Ratio advice

[iHs]

If you can do the bolus at about 7pm and leave the basal until 10 or 11pm when you go to bed then the bolus action will be working independently from the basal. Of course, there will be the need to remember to always do the basal wherever you are or might be at this time but if you leave the basal until 10 or 11pm, then its action will be a tiny bit greater overnight resulting in slightly lower bg in the morning and will still be working in the morning till about 2pm and that should enable you to use less bolus at lunch. Seems as though youve got to use a lot less bolus at lunch at the moment but this should enable you to hopefully get better results. You may still need a snack mid afternoon though but maybe not quite so much...

 

[smidge]

Hiya!

This is all really interesting as I am on Levemir and having similar problems to Hale. I split mine 6.30 am and pm but high most mornings, low mid morning high again by tea time, so iHs's suggestion of moving the evening dose later at night is one I might just nick LOL.

Hale - I used to be on Insuman Basal and I can vouch for what Brett said about the peak of intermediate acting keeping fasting levels excellent - mine have gone to pot since the move to Levemir. I wonder if you can do an evening jab of Insuman and a morning one of Levemir? Think I'll ask my consultant that when I see him next week because I reckon that would work for me. Anyway, I'll butt out and stop hijacking this thread with my basal issues LOL.

BTW, I reckon Levemir lasts no more than 16 hours for me Hale.

Smidge

 

[mrman]

Tbh, I think if on a long acting insulin there will be a problematic period for most. Its just some lucky ones counteract the wearing off of the long acting by covering with extra quick, and opp to that counteract a period off too much long acting either by reducing qa for a particular meal or by having a snack.
for some though by covering with quick acting gives a good 2 hour reading but results in a hypo.

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[hale710]

Ok cool so I'll try doing a later basal from tomorrow. Can't go later than 10pm because I like to be snoring by then.

Do I leave my breakfast bolus the same?

Mega high again this afternoon so I'm going to make my lunch ratio a 1:1 I think


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[mrman]

Hate to say it, but, test and see lol. Knowing that you should have more basal working should mean a reduction with breakfast bolus. But not much

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[Engineer88]

Yeah lost me too. Bit confused myself by this one hale.


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[hale710]

Shambles. Don't think my brain is working right now haha


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[iHs]

Oh dear .......lol

Brett has explained the action of basal against bolus fairly well, whereas I didnt so much. We all need different amounts of insulin according to how our body needs it even without eating any food but unfortunately all the injectable insulins have a duration of action to them and some have a faster onset than others so that is why we all need to adjust these insulins like we do....

If you start from Weds night with the bedtime basal (not tonight if youve injected it with the bolus) then you will need to adjust the eve meal bolus to be slightly more and only by testing yr bg level will you be able to alter the doseage through trial and error. Try and get the eve meal bolus carb ratio to give you the sameish bg levels 4hrs later but remember that the bolus action will be nearly at its end but not quite so if going to bed 4hrs after bolus, then aim for bg to be about 8mmol for safety and then that will allow for the tail of the bolus.....

In the morning like Brett said.... you could leave yr morning bolus the same or increase it slightly (use yr previous bg reading to be your guide) and just test bg to see what happens. The first day, you might not see too much of a change, but will see it more on the start of the second day....

Just make sure that you have test strips to hand and some jellybabies or carb to deal with how the alterations affect your bg levels. Also, although a complete PITA, get up in the night about 3am just to see what the basal is doing.....

 

[noblehead]

Hale, without stating the obvious but have you asked for your DSN's input on what is happening with your bg levels? Might just be that they could offer you some advice on adjusting your insulin doses.

 

[mrman]

Re-did my basal today

7.15 9.8 not enough basal early hours

Enough now to keep stable

8.15. 9.8
9.15. 9.7 (looking good right?)

To much basal kicking in now
10. 7.8 (oh, weird)
11. 6.8
12.45. 5.9 (meetings ran on. I almost ate my own fist)

I was stationary at my desk 95% of this time and drank 650ml sugar free diluting juice.

Ideas?

I THINK I need the full 2.5u over night, but from 9am I don't.
Exactly

Hence I'm feeding the insulin.

Doesn't explain my afternoon highs yet but I'll get to that!

Basal running out earlier than expected

By moving your basal to 10pm there will be more of it in you actively working to help reduce morning.
Make sure you have breakfast and hopefully would need less qa than normal to counter effect of the drop later.
Basal may actually need increasing for better bg numbers am, and to stop the 2 hr after breakfast reading being too high.
Also, more basal may help with afternoon highs
Also, by having it later at night hopefully will stop any early hypos.
Please discuss with your dsn lol as noblehead does rightly say.



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[smidge]

Hale, not sure if this helps at all, but I'm on DAFNE this week (not ideal for a low carber but that's another story!) And they insist everyone splits their basal. Mine was already split, but everyone else has had to split there's even if they're on Lantus. I wonder why you were told not to - was it because you take such small doses? Just wondering if it would help you to increase the basal by a unit, but then split the increased dose morning and night to give longer coverage but avoiding having the whole dose active at the same time. In the early stages, I used to take 3 units in the morning and 1.5 at night - although that was an intermediate rather than Levemir. Just a thought.

Smidge

 

[hale710]

Yes spoke to DSN on Monday and the doctor when I was at the clinic last Friday. Neither see any issues with my BG because I'm in range by the next meal. They're against too much tweaking in the honeymoon, I understand why to some extent. Honeymoon makes things fairly erratic at times!

I'll try my DAFNE DSN again (different woman to my normal DSN) but I think she's one of the ones who has left. They all went on maternity leave and/or went to different hospitals hence DAFNE is no longer being taught in Aberdeen.

Plenty testing strips so ill move the basal tonight and see where things go with that for a week or so


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[hale710]

Hale, not sure if this helps at all, but I'm on DAFNE this week (not ideal for a low carber but that's another story!) And they insist everyone splits their basal. Mine was already split, but everyone else has had to split there's even if they're on Lantus. I wonder why you were told not to - was it because you take such small doses? Just wondering if it would help you to increase the basal by a unit, but then split the increased dose morning and night to give longer coverage but avoiding having the whole dose active at the same time. In the early stages, I used to take 3 units in the morning and 1.5 at night - although that was an intermediate rather than Levemir. Just a thought.

Smidge

There were a few of us not split. They made some split and others not (mostly those on levemir), but 3 of us on levemir (all still in the honeymoon period) were left on single doses as they said there was no evidence of it running out. Since my BG drops usually in the few hours before my jab I am currently inclined to agree with them


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[Engineer88]

they were against us splitting on my DAFNE course - it was something i suggested for myself because DAFNE itself screwed my BGs up so much. (capping correction at 4...my BG is 27.7. Fook that.) but basically they said no changes to insulin type or injection routine. Dont really know why. Hang in there Hale and I understand the hoops you got to get through for a pump trust me. It'll be worth it in the end

 

[Lucie75]

This is fascinating reading and how good is it that you can get top quality advice from the forum when you are unable to get it from the 'professionals'. Well done everyone (sorry - was that condescending - not meant to be?!?)

 

[hale710]

This is fascinating reading and how good is it that you can get top quality advice from the forum when you are unable to get it from the 'professionals'. Well done everyone (sorry - was that condescending - not meant to be?!?)

DAFNE professionals were great until they all got pregnant or jumped ship

We are definitely lucky to have the benefit of experience to help out. Since I'm changing without full DSN/doctor support ill of slow. One thing at a time! And hopefully see some improvements when it all comes together


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[hale710]

Took my levemir at 9.45 last night. Interested to see any chances to BG control today!


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[hale710]

Close to perfect at lunch, might need to increase breakfast ratio a touch but I'll give it a few days.

Next check will be 4pm, that's the key one!


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[hale710]

Pre lunch 7.3
2 hours 4.9

Lunch had cheese and a square of milk chocolate so I'm biding my time to see if it's just slow digestion.

Using a 0.5:0.5 instead of my previous 0.6:0.5 might be the reason though because today it was a whole extra unit more than I previously would have done

Or maybe it's the basal change. Who knows! More testing me thinks


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[hale710]

7.1

Walking before dinner tonight which will hopefully counteract any further rise from lunch digestion


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