Nightmare diabetes appointment

[robert72]

Thanks Robert. 9u at 10pm to start with then!

Smidge

Keep us posted. Are you using a Libre at the moment?

 

[smidge]

Keep us posted. Are you using a Libre at the moment?

I've not got the Libre on at the moment because of the skin irritation issues - I might risk one over a Compeed tomorrow to see how the Tresiba changes my profile. It would certainly be interesting.

Smidge

 

[drahawkins_1973]

So, today I went back for my 3 month review - what a different experience than the December one! I was back at my local hospital instead of the major city one I visited in December - same consultant but a much more positive experience all round. I have been on Insuman basal evening and Levemir morning for 3 months now and whereas my control was shot to pieces and my HbA1c had risen to 5.9%, it is now back to 5.5% and the huge swings from high to low are greatly reduced. My fasting levels still tend to be a little unpredictable - 5.5, 11.2 and 4.8 in the last three days. So, I start on Tressiba this evening!!! I think I need some advice from @robert72 and @drahawkins_1973 on how to phase in such a long-acting insulin when I've already had 7 units Levemir this morning!



Hey smidge thats great news!!! Welcome to the Tresiba club

I started off slightly lower dose of tresiba vs levemir but in actual fact after a bit of tweaking I've ended up taking the same amount. As Robert suggests though maybe start off around 9u to be on the safe side.

Also I found that taking the tresiba in the morning works better for me rather than in the evening when I used to take my levemir....dont know why and dont have an explanation. I was holding perfectly steady overnight but dropping a bit mid afternoon. Now I've change the timings I'm pretty level all day. Something to keep in mind when you getting your levels right.

Good luck and let us know how you get on!

 

[drahawkins_1973]

p.s while I remember
Also, I don't know whether others found this but for me it took a few days for my BS to level out.
When I kept upping the tresiba by one dose each time it took a couple of days to stabilise so it took me quite while to figure my right dosage out.

 

[tim2000s]

Based on moving to Levemir smidge, I'd say use the libre while you adjust. It really makes life easier.

 

[LucySW]

So, today I went back for my 3 month review - what a different experience than the December one! I was back at my local hospital instead of the major city one I visited in December - same consultant but a much more positive experience all round. I have been on Insuman basal evening and Levemir morning for 3 months now and whereas my control was shot to pieces and my HbA1c had risen to 5.9%, it is now back to 5.5% and the huge swings from high to low are greatly reduced. My fasting levels still tend to be a little unpredictable - 5.5, 11.2 and 4.8 in the last three days. So, I start on Tressiba this evening!!! I think I need some advice from @robert72 and @drahawkins_1973 on how to phase in such a long-acting insulin when I've already had 7 units Levemir this morning!

All in all, a much happier Smidge!

Wow - congratulations !! Tresiba sounds ace, all that steadiness.

I should think you're a *much* happier Smidge! Fingers crossed, you're on the way to pretty permanently steady control, like Rob.

Let's hope that not too far down the line this way of handling diabetes will be seen as the normal goal to aim for, not a freakish exception. Many of us can achieve this. (I'm on my way to it - small deviations, but basically 5.5 average.)

Why shouldn't everyone try?

 

[noblehead]

@smidge, great news about getting changes to Tresiba, hope it all goes well

 

[smidge]

Well, I survived overnight - is it just me who worries about that every time I have a change of insulin? BG a bit high this morning 10mmol and has been stubbornly sitting between 7 and 8 all day despite my best efforts at encouraging it down with Apidra! I'm guessing that's because I've only taken 75% of my normal basal dose and because not all of the Tresiba I've taken is really working yet, so I expected that. Lovely to wake up this morning and for the first time in 5 years not have to do a 6.30am jab!

I've put a Libre sensor on now, so I'll track how it goes.

Smidge

 

[smidge]

Oh gosh, last night was awful. I'd had quite a bit of wine with my meal, ate out so no real idea of carb content and had several tiny pieces of home made bread roll with my meal - didn't have a whole one, but couldn't resist having a few small pieces - maybe a quarter of a bread roll overall. Went to bed with BG at 11.9 and rising. Decided not to correct thankfully. Increased Tresiba by 1 unit to 10. Woke at 1am and scanned at 8.3 and rising, so thought that's ok as it's come down but no danger of hypo. Woke 2 hours later and tested at 3.2. Oh dear! Had 3 mini jelly babies totalling 9g carb. Woke at 6am at 13.7 and rising sharply. Jabbed 2.5 units Apidra and woke again at 8am at 6.5. Not really the start I wanted to Tresiba, but my own fault for the mad evening meal and wine. Back on a much calmer BG day today - no more wine or bread! I'll have a week of decent low-carb food to try to settle into a proper Tresiba dose!

Smidge

 

[smidge]

Last night was a much better night. My BG stayed fairly stable in the 4s and 5s whenever I scanned with the Libre (although the Libre seems to be running a bit low) - I can see from the daily graph that I dropped below 4 for a short time overnight, but not far below and given that the Libre is at least 1mmol low, I'm hopeful that it was actually in the high 4s. I'll check all the data later so I get the overnight pattern. I have increased my Tresiba dose to 11 units and given my steadiness last night, will leave it at that for a few days.

Smidge

 

[LucySW]

Remember that the Libre isn't really accurate for the first two nights at least. At least mine never were. They showed mirage lows when there weren't any.

 

[smidge]

OK, so my BG is still a bit inconsistent - particularly at fasting. I'm not getting hypos and my BG does seem more stable generally, but I get the odd mad high and I am finding a considerable increase in my Apidra needs. Monday and Tuesday night I took 11 units Tresiba at 10pm but my BG was rising late evening and into the night, resulting in a 16.6 at 2am one morning! The Libre shows me that there was a steady climb from about 9.30pm even though I'd eaten and taken my Apidra about 6.30pm and my BG had started to fall about 8pm. Tuesday night I decided to arrest the similar looking pattern at 11.30pm by jabbing 1.5 units Apidra before bed - this meant I woke with a good 5.7 fasting level. Last night I increased the dose of Tresiba to 12 units and despite seeing a similar rise starting at around 9.30pm, I didn't correct and went to bed with my BG at 9mmol - I woke this morning with it at 4.5mmol - worrying!

I am finding that during the day, I need 2.5 units Apidra for a lunch that needed 1.5 Apidra when on Insuman - I'm guessing that's because I was using the Insuman peak to off-set that, so that's to be expected. From breakfast to late afternoon, my BG has been very flat and stable - albeit at too high a level for my liking (around 6 - 7 mmol), but from about 5.00pm, I see a gradual rise until I eat and correct with the Apidra. Then I get a rise again from around 9.30pm, so I'm thinking a) my dose needs increasing or b) Tresiba doesn't last 24 hours for me and is running out before my next 10pm shot - it certainly wouldn't be the first insulin I've had that lasts nowhere near as long as it claims!

So, very much a work-in-progress at the moment. I'm hoping that once I get the correct dose for consistency, I can then lower the overall level.

Smidge

 

[drahawkins_1973]

Hi Smidge,

Have you tried taking your tresiba earlier in the day, lunchtime or morning.?

Dont ask me why but when I was started taking my tresiba in the evening at the same time I used to take my levemir I would hold steady overnight but late afternoon between 4- 7 ish i was starting to get a few hypos. (with no QA on board)

If i lowered my tresiba dose then I would hold steady during the day but my sugars were rising overnight.

So out of interest i took my tresiba in the morning and it fixed the problem. Now I really dont understand why and can't think of a logical reason, but it works so might be worth a try?

Good luck
Andrea

 

[noblehead]

Yes I agree with Andrea, the timing of a basal dose can make all the difference. Have a word with your DSN @smidge and discuss moving your Tresiba dose back to earlier in the day, its worth a try.

 

[smidge]

Well, I think I might try switching to morning basal jabs some time over the weekend - although I've no idea how to switch on such a long-acting insulin - do I take half my dose one eveing and then a full dose next morning or what? I guess that'd hypo me so probably not the right approach! Anyway, I guess I'll figure it out!

I woke at 6am to a very nasty feeling hypo this morning - 2.0 - so maybe the increase from 11 to 12 units was too much. I've had a really bad headache all day and just want to go home! Anyway, I'll knock back the units to 11 again this evening and then tackle moving my basal to jab to the morning on Saturday/Sunday.

Smidge

 

[robert72]

Well, I think I might try switching to morning basal jabs some time over the weekend - although I've no idea how to switch on such a long-acting insulin - do I take half my dose one eveing and then a full dose next morning or what? I guess that'd hypo me so probably not the right approach! Anyway, I guess I'll figure it out!

I woke at 6am to a very nasty feeling hypo this morning - 2.0 - so maybe the increase from 11 to 12 units was too much. I've had a really bad headache all day and just want to go home! Anyway, I'll knock back the units to 11 again this evening and then tackle moving my basal to jab to the morning on Saturday/Sunday.

Smidge

@smidge - I think you'll find that you can move Tresiba dose times around without affecting the basal levels. Since you are currently hypoing overnight it might be worth just switching tonight's dose to tomorrow morning. Sorry to hear you are having so many night time lows.

 

[iHs]

@smidge.......although pumps have their problems at times, what they are really great on is sorting out basal needs overnight. I dont think its uncommon for type 1s to have low bg between certain hours of the night and sometimes eating some carb before going to bed, doesnt always do the trick especially if bg levels decide to change course for who knows what reason. If you cant get on with Tresiba with changing the timing, get a pump and if necessary change to a different hospital that favours pumps.if yours doesn't.

 

[smidge]

@iHs - thanks for the advice - I've never really fancied a pump to be honest, so I hope it doesn't come to that - my consultant would have happily recommended a pump and they are relatively easy to get in this area - easier than Tresiba in fact! I just hating having something permanently attached to me.

I've actually had a better day today - I cut the Tresiba by 1.5 units last night and no hypo - but I still dropped too much overnight - it's not exactly holding me steady overnight at the moment - although it's keeping my BG almost perfect during the day as long as I stick to my low carb and don't eat anything silly - like that slice of bread earlier! I'm so tempted to move the jab to the morning as @drahawkins_1973 has suggested, but I really am loving not jabbing in the morning - I actually had a lie in today but that will be a thing of the past again if I move the Tresiba to the morning as it would have to be 6.30am because of weekdays and work. For some reason basal insulins seem to have a strange profile for me whereby they seem to have a peak a couple of hours after I've taken them and then don't last as long as they're supposed to! I think I must just be strange LOL. Anyway, I think i'll persevere for a while longer.

Smidge

 

[drahawkins_1973]

Hi Smidge.
Could you try taking it at lunch when you have your meal time bolus?
I take mine at 9 am so I don't have to get up early on the weekend. Was a bit worried I would keep forgetting to take it when I was at work as it's a bit if an odd time for a basal but I just put my phone alam on.
Hope you get it sorted. Also I think with tresiba it takes 2-3 days to reach steady state so I'd leave a few days before changing dose higher if you feel it's not enough.
Andrea



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[RuthW]

For some reason basal insulins seem to have a strange profile for me whereby they seem to have a peak a couple of hours after I've taken them and then don't last as long as they're supposed to! I think I must just be strange.
Smidge

I don't think that's strange. I suspect it may be quite common. I think it may be one of the reasons so many Type 1s have night time hypos. (I did switch to a pump eventually because that problem proved completely intractable for me. ) My Lantus used to give me night/early morning hypos, then apparently completely disappear by late afternoon. I considered twice daily shots of Levemir instead, but juggling that many injections a day just seemed too much. What's your basal insulin?