Lost hypo awareness?!

robert72

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@iHs - completely agree that going to bed high is not ideal. Let's hope that @TooMuchGlucose can establish a better basal regime with his DSN to stay level overnight and aim for lower betime readings.
 
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donnellysdogs

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I agree with the too high at night but when dropping 9ml the starting point is to rliminate that drop.. Otherwise night hypo's are going to be awful.

I totally agree with @tim2000s about solitting doses. S d the qty. Boy... I remember going back from pump and taking the singular high dose recommended by DSN.

The advise I got here was superb. So good that currently with my levels they are better than I achieved with my pump....and they were good. Its was down to you guys advice that got my regime sorted... Thankyou so much.

@TooMuchGlucose hope you can fathom out what we are talking about...

@tim2000s ref splitting is good. He was spot on with me...@robert72 is also very good. Both of them helped me so much.

Thanks guys for responding.
 

TooMuchGlucose

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I agree with the too high at night but when dropping 9ml the starting point is to rliminate that drop.. Otherwise night hypo's are going to be awful.

I totally agree with @tim2000s about solitting doses. S d the qty. Boy... I remember going back from pump and taking the singular high dose recommended by DSN.

The advise I got here was superb. So good that currently with my levels they are better than I achieved with my pump....and they were good. Its was down to you guys advice that got my regime sorted... Thankyou so much.

@TooMuchGlucose hope you can fathom out what we are talking about...

@tim2000s ref splitting is good. He was spot on with me...@robert72 is also very good. Both of them helped me so much.

Thanks guys for responding.

I am trying to understand, but they didn't really tell me anything about Bolus ratios there was a comment made in my first few days about a 50:50 or 40:60 with basal to bolus but that was about it. Based on what tims2000s said about weight I should take either 7 or 8 Levemir. Should I take 8 tonight or split it up into two?
 

robert72

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Only if you feel comfortable about splitting your doses, then I would go with Tim's suggestion of 6u+6u. It's better to start a bit lower and titrate doses up (based on results) than having too much and hypoing.
 
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donnellysdogs

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I would from my experience of Tims advice be taking what he has suggested which is 6 units tonight and 6 units tomorrow morning.

The talk from iHs ref bolus ratio has nothing to do with basal. You are quite correct that nurses and staff like to see basically that you are having an equal amount if basal in 24 hours to the bolus that you have taken for all your meals in 24 hours. This is not perfect for everyone. It is just a starting point. Children, adults, times off sickness etc it all can vary.

If you were at a level of 9.0 tonight and took 6 units without eating more you should be safe to not go hypo. You shouldn't need to eat more either to push your bg up intentionally....

Then tomorrow morning as soon as you wake and test we would if in your shoes take 6 units of basal then.

When you start off counting carbs and injecting bolus normally the nurses will put you on 1 unit of insulin for 10carbs. This is called the bolus ratio. It is this that iHs mentioned that maybe wrong for your evening meal time. However, I don't tjink iHs realised that you were eating before bed and not bolusing to stave off those big drops and hypo's.

As said it looks like a huge drop to go from 11 units last night to just 6 but it isn't because you would not need to eat extra and you would be having more in the morning. Then you would need to carry on testing tomorrow every 2hours because of the changes.
 

donnellysdogs

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In fact you had 11 units last night to last you 24 hours. Tim is suggesting 12 units but just dividing it into two doses.

Don't go worrying about bolus ratio that was mentioned previously. Take one step at a time and get your basal right for night time without having to stuff and having big drops still.

The 50/50, 60/40 is nothing to worry about at this stage either... The only thing currently is to stop you having to eat to get your levels up to 15 jyst to stave off those drops....

Honest... We don't want you hypo and it would also be a good idea to do another test during the night if you can.

You are doing fine with your understanding and learning. You have the best two guys giving advice here.

Please note though this is only based upon our experiences of long term T1. We are not qualified. We are jyst saying what we would be doing if we were you. Because of the rules of the forums we cannot officially advise you... We can only state what we would do....
 

TooMuchGlucose

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Yeah of course you're not officially qualified but living with it for a long time I'd say you are really. I know it's a very personal disease and there are so many factors that affect blood sugar, but I'll pretty much try to go off what's been said. If I take two 6 units shouldn't I take it roughly 12hrs apart so I don't have an overlap of the two doses?
 
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donnellysdogs

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For me, I take my levemir in evening when it suits me and in the morning when it suits me to be honest.... Probably shouldn't officially but diabetes lives with me- not me fixing my life around times for my diabetes. I do my levemir anytime between mudnight and 1am and my morning dose anytime really between 8 and 10am.. This is only because my hubby doesn't get in ftom work till 11pm...

Perhaps @tim2000s will come back to give better advice than me.

I personally don't think its good to run our lives regimented to obstinate 12 hour splits....
 

donnellysdogs

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Its not really too much to worry about on the overlaps because the peak times of levemir to work and wear off etc won't interfere that much if doing jabs when convenient to you....

I guess only that you get around 8 hours sleep so could do a jab basically when you go to bed and when you wake for your levemir?

I have my levemir injection left on my bedside table. That way its always a reminder when I go to bed and soon as I wake...and stops me ysing the wrong pen for bolusing.

Hope this is making sense.
 

tim2000s

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This is the topic I wrote about changing my basal insulin. http://www.diabetes.co.uk/forum/ind...fully-providing-some-"lessons-learned".70039/

Some of it may help you.

My timings are 9.30-10.30 in the evening when I do an 8u dose then 9.30am when I do a 14u dose. I also add an extra 2u at breakfast due to my 8u overnight running out at about 7.30 but if I take more overnight it gives me too much pressure on my bg and pushes me low. Both of these doses keep me flat on basal when fasted. I must generate more glucose from my liver during the day.

Sadly there's not a cut and dried formula for it.
 

donnellysdogs

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I also do a 2 unit bolus as soon as I wake. 3 units if I'm at home that day not working.

I think we need to see how your bloods react tomorrow morning and afternoon.

Basically you need to test when you get up and at least 2 hours after you get up and 2 hourly after that as well. If you get a sharp rise 2 hours after getting up then you may well need a bolus injection in the morning like Tim and me. Tim has his with his breakfast. I'm
odd... I do not eat breakfast or lunch but I still must bolus when I wake as well.

It sounds horrendous, but it isn't. You will get a routine. Its early days still for you.

Tomorrow morning if you decide to give yourself 6 tonight. Give 6 tomorrow morning and keep testing...

It will all click into place in a few days..... It will need fine tuning. Do ask for a 1/2 unit pen for both your basal and bolus.. And try to get pens that are different colour!! It helps!!

You will get there. You are doing well. Please don't worry if you go slightly higher overnight or tomorrow.

Tim is wise. Robert too. You will get there... Please report back this evenings levels and tomorrows levels etc...
 

TooMuchGlucose

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Thanks again for the support, it's just that up until a few days again I didn't really have any problems for months now all this has happened. Really thought I'd got a good control, but then I find out about adjusting basal ratios and my insulin requirement drops and it's like I've entered the second circle of diabetes hell :p I just took 6 of Levemir and will check in around 20 minutes before bed.
 

TooMuchGlucose

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Okay so at dinner I was 13.6 ate 120g took 9 units so I'd be about 15 or something again before bed. 2hrs after 6.2 then just now 10.7. I don't know if I've started to honeymoon again or if my body has decided it hates Levemir.
 

donnellysdogs

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Don't worry. Your body may well have just be dipping in and out of honeymoon period...
Frustrating and feels like hell... But it will be okay...
Did you go to bed at 10.7? How did the night go?
 

donnellysdogs

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The fact you dipped down 2 hrs after your food shows that your bolys was a little too much. However that can be tweaked. Then the fact that your levels then rose could be down to 2 reasons.. As with many of us your levemir shot that you were giving once a day doesn't last and thats part of reason you have been going a little upward pre bed or the food you eat at tea time may break down slowly ie pasta or rice etc.

Switching to 2 jabs a day of levemir does allow for abit more flexibility on life too. It gives a bit more freedom to me to decide in the mornings how much to give according to how I plan my day. I don't have to think about it the night before.

I hope you can ask for novopen echo 1/2 unit pens for both your bolus and basal.they allow more flexibility.

Well done for your approach and positiveness. Although feeling like hell towards the diabetes currently you will be ok and you will get there and be happy that you can manage it.

It does take time.
 
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TooMuchGlucose

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Okay, so I woke up today at 8.1 but I did eat around 20g after checking to keep me stable through the night. Haven't taken the second Levemir as I will wait to see what my dsn says tomorrow at the appointment.
 
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donnellysdogs

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Well that was better!!

What has todays levels been like? Just worried that less basal last night will be shoving your day time readings up and that especially after tea tonight - you may be very high...
 

tim2000s

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Given that you took such a low level of Levemir last night, please confirm that you have been testing during the day today. I would expect that your BG levels would start to increase from around 12 hours after you took the dose, simply based on the duration at that volume.

The reason the nurse was titrating you down 1u at a time was because she was suggesting you only need one dose of insulin, but you've already seen that one dose knocks you low overnight and runs out later afternoon.

My experience is similar, which is why I moved to two - that way I could increase the duration and get a decent flat basal response without the significant drop off that comes from too large a dose. Shrinking your dose significantly will lead to that high starting earlier.
 
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Diamattic

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If you are fighting with basal amounts you will need to run some tests. You seem like you are normally going low so start dropping your basal day by day 1 unit at a time, and pick a period in each day (i use the mornings) and ingest no carbs. So this means eat dinner and eat no carbs, and inject no bolus following dinner until you wake up the next morning. Test before bed, 3am, and then when you wake up. Even if you are high before bed, you can't inject or it will skew the results. See if you can see a trend of rising or falling sugars, and then either raise or lower your basal for the next day. Repeat until you are happy with the trend,.

Also - Hypo awareness usually comes and goes. If you are constantly running in the 4s then after a couple days your body will adjust and it will feel normal to be in the 4s. If you are always in the 8s your body will adjust to that and you will feel 'low' whenever you drop a unit or two below 8.

Right now I don't feel 'low' until i hit around 3.2 to 3.7, I am happy with that. When i was first diagnosed i felt 'low' anything under 7!

I know that after 3 to 4 days of being in the 6s i feel my 'low' at around 4.5, so its something that adjusts with your levels. If you want to raise your hypo awareness then try sticking in 5.5-6.5 range and I am sure after a week or so you will feel low in the mid 4s
 

TooMuchGlucose

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Well it was a different nurse that suggested the one basal I've moved since diagnosis I was at university at the time. So today ate 30g toast again, 2 units 1hr 50mins later 12.6 then 4hrs after breakfast 10.4 would've eaten around here but things happened then another at lunch 9.2 so bolus seems about right.