sugar levels at bedtime??

[novorapidboi26]

What about the fact the the change in dose won't have an immediate effect....

I suppose a 10-20% adjustment is large enough to see a difference....

I take it exercise is important to you lol....

If you didn't do any significant exercise, could you stop the daily changes....

Have you tried Levemir

 

[noblehead]

Hi ive been diabetic for 20yrs and in the last year had problems with my night time sugars. I wouldnt go to bed less then 10.0 and take 20units of lantas, and wake either high or low. sometimes if it above 12 i would take 25-30 units of lantas and my sugars would be 3.2 in the morning. its trying to get a balance. I work long hours and theres days am less active then others, plus its what ive eaten at teatime that can have an effort too. Theres never the 2 nights the same. I worry going to bed about taking a hypo and not getting any signs as ive starting to lose some of them, so i end up staying up till 3 or 4 in the morning and getting a few hours sleep. there alot of factors. Its not easy, if you know what i mean, and no 2 people are the same, so 1 thing might work for me but not for you. Lol

You seem to have the whole idea of basal injections wrong, you wouldn't increase your basal dose by 5-10 units just because your bg levels are 12 before bed, it's no wonder you are having night hypo's and losing your hypo awareness symptoms. The following has a good explanation on the role of basal insulin and why it is important to get the dose right:

http://www.diabetesselfmanagement.com/articles/insulin/getting_down_to_basals/all/


I strongly suggest you discuss your night levels and basal insulin doses with your diabetes team, you should not have to wait up till 3 or 4 in the morning for fear of going hypo in your sleep.

 

[SamJB]

What about the fact the the change in dose won't have an immediate effect....

I suppose a 10-20% adjustment is large enough to see a difference....

I take it exercise is important to you lol....

If you didn't do any significant exercise, could you stop the daily changes....

Have you tried Levemir

How do you mean, not have an immediate affect? Within a couple of hours it will start having affect on BGs.

Exercise...hmm, if I'm out of the routine of doing it, its a ****** to get back into it. If I'm in the routine, it's quite addictive. I find it makes my BGs a lot more predictable, which is why I force myself to do it when I can't be *****!

And if I didn't do exercise, yep, my basal would be steady.

 

[novorapidboi26]

If you take exercise out the equation and your testing your basal just for general changes, each dose change that you do would need 2 to 3 days to see the effect, so you couldn't say that the dose change had worked the next day....

Was taught in DAFNE. I think its to do with the design of the Lantus....

Levemir is opposite though and that's why its better suited in most cases to people with active lifestyles as its split and you can reduce or increase with immediate effect...

 

[SamJB]

If you take exercise out the equation and your testing your basal just for general changes, each dose change that you do would need 2 to 3 days to see the effect, so you couldn't say that the dose change had worked the next day....

Was taught in DAFNE. I think its to do with the design of the Lantus....

Levemir is opposite though and that's why its better suited in most cases to people with active lifestyles as its split and you can reduce or increase with immediate effect...

I've heard this before and it's actually a fallacy. It's based on the "once an incident, twice a coincidence, three times a rule" method used by diabetes healthcare professionals in teaching people how to cautiously and correctly determine your correct basal dose.

I work in pharma, and from a pharmacokinetic perspective (how your body responds to a drug), saying that Lantus taken three days ago is effecting your BGs, is exactly the same as saying Novorapid taken three days ago is affecting your BGs; which, of course, it isn't. Insulin that has left your body three days ago cannot be affecting your BGs.

 

[novorapidboi26]

So why say that about Lantus and not Levemir....?

They do say wait for 3 days readings before adjusting a bolus ratio so I understand that. But the Lantus issue was never portrayed as that.....

You work in the industry so you must know something..........

Have you ever challenged a diabetic nurse who made that statement....?

 

[noblehead]

Well as experienced people with type 1 diabetes I don't think any of us would make any changes to our insulin going from one days readings, perhaps this is the reason why they say wait 3 days, but if this is the reason why then why isn't it applied to other insulins............if you get my drift

 

[SamJB]

Yes, that's precisely why, Noblehead. The three day rule appears to be there to provide a more cautious, considered calculation of basal dose.

I don't think it's fair to say experienced diabetics wouldn't make day-to-day changes to basal dosing. If you need to, as I do (and I'm pretty experienced now), then it's absolutely necessary to do so. The alternative is to knowingly expose myself to avoidable hypos and highs. Why would I, as an experienced T1 do this? If a diabetic doesn't experience day-to-day changes in basal requirements, then there is absolutely no reason to make daily changes. In which case, they'd be less well placed to calculate basal doses, so probably should follow the three day rule.

Regarding, Levemir, it's got a shorter exposure duration than Lantus, injecting it twice a day would mean that you can calculate the correct dose within a shorter time frame.

Finally, I don't have much confidence that HCPs are any good at calculating insulin doses. Getting insulin doses right is by far the most fundamental part of controlling T1. If HCPs could calculate - and instruct us - how to dose insulin correctly, then 93% of T1s wouldn't be missing efficacy targets. If they knew how to do this, I'd expect the opposite - 7% to be missing efficacy targets.

 

[Emmotha]

Hi. I finished my DAFNE today and they mentioned reducing basal the night before exercise, ie mainly for a hike or marathon - endurance type stuff I guess, but also because in some ppl exercise can continue to reduce blood sugar after the event.

Not sure if it works but they're definitely suggesting it

 

[novorapidboi26]

I can confirm it does work, at least on Levemir................

That's the thing about a single dose of Lantus or Levemir..................say your going for a hike all morning, you can reduce your dose to compensate for the mornings activity, but will that reduction be enough to accommodate for any BG reduction throughout the night.......it might be too much or too little........a split can accommodate for that better........there's no doubt about it.......

everyone will need to fine tune there own regime though and make it work for them......

HCPs don't actually calculate the basal doses, we do..........so your comments are correct @SamJB

They will however advise us on insulin behaviors.......and for Lantus, being an 18-24 hour insulin, there will likely be some effect from the previous day, so the 2nd day would give a more accurate picture of the dose changes true effect.......

the adjustments your talking about though is for exercise etc...............this 2-3 day rule that they talk about is for general dose adjustment to match the liver...............when your doing that kind of adjustment do you wait longer than one day?

I just realized the thread has veered of course, so we can stop if needed............

 

[SamJB]

HCPs don't actually calculate the basal doses, we do..........so your comments are correct @SamJB
.

HCP advise insulin doses all the time! They also advise and help diabetics to calculate insulin doses, if they didn't, they would be pretty useless wouldn't they? So, if they were doing this correctly, would you expect the 93% of diabetics to miss efficacy targets? Are the ~230,000 T1s too lazy to control their diabetes properly? No. They are not taught how to dose properly. Simple as that. If they did know how to dose properly(which is all you need to do to control T1), 93% of T1s would be hitting efficacy targets.

There will likely be some effect from the previous day

If Lantus lasts 24 hours, how can there be some left in the body 30 hours, 36 hours, or even 47 hours later? Does Novorapid that left your body yesterday affect your levels?

 

[novorapidboi26]

I was trying to highlight the difference between making general basal dose changes and the daily changes you are talking about, to accommodate activity levels.....

are you saying the HCPs we use cant successfully instruct us on how to change our doses..........? I disagree, the fine tuning of it all is down to us but the basics are passed on, how else would we learn....

 

[SamJB]

are you saying the HCPs we use cant successfully instruct us on how to change our doses..........? I disagree, the fine tuning of it all is down to us but the basics are passed on, how else would we learn....

Well, we can agree to disagree then. It's my job to calculate doses for new cancer drugs that are going into humans for the first time. If 93% of our patients weren't hitting efficacy targets, then it's either because the drug doesn't work, or the dose is wrong.

Are 93% of T1s getting their insulin dose right? Nope. Is it the fault of the ~230,000 T1s? Nope. To suggest that it is their fault, is barmy. This is a systemic problem with diabetes care. If HCPs told everyone how to calculate doses correctly, we wouldn't be faced with such poor efficacy results.

Anyway, I agree, we're drifting off course from the topic of the thread.

 

[novorapidboi26]

the reason the dose isn't 100% correct is because for one, injecting insulin's no where near 100% efficient, pumping is much better but not perfect......

not forgetting the every changing hormones amongst many other factors which can effect our blood sugar, it isn't our fault, but its not theirs either....

I suppose you could say its the fault of the human ability at this time.......so far injecting and pumping are the only ways of getting the insulin dose in, with manual calculations from us, with the help of the odd pump wizard of course......

from your post it seems your upset at the type 1s being blamed for not reaching the efficacy targets as opposed to the HCPs not being blamed.....

no one is to blame in my opinion..........

my expertise with my diabetes far surpasses that of my HCPs, so mine definitely cant take blame...........