously and was kind of living in denial. Got some test strips and went back to VLC and got the HBA1C back to 42. However, overnight readings still consistently at 9 - 9.5. After fighting tooth and nail to get some insulin to mitigate the problem, they grudgingly allowed me to try long acting insulin over night. Well after much fighting, I ended up on 22 units of insulin for a mostly well controlled diet of about 30 - 40gms of carb a day. Stubbornly the insulin has had little effect but did help with overall readings a little and did help with getting the mornings to stop rising and settle more quickly.

For the next year, my HBA1C remained at or below 45. Over the last few months, I have allowed myself a little more in the way of carbs and am currently eating 60 grams per day. My morning readings again were creeping up into the 10's and the diabetic nurse had told me that until I started eating normally(stopped low carbing or as she put it, starving myself) that they wouldn't prescribe anything. Hence why I ate more as I wanted to resolve the issue. Last HbA1C at 54.

Went back to the Doctor a week ago (endless visits) was told I was obsessing about nothing. Insulin spikes and high morning readings are irrelevant. HbA1C is God. I argued. We looked at full bloods for about a month. She agreed that long acting overnight didn't seem to be doing much so announced that I didn't need it and she wasn't comfortable with 22 overnight as she thought I would end up 'dead in bed' due to hypo. Point blank refused to give me rapid acting insulin to get the morning readings down so I was set up for a good day ahead and told me I would probably kill myself and I don't need it.

So despite 2 insulin dependent pregnancies I cant be trusted with insulin and I am obsessive. So now a week or so later with no long acting insulin and admittedly, a major case of depression and frustration and a bit of bad eating (not appalling - a chocolate bar the very same day, cant help thinking - if my kidneys are going to go anyway I might as well enjoy it!). Morning readings are now at 12.5 rising to 14.5 after coffee and scrambled egg and what should I do? They are convinced I don't eat enough and am causing insulin spikes etc. Could this be true? Insist this must be what is happening as the Hba1C is fine!!

Exercise currently nil but vis a vis dawn effect, I have tried before and found that 20 minutes of walking a day wasn't enough to do anything for my overnight readings and at my weight, I am not up to much more. I concede that it was helpful with pos prandial BG control in a general sense but not discernible overnight. And yes I do need to get back to it. I have asked a number of people if they were significantly able to lower the overnight reading and have concluded that those who do so are exercising significantly eg: 40 minutes running or a full gym workout daily. I'd be interested in whether there are any shortcuts that may help with the problem either specific (manageable types) exercise or supplements.

Ok so all in all, what I am saying is? Is the Doctor right? Should I change Doctors or are they all the same? Am I being obsessive? Surely readings of up to 14.5 cant be doing me any good whatsoever? Why is my HBA1C so relatively good? What more can I do about the overnight reading? And yes I have tried a few units of long acting insulin during the day and snacking on fats and on carbs before bed? Does anyone know exactly what the cause and effect ratio is? Is there one? Its clear to me that there isn't an obvious relationship between what you eat the day before and the next mornings reading.

I am so frustrated and fed up.

 

[Arab Horse]

Hi @Binky21, I am no expert but you are correct when you say " Surely readings of up to 14.5 cant be doing me any good whatsoever? ". No, they are not. The HbA1c is a measure of your AVERAGE blood glucose over the last two and a half to three months so if you have highs and lows obviously your mean will be OK. It is wrong to tell you to eat more carbs. I can't tolerate carbs so have to go very low carb to keep my glucose from being way too high, wouldn't be able to have 50gms per day unless it was by eating a ton of veg!!!! I don't have any of the "carby" foods; bread, pasta, rice, cereal, porridge, potatoes, root veg, milk as well as the usual things like cakes, pies, high sugar fruit etc.

Like you, my DN (I have never seen a Dr) is of the "cut the fats and you need carbs" NHS mantra. I don't have any support for what I am doing apart from her saying that it is nice to see someone who is making a real effort to to take control of their diabetes. She wanted to put me on more drugs so I can eat more normally but having been started on Januvia and then refusing to take them when I read the scientific literature (I am a biochemist!) I am just on metformin. She knows that while she knows a lot more about diabetes than I do I understand the "science" bit better than her and actually asked me what one of my blood results meant when she gave them to me.

I would ask to be referred for a second opinion although the general concensus of opinion is 10 years out of date. Personally I would do LCHF diet if you don't have any health problems that make this a risky strategy, no insulin (as insulin resistance is the cause of T2 and you are adding more insulin which may help initially but will add to the problem long term hence the mantra that T2 is a "progressive disease"), Speak to your Dr as you do need the support and advice to help you but you will get a lot of info from the various threads on here and can bring things you learn here up with him/her.

Good luck.