Basal Dose Woes

JoeT1

Well-Known Member
Messages
277
Type of diabetes
Type 1
Treatment type
Insulin
Hi All,

After my little fright last weekend, i have been in regular contact with my DSN throughout the week. Initially I was optimistic as we changed my Basal dose of Levimir to 14U at night, and 6U at about 7am in the morning. However, i'm a little confused and a bit downbeat about a couple of things.

- It seems during the night, my levels may rise +2mmol (even after upping the dose to 14U)
- My correction in the morning with a no carb meal, doesn't even seem to touch the surface of the high. Example is this morning waking at 11.8, and 2U correction only brought me down to 9.9 after 5+ Hours.
- Upon my second meal of the day, lunch, after a correction of 2U, I make it down to 6.3, which holds steady until about 6.30
- 7pm I have my dinner, this evening, no carb at all, so no insulin, and now at 8:45pm it's 9.2...a jump of nearly 3mmol and I think it's still rising.

What's really frustrating for me is I am working so hard on this. I count carbs, I am measuring my food to weight, i'm not snacking between these meals even when I feel like I could do with something small. Taken 3 1km walks during the day from work just to try and stop a rise.

I know my DSN is super helpful, and i am seeing her against next Wednesday and maybe adjustments may be made then. It just seems like sometimes i'm taking 2 steps forward....and 7 back. Trying to be optimistic, but it's playing on my mind. I get the feeling that every day I have these up and down readings, along with rising numbers in the evening/overnight, that i'm getting worse, sicker, not good enough to figure all this out. A day of being in range? It seems like the impossible at this stage.

Sorry, long rant, feeling sorry for myself. Not what people want to be reading and I know there are many a lot worse off than me. I'm just struggling with the points I listed, should we be looking at upping my nightime dose again, upping my morning time dose, changing ratios as morning seems to be really resistent to insulin for me. I feel the more dosages i need to take, the worse I am.
 

Gaz-M

Well-Known Member
Messages
1,108
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Dislikes
baked beans
what no carb foods are you eating? I am on a pump and say, if I have just a cup of lemon tea for my brekkie (5 carbs) and bolus for it I get a huge peak but if I eat a protein bar and a cup of lemon tea (13 carbs) it does not peak as much infact no where near. Protein with no carbs can cause a BS rise in alot of us and some not so much
 

catapillar

Well-Known Member
Messages
3,390
Type of diabetes
Type 1
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Have you done any basal testing? https://mysugr.com/basal-rate-testing/

Why are you having no carb meals? Do you have any understanding of how to bolus for protein? That probably explains the post dinner rise. It seems like your post lunch time levels were good because you had a sensible meal with carbs in and understand how to bolus for that. But breakfast and dinner don't work because you had no carbs, so you incorrectly assume you don't need to bolus, failing to take account of gluconogenesis. You'd probably be better off eating normal food with reasonable carb content.
 
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JoeT1

Well-Known Member
Messages
277
Type of diabetes
Type 1
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Insulin
@catapillar Thank you. Yeah, I have some Basal testing. Mainly though from having a no carb meal, as this was the plan that my DSN asked me to do. I have been running some on my own as well, to try and get ahead of the game I guess. I have seen a rise though, also with some carbs in my meal, for instance last night I had about 15g carbs, and 3U of Apidra to try and correct, but it still managed to rise slightly by the time bed came.

I understand what you mean about the protein, I have done plenty of reading on this, but it has not been brought up by my healthcare team just yet.

@Jaylee I take my Levimir at 10pm and then at 6:45-7am in the morning. Retiring and Rising was how it was put to me....

Thank you guys for the help.
 

scotteric

Well-Known Member
Messages
312
Type of diabetes
Type 1
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Pump
You are probably experiencing dawn phenomenon, meaning that your liver starts releasing glucose (its glycogen stores) in the middle of the night. You can try compensating for this by increasing your Levemir dose or taking it at a time when its peak matches your overnight rise in blood sugar (easier to figure out if you have a CGM), or by using an insulin pump where you can increase the basal rate at a certain hour. To make matters worse, the minute you wake up in the morning your liver starts releasing more glucose. I always have to take a unit of NovoRapid the minute I wake up or within half an hour I will rise anywhere from 2-5 mmol! Once you are above 10 mmol/L it takes much more insulin to bring you down than your normal correction ratio, so you are facing an uphill battle waking up over 11.
 

TheBigNewt

Well-Known Member
Messages
1,167
Type of diabetes
Type 1
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Insulin
For an 11.8 I'd take 4 of Novorapid not 2. One unit for about every 1.8 or yours. 30 of ours. I pay more attention to total calories not just carbs. For instance large egg/cheese omelet: 7-8 units. Not much carbs in that dude.
 

leahkian

Well-Known Member
Messages
302
If they have only change your insulin a week ago it is still early days as your body gets used to it. It is fine to have a rant we all do at some point but if you getting stressed this can also effect your BS and from what you are saying about your carb counting you are doing well. You could ask about a pump to see what they think but i hope in another 2 weeks you might have got it under better control with the help of your DNS. Try not to get down with yourself as you are doing every thing right but at the moment things are not going your way that is why when things are going your way enjoy them as diabetes always likes to remind us that it is always there. Keep posting and let us know how you are doing and keep your chin up
 

tim2000s

Expert
Retired Moderator
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I understand what you mean about the protein, I have done plenty of reading on this, but it has not been brought up by my healthcare team just yet.
Hi Joe. Depending on your who is in your diabetes team, this may never be brought up. There are a significant number of DSNs that have little or no idea about the need to bolus for protein or the timeframe in which it converts to glucose, so it's worth giving it some thought and experimenting.

As with all dealings with T1, the key thing to learn and remember is that you need to take the active role in managing it, so if you aren't seeing optimal outcomes, you have permission and the right to make changes on your own without referring back to any HCP (and if your Healthcare professionals tell you otherwise, they aren't necessarily acting in your best interests).

So let's have a look at you. You're using Levemir. Your dose sizes are similar to the size of the ones I used to use when I wasn't on a pump. LEvemir has an interesting profile that is very dose dependent, and lasts anywhere from 8 hours to 24 hours, purely based on dose.

The second thing is that we are often taught that there is only one Carb Ratio and correction factor. Sad to say it, but this is actually wrong thinking on the part of diabetes professionals, designed to make it easier for those who can't cope to live with the condition. Most people see different ratios at different times of the day, and it's worth doing the sums to work that out as it will make your early morning correction much easier if your CF turns out to be 1u:1.5mmol/l instead of 1u:3mmol/l.

They key thing in all of this is that if you want to see change in shorter timeframe, you have to grab it all with both hands and make the decision that you're in control. Many DSNs find it hard to allow that to happen, but you'll be better placed going forward if you can make that jump.

Finally, many of us have found that using the Abbott Freestyle Libre gives us much more insight into our condition, what happens around food, overnight, etc. Whilst they are still not being prescribed by most CCGs, it might be worth paying the £48 for a sensor, if your phone works with it, or asking the hospital for a trial package, so you can get a much better picture of what is really going on.
 

scotteric

Well-Known Member
Messages
312
Type of diabetes
Type 1
Treatment type
Pump
I second what Tim said, you can't truly know what's going on without a CGM. It's akin to living without a glucometer in 1995. The problem with health professionals is that many (not all) will make it sound like you just figure out your ratios, dose according to them and everything should work out splendid. In reality there are far too many variables. Also, a pump does make things easier if your basal rates are variable. I'm able to get similar results using a pump or MDI, but only because my basal needs are pretty constant and I don't experience much of a dawn phenomenon with my Levemir dose. If I did, I probably would still be pumping.
 

JoeT1

Well-Known Member
Messages
277
Type of diabetes
Type 1
Treatment type
Insulin
Thanks for the replies. I have been using the Libre for 2 weeks now, and am seeing the benefits of it. This is how I came to the conclusion that my levels are rising slowly over a period of 5pm to 6pm...leading to the thinking my Levimir morning dose is wearing out. But throwing the protein into the scenario, I will have to test it out.

I find if I go for a 10min walk directly after eating and taking my Apidra, my levels will come down a whole lot quicker. If I'm sitting, for instance an hours car journey, they'll go up quickly too.
 

Skim

Member
Messages
13
Type of diabetes
Type 1
As others have said
1. Dawn Phenomenon
2. For me morning ratios are less.. ie I need more insulin
3.On a low carb diet your liver will convert protein to glucose.. so be mindful of protein. Supplement diet with fats to get a good calorie intake if your ldl-p is good
4. Eating even newspaper will increase bs. Body detects expansion of stomach and releases some insulin plus glucose from liver ie primes itself.. so as we don't produce insulin bs will rise. So even if a meal is low carb or no carb b.s. can rise.
5. Use a cgm if you can afford it
6. If carb counting use something like exactmeals.com It also has setting for converting some protein to carb when calc carbs