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[IPk] update on A1c and ketones

Hi all -

You may recall my post about the deterioration in my A1c and my overnight 
ketones at normal and near-normal BGs.

My DSN sent me to the clinic to see the consultant. He agreed with me that I 
need to work more on the overnight basals, and I shared with him my insight 
of the day before my visit: I need more insulin between 1am and 3am than I 
do between 3am and 6am. If I had been paying better attention, I would have 
noticed this a long time ago because when I was on injections, I took my 
long acting insulin at a time which allowed one dose to peak and the other 
to start just in time to catch my dawn phenomenon - which was 2am.

So what's been happening, my overnight testing shows, is I've been waking 
with a normal BG but going high between 1am & 3am and then fixing it between 
3am & 6am with too-high basal rates. I discovered this when I did 3am tests, 
corrected highs, and then woke up with appalling BGs (1.9 one day).

On ketones, the consultant pointed out, as people here did, that ketones are 
a natural physiological function, and that it meant I was either eating a 
low carb diet or running out of carb energy overnight. We didn't come up 
with anything more specific than that: he said not to worry if my BGs are 
normal. I said I would worry because my weight is marginally low, and he 
said my weight is medically stable. (But it is really obvious when I drop a 
pound or two).  I said I don't mind if I'm producing ketones so long as the 
protein I'm digesting is cheese and not my own muscle.

So I'm continuing my intensive tracking of overnight BGs and as a result of 
this, it looks like I'm finally discovering the pattern of change in my 
basal needs. I'm having another A1c in July to see how I'm getting on.

I also decided to make my BG target 5 because I've been having trouble 
concentrating and I realised that the times when my brain has functioned 
best  in the past few weeks was when my BG was just above 4! So I take 
insulin for anything above 5.5 now, unless there's enough remaining insulin 
from a bolus to bring down the BG.

My post is too long once again - sorry. Last thing: my clinic will have 30 
pumpers by the end of the year, and they're going to institute pump-only 
clinics two or three times a year!



Grain is the enemy of the sedentary classes.

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