70s and cloudy
April 1, 2015 7:08 AM Subscribe
I'm type 1 diabetic on a low carb diet taking a basal dose of Lantus. I notice that within a wide range of daily units, I fast at a nearly constant blood glucose level of 69-72, determined with a continuous monitor and fingerstick calibration/confirmation. Why would this be happening? (I'm looking for a good explanation or resource, but not Medical Advice™ as I have a doctor I consult with before making changes to treatment.)
My guesses, if it helps to talk to me about it:
My guesses, if it helps to talk to me about it:
- My Lantus dose is low in most of the range and my remaining insulin production can complement it (not sure why it would produce so hard as to keep the number at 70, though.)
- My Lantus dose is high in most of the range and my liver is releasing a minimum amount of glycogen to keep glucose level acceptable (total guess, and doesn't a diabetic's liver regulate poorly/overcompensate?)
- My Lantus is somehow not effective or bottlenecks so the actual insulin available doesn't vary much (I insert it on my stomach in various places. I experience this between 7-20 units.)
- When I'm on a normal-carb diet, I have to take 27-35 units of Lantus to fast in the 90s or low 100s and I go up between 150 and 200 after most meals.
- I'm 32 and male, and I was diagnosed at 30. I am slightly overweight and exercise a little less than I should, but I do it every day. If I eat carbs on my low-carb diet (yogurt or carrots, usually), exercise can stop the rise in blood sugar and I usually do this after eating carbs.
- Why do I want to know this? Mainly, I want to understand how my body works. I also want to know if I am taking too much Lantus and understand what could be the effects/risks of reducing it low enough that I don't fast at 70 anymore. Again, I work with a doctor to make treatment changes, but like most diabetics, my successful treatment depends on my understanding my body, and I'm interested in a good explanation.
I have DM2. Because of some other problems, I am on both Lantus and Humalog. My endocrine doctor explained it to me like this:
Lantus (erratic as k5.user says above) is more of a long-acting insulin.
Humalog (and Novolog, etc.) are thought of as short-acting (i.e., injecting yourself after a meal that pushes your sugars up quickly (or if you're taking a medication that makes your sugars go up).
posted by kuanes at 7:52 AM on April 1, 2015
Lantus (erratic as k5.user says above) is more of a long-acting insulin.
Humalog (and Novolog, etc.) are thought of as short-acting (i.e., injecting yourself after a meal that pushes your sugars up quickly (or if you're taking a medication that makes your sugars go up).
posted by kuanes at 7:52 AM on April 1, 2015
Mod note: This is a followup from the asker.
Just to clarify, more than anything I'm looking to understand why my body might be regulating me to 70 when fasting regardless of the Lantus dose. It's possible my Lantus dose is erratic over 24 hours, but that would just make the steadiness at 70 more strange. I don't take any insulin besides Lantus once a day; the rest is low carb and exercise after eating. I confirm my CGM readings with several fingerstick readings daily so I think it is fairly accurate.posted by cortex (staff) at 9:04 AM on April 1, 2015
Type 1 diabetic here. I'm currently on an insulin pump but I take Lantus whenever I go off my pump. I was diagnosed at age 4 and I am now 27.
I think the Lantus is doing exactly what it's supposed to. Yes, it's interesting how you can stay steady at 69-72 regardless of your dose of insulin. It would be interesting to see what your blood glucose level would be when you take no insulin (however, that's incredibly dangerous and should only be done with close supervision by your doctor.)
It honestly sounds like you have Type 2 diabetes, and you are controlling your diabetes through diet and exercise.
Also, 70 sounds a little low. That's the number where I start feeling a little shaky and reach for the orange juice. But everyone's body is different.
posted by bobber at 9:45 AM on April 1, 2015
I think the Lantus is doing exactly what it's supposed to. Yes, it's interesting how you can stay steady at 69-72 regardless of your dose of insulin. It would be interesting to see what your blood glucose level would be when you take no insulin (however, that's incredibly dangerous and should only be done with close supervision by your doctor.)
It honestly sounds like you have Type 2 diabetes, and you are controlling your diabetes through diet and exercise.
Also, 70 sounds a little low. That's the number where I start feeling a little shaky and reach for the orange juice. But everyone's body is different.
posted by bobber at 9:45 AM on April 1, 2015
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Lantus is absorbed/processed differently. Injection site, person, time of day, etc. Unlike other drugs, the effects of lantus aren't steady and repeatable, it's pretty erratic.
CGMs are unreliable in my experience, whereas fingerpricks are the gold standard.
Generally, figuring out your insulin dose should be something you work out with your endo or primary, and an educator or nutritionist, to get a feel for things. Because there's so much variation, you'll only get so much from them -- a general understanding. After that, it's a lot of trial and error to get your dose right so that your numbers/A1C are "good" ..
posted by k5.user at 7:16 AM on April 1, 2015 [1 favorite]