The decision to start a small dose of insulin depends on several factors, including fasting blood glucose levels, postprandial (after-meal) levels, and overall trends. For someone in the honeymoon phase of Type 1 diabetes, where the pancreas still produces some insulin, endocrinologists aim to balance keeping blood sugars in range without causing hypoglycemia.
Typical Blood Sugar Levels for Starting a Small Dose of Insulin:
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Fasting Blood Glucose (FBG):
- If fasting blood sugar is consistently elevated, typically above 130-140 mg/dL, a small dose of basal (long-acting) insulin might be introduced to help control glucose levels overnight and between meals.
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Postprandial Blood Glucose (After Meals):
- If blood glucose levels rise significantly after meals, usually above 180-200 mg/dL, a small dose of rapid-acting insulin may be considered to manage meal-related spikes.
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HbA1c Levels:
- If HbA1c is trending higher (above 7% in most cases), but not extremely elevated, small doses of insulin might be initiated to prevent further glucose dysregulation.
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Time in Range:
- If a patient spends a significant amount of time outside the target range (typically 70-180 mg/dL), a small dose of insulin might be prescribed to help increase the time within range, even if average glucose levels aren’t excessively high.
Small Dose Insulin Strategy:
In the honeymoon phase, endocrinologists may introduce:
- Basal insulin (long-acting): Very small doses (e.g., 1-3 units) to manage fasting blood glucose.
- Bolus insulin (short-acting): Tiny doses (e.g., 1-2 units) at meals if postprandial levels spike significantly.
The goal is to complement the pancreas’ residual insulin production while minimizing the risk of low blood sugars.
Given that you are averaging 115 mg/dL and managing your diabetes with a low-carb diet and exercise, an endocrinologist might only introduce small insulin doses if your blood sugars trend higher than this, especially after meals or overnight.
Thus, while the blood sugar thresholds and insulin use I mentioned align with ADA guidelines, they are tailored to account for an individual’s unique response to treatment, which is a central principle in the ADA’s approach to diabetes management.