[Jan B]

Eddy,

My goodness -- EXCELLENTO!!! You can lighten up a little if you feel you should . . . just not too much! Great work.

[SGT Shoutmore]

Eddie, good on ya!

[BlueSky]

Congratulations on that fantastic result. Whatever you are doing seems to be working really well

Originally Posted by Eddy

... I find it easier to keep control than to regain it. ...

This really is the crux of the control issue. The irony is that it is easier to stay in a narrow target range than it is to stay in a big one.

[Eddy]

Originally Posted by BlueSky

Congratulations on that fantastic result.

Thanks. Thanks, everyone.

Originally Posted by BlueSky

Whatever you are doing seems to be working really well

Heh. That's what the doctor said.

Quick anecdote about switching to Levemir: The doctor's office had never heard of it. After looking it up, and listening to my case for it, he wrote the prescription.

"It says 'use as directed'. My directions to you are: Do it safely." Heh.

Originally Posted by BlueSky

This really is the crux of the control issue. The irony is that it is easier to stay in a narrow target range than it is to stay in a big one.

You know, I'd never really thought of it that way... but it _is_ easier to stay in a narrow range than a wide one. Interesting angle.

This observation leads me to believe that glycemic control must have some sort of positive feedback mechanism... which really doesn't make sense to me:

Why would the body tend to drop BG when it's already low? Or to raise it when it's already high?

Of course, perhaps those mechanisms posed some sort of survival advantage in "normal" people. *shrug*

Any ideas?

[BlueSky]

Originally Posted by Eddy

.... Why would the body tend to drop BG when it's already low? Or to raise it when it's already high?....

In the absence of a fully functional counter regulatory system, the body needs to be fed the right amount of glucose. Not too much (high BG) and not too little (low BG). If you don't provide enough glucose, insulin sensitivity increases as cells compete for the limited supply. This drives BG down. If you supply too much glucose, BG goes up and cells block the entry of this surplus glucose by shutting down insulin receptors. The increased insulin resistance drives blood glucose even higher.

So the secret of good control is to ensure that your cells have access to the right amount of glucose at all time. That is my take on it, anyway

[shiftzor]

Originally Posted by Eddy

...
You know, I'd never really thought of it that way... but it _is_ easier to stay in a narrow range than a wide one. Interesting angle.

This observation leads me to believe that glycemic control must have some sort of positive feedback mechanism... which really doesn't make sense to me:

Why would the body tend to drop BG when it's already low? Or to raise it when it's already high?

Of course, perhaps those mechanisms posed some sort of survival advantage in "normal" people. *shrug*

Any ideas?

I would guess that it’s more to do with covering the carbs, i.e more carbs you eat the more insulin and the more mistakes you can make. The body doesn’t have much control over it other than a liver dump. The only other thing could be that the body is use to dealing with these bg ranges and somehow regulates carb intake better, I really don’t know. As to why the body works the way it does unlike those lizards (can’t remember their name) which use insulin that stops working below a certain bg level , I have no idea.

[edit] BlueSky has a better answer [/edit]

[Eddy]

Originally Posted by BlueSky

If you don't provide enough glucose, insulin sensitivity increases as cells compete for the limited supply. This drives BG down. If you supply too much glucose, BG goes up and cells block the entry of this surplus glucose by shutting down insulin receptors. The increased insulin resistance drives blood glucose even higher.

Ahhhh.... it makes perfect sense. My flaw was thinking from a macro BG perspective, instead of an "each individual cell getting [only] what it needs" standpoint.

D'oh.

Thanks.

[Gary_W]

Eddy - Well done on your fantastic numbers. You do it in a very weird way compared to most folks and your body obviously loves you for it

Do go careful with those super-low numbers; having regular sub-50 hypos may well mean that you won't feel 'em in time to help yourself. I certainly go lower than I used to before the old brain warns me about it, but (provided I'm not excersising) I still get ample warning.

You're right about the 'sleep is a 1/3rd of your A1c number'. I'm sure mine is going to suffer a bit in the short term as going to bed high to avoid Lantus drop has become a way of life for me at the moment. Roll on pump-day...

BlueSky - nice description of the insulin sensitivity thing. I know with correction shots, they work according to the book provided I'm below 10 (180 US). If I go North of there, the rule book gets torn up and thrown out of the window

Gary

[Eddy]

Originally Posted by Gary_W

Do go careful with those super-low numbers; having regular sub-50 hypos may well mean that you won't feel 'em in time to help yourself.

*nod*

Plus I'm unsure of the ipso facto wisdom of regular sub-50 excursions. I correct below 70-80, and _really_ prefer to stay above 60. I'm definitely glad I switched basals.

Frequency definitely affects sensitivity. The first time I went below 50 (46), I was sweating like crazy and thought I'd pass out. How long ago that seems...

[owlyn]

That's a great result. I am very envious. I just got my latest A1C back, and I was excited to have it come in at 7.0, the lowest I've ever had (was 7.9 back in August). The doctor keeps telling me that it is rare for a T1 to come in under 7.0, so I should be pleased, but I keep seeing T1s here with results <6, so I am still bummed though not as much as in August.

BTW, I suspected it would be lower than in August, as I have had a significant increase in hypos.

[xMenace]

Originally Posted by Eddy

I'm 26 days shy of my one-year DXiversary.

LADA?

I suspect a honeymoon is helping with your control. A 5.2% A1C is just sick!

[Eddy]

Originally Posted by xMenace

LADA?

In retrospect, I'd had the three polys for... uhhh... quite a while. Like, on the order of five+ years. I'd not been to a doctor in forever, so I'm unsure just when the onset was.

Originally Posted by xMenace

I suspect a honeymoon is helping with your control. A 5.2% A1C is just sick!

I honestly don't know. I { proposed to my doctor } + { asked for a price on } a c-peptide test... have others found said test useful in evaluating residual beta cell function? About how much does that "typically" run?

My basal seems to be 31U/day, regardless of whether I'm 76kg or 84kg. For the heavier mass, that's 0.37U/kg daily, which I guess could well indicate residual beta cell function. The hospital originally started me at 0.50U/kg daily basal, but I soon ended up feeding the Lantus too much. (Basal needs may have been higher, as my elevated WBC at DX indicated I was fighting something.)

Carb coverage ratio is 1U:15g.

What's particularly unusual -- and I don't mind in the least -- is how quickly I respond to the insulins. Rapid response helps keep postprandials down, which I believe has a notable effect.

I'm also fortunate to have a smooth basal. Honeymoon? Just lucky? I don't know. Now that I'm using Levemir, my overnight very consistent, too... so I try to dial in a low-90s at bedtime to awaken with 85 or so. Having several hours around 90 probably helps, too.

How did I arrive at those start/stop numbers? Empirically, based on what makes me most energetic and feel the best. I do not feel good after sleeping above 100 mg/dL.

Anyone who's had the c-peptide test care to chime in? Perhaps I should fork the thread...