Basal Insulin Help Plz!

[Alison54321]

I was taking 21 units of Lantus at 7am. Breakfast lately has been 2 hard boiled eggs, which shouldn't affect my blood sugar at all. Lunch is a sandwich. I think I may still have a ratio issue at lunch though.

We'll see what happens today, since yesterday was the first full day of split dose.

I suspect I might have to take a few units of Humalog in the mornings as well. I did this morning, but looks like not enough. Took 4 unitls

Yes. I'd stick with a 4 unit correction until things settle down, from the change. You may need to look at what you're doing at lunch. But thinking about it, if your blood sugar is ok in the afternoon, that would suggest lunch isn't that much of an issue.

So it's just getting the adjustment dose right in the morning, so that before lunch you have an ok blood sugar. So maybe it's better to get that early morning correction dose right first.

 

[evej]

I would say lunch is an issue. It's the time I will rise the most. It's good after about 2pm, but 12:30ish to about 2 is abysmal. I can't seem to get the ratio right.

 

[Alison54321]

I would say lunch is an issue. It's the time I will rise the most. It's good after about 2pm, but 12:30ish to about 2 is abysmal. I can't seem to get the ratio right.

It's your body, so you would know. It may be worth looking at then. But if's it dropping after 2 pm, and you're eating at 12.30 it might be worth looking at timing as well. A long period between injecting, and eating might help. I got this advice when I got freestyle libre, which makes it much easier to do that.

 

[evej]

It's your body, so you would know. It may be worth looking at then. But if's it dropping after 2 pm, and you're eating at 12.30 it might be worth looking at timing as well. A long period between injecting, and eating might help. I got this advice when I got freestyle libre, which makes it much easier to do that.

Hehe Alison... I don't think I know my body very well at all! I have been trying to increase the time between injection and eating - so far that has helped quite a lot, but I'm screwing up as often as it's working. What do you use for guidelines on timing between the two?

 

[evej]

Maybe I shouldn't be surprised, but I guess I am - totally unexpected... my supper insulin to carb ratio was 1:11. It appears to have totally changed! I took my normal suppertime dose and have a really high blood sugar - 16.3 two hours after supper. Now what?!?

 

[Alison54321]

Maybe I shouldn't be surprised, but I guess I am - totally unexpected... my supper insulin to carb ratio was 1:11. It appears to have totally changed! I took my normal suppertime dose and have a really high blood sugar - 16.3 two hours after supper. Now what?!?

I use the Freestyle Libre to guide me on how long to wait before eating. I take a reading just before I inject, and then a few more, and when there's a small reduction, only a tiny one, but an indication that the insulin is having an effect. I then eat. I don't cook much though, so there isn't a meal getting cold while I wait!

It just varies. Sometimes it starts going down quickly, and other times it's very persistent. It all depends what's going on in the background. Which is hard to predict. My body will follow the same daily pattern for a while, and then, without warning, change.

On your supper, my guess would be that when you were taking all the Lantus in the morning, in the background there was a downward trend at supper time. But because you've shifted some Lantus to the evening something different is going on in the background. Which will hopefully mean, once you've ironed out the supper blip, that the morning background insulin will be more efficient.

I would raise the evening fast acting dose a little bit, that should help, I would think.

 

[Alison54321]

Just after I posted that last comment I had another thought. If your Lantus isn't doing the full 24 hours, then the evening dose is wearing off then, so you would have definitely have less background insulin than before.

 

[novorapidboi26]

There may be small adjustments needed with insulin/carb ratios and correction factors, but now that you have committed to the basal split, you ideally need to get both those doses adjusted first, then tackle the rest of it....

So are you going to try 6 units of Lantus at 7pm?

The true effect of a Lantus adjustment, so they used to say anyway, was that it took a few days to see it....

 

[Alison54321]

There may be small adjustments needed with insulin/carb ratios and correction factors, but now that you have committed to the basal split, you ideally need to get both those doses adjusted first, then tackle the rest of it....

So are you going to try 6 units of Lantus at 7pm?

The true effect of a Lantus adjustment, so they used to say anyway, was that it took a few days to see it....

I tend to surf the sugar wave a bit, even more so now I have Freestyle Libre, so my instinct would be to respond to a 16 mmol/L after meal reading, unless there were other reasons, maybe an unusually high pre-meal bg, more carbohydrates than normal, or something like that.

But if your preference is to have a more stable management regime, then I would follow @novorapidboi26 advice, and get the Lantus doses right first.

 

[evej]

@Alison54321, I'm doing the same thing re taking a reading, injecting and then watching for a trend change before eating. I am using the Sugar Surfing guy's method for that. I would guess that when I was taking the Lantus once per day, the peak was probably at suppertime?

Now that I'm dosing Lantus twice a day, I guess it's changed.

 

[evej]

@novorapidboi26, then I should not worry too much about ratios now, and just fly by the seat of my pants for the short term (while I'm working out the basal)?

Yes, I did 6u of Lantus at 7pm - had 15u at 7am for a total of 21u.

I had to take a correction bolus at 10:30 so no true night fasting results from the basal, but wouldn't there be some valuable information from 5 hours later when the Humalog wore off? Meaning results from 2:30am onwards would have some value, wouldn't they? If that's the case, my trend is still somewhat upwards by about 2 mmol/L.

I took 15u Lantus at 7am and will take 6u at 7pm.

So, once I have the night-time Lantus right, then I work on the daytime Lantus first I would assume?

I eat 3 times a day, plus sometimes a small snack around 8pm but I've read that eating more times a day is sometimes helpful. What do you think - do you snack during the day?

 

[novorapidboi26]

@novorapidboi26, then I should not worry too much about ratios now, and just fly by the seat of my pants for the short term (while I'm working out the basal)?

Yes, I did 6u of Lantus at 7pm - had 15u at 7am for a total of 21u.

I had to take a correction bolus at 10:30 so no true night fasting results from the basal, but wouldn't there be some valuable information from 5 hours later when the Humalog wore off? Meaning results from 2:30am onwards would have some value, wouldn't they? If that's the case, my trend is still somewhat upwards by about 2 mmol/L.

So, once I have the night-time Lantus right, then I work on the daytime I would assume?

While you actively analysing and adjusting the basal there would be no point in doing the same for any bolus ratios, yes....

Once the correction had wore off then yes, you would start to see the true basal action after that....it probably wouldn't be a full 5 hours though but assuming its lasted that long is good practice I suppose...

If you only change about 2 mmol then your basal is pretty much there.....I would be happy with that....

So you can then move on the day time 15 units.......how do you plant to attack that....?

 

[evej]

While you actively analysing and adjusting the basal there would be no point in doing the same for any bolus ratios, yes....

Once the correction had wore off then yes, you would start to see the true basal action after that....it probably wouldn't be a full 5 hours though but assuming its lasted that long is good practice I suppose...

If you only change about 2 mmol then your basal is pretty much there.....I would be happy with that....

So you can then move on the day time 15 units.......how do you plant to attack that....?

I would like to test the 7pm Lantus once more, but without having to take a bolus correction in the evening, particularly since you suggest it takes a few days for Lantus to level out.

I am not sure how to test daytime, but do have one question first. Since Lantus is an almost-24 hour basal, how much does that 6 units at bedtime affect daytime results, and how much does the morning dose affect the night?

In other words, if I increase the night time Lantus by 1 to 7 units, would I offset that with a reduction in daytime Lantus from 15 to 14u?

I kind of think I may be taking too much in the morning and not enough at night - I think the ratio of day to night time Lantus should be closer together? And, according to one article I read by Dr. Bernstein, he has suggested that a 146lb man would take about 14 units, which would mean an overall reduction for me (I'm 110 lbs). He thinks most people are on too much basal. Thoughts?

For daytime breakfast testing, could I eat something around 2am, and then test from about 5 hours later, so from 7am to noon?? But, if I have DP, how would I test that - I'd have to take a bolus correction in the morning?

Maybe I should test supper first? To be honest, not sure where to start with daytime testing. Advice please?

 

[novorapidboi26]

I would like to test the 7pm Lantus once more, but without having to take a bolus correction in the evening, particularly since you suggest it takes a few days for Lantus to level out.

I am not sure how to test daytime, but do have one question first. Since Lantus is an almost-24 hour basal, how much does that 6 units at bedtime affect daytime results, and how much does the morning dose affect the night?

In other words, if I increase the night time Lantus by 1 to 7 units, would I offset that with a reduction in daytime Lantus from 15 to 14u?

I kind of think I may be taking too much in the morning and not enough at night - I think the ratio of day to night time Lantus should be closer together? And, according to one article I read by Dr. Bernstein, he has suggested that a 146lb man would take about 14 units, which would mean an overall reduction for me (I'm 110 lbs). He thinks most people are on too much basal. Thoughts?

For daytime breakfast testing, could I eat something around 2am, and then test from about 5 hours later, so from 7am to noon?? But, if I have DP, how would I test that - I'd have to take a bolus correction in the morning?

Maybe I should test supper first? To be honest, not sure where to start with daytime testing. Advice please?

Its meant to be 24 hours, but its likely not doing that in you personally.....also, the bigger the dose, the longer it lasts, so 5 units probably wont be lasting that long....

There will likely be some overlap in the two doses but that's OK....Welcome actually, especially when trying to tackle DP...

You wont need to offset the doses either.....each dose is doing a separate job....one for overnight...and one for the day time....so you can adjust them separately too.....

everyone is different in terms of basal needs and the mass of each of us will have an effect but its only a guide.....you can't beat raw data from testing in this case....

you can break the daytime up in anyway you please from waking.....5 hour segments is a good place to start....

why would you want/need to eat at 2am.....? you can just go carb free foods for basal testing, although some would say refrain from eating....but unless your pumping or low carbing and see an effect from protein/fats you shouldn't worry about having some cheese or meat during a test..

testing from 7am to noon with DP is an issue obviously as you will continue to rise until you break the fast, but you can still break the fast with something carb free, but probably best to leave that time slot till last, and of course correct if too high......you will only have that one dose to do multiple time slots anyway so the data from lunch till dinner, and dinner till 7pm will dictate what the dose will be......any deficit of surplus in the morning slot can be accommodated with the bolus...

supper or from lunch onwards is a good place to start.....

 

[evej]

Its meant to be 24 hours, but its likely not doing that in you personally.....also, the bigger the dose, the longer it lasts, so 5 units probably wont be lasting that long....

There will likely be some overlap in the two doses but that's OK....Welcome actually, especially when trying to tackle DP...

You wont need to offset the doses either.....each dose is doing a separate job....one for overnight...and one for the day time....so you can adjust them separately too.....

everyone is different in terms of basal needs and the mass of each of us will have an effect but its only a guide.....you can't beat raw data from testing in this case....

you can break the daytime up in anyway you please from waking.....5 hour segments is a good place to start....

why would you want/need to eat at 2am.....? you can just go carb free foods for basal testing, although some would say refrain from eating....but unless your pumping or low carbing and see an effect from protein/fats you shouldn't worry about having some cheese or meat during a test..

testing from 7am to noon with DP is an issue obviously as you will continue to rise until you break the fast, but you can still break the fast with something carb free, but probably best to leave that time slot till last, and of course correct if too high......you will only have that one dose to do multiple time slots anyway so the data from lunch till dinner, and dinner till 7pm will dictate what the dose will be......any deficit of surplus in the morning slot can be accommodated with the bolus...

supper or from lunch onwards is a good place to start.....

I did not know I can eat carb-free during basal testing. I thought I needed to eat nothing. In that case, I can have 2 eggs for lunch and still test - that's good news!! Also, makes sense that I don't need to test breakfast since I'm using one Lantus dose during the day - also good news because I did not know how to account for what I THINK is dawn phenomenon. However.... could that early morning rise have simply been due to once-a-day Lantus taken at 7am running out? If it was, the 7pm Lantus should start to take care of that, correct? Or, if it was a combination, it should at least partially take care of it?

Also... do I start testing 4 or 5 hours after breakfast? Should I eat eggs for breakfast, and no carbs for lunch, and then start testing 4 or 5 hours after my last bolus (the correction for morning)? And how long do I run the test for?

I assume I should wait to test daytime until I'm finished testing nighttime, or can I test them both at the same time?

Thank you soooo much for your help!

 

[novorapidboi26]

I did not know I can eat carb-free during basal testing. I thought I needed to eat nothing. In that case, I can have 2 eggs for lunch and still test - that's good news!! Also, makes sense that I don't need to test breakfast since I'm using one Lantus dose during the day - also good news because I did not know how to account for what I THINK is dawn phenomenon. However.... could that early morning rise have simply been due to once-a-day Lantus taken at 7am running out? If it was, the 7pm Lantus should start to take care of that, correct? Or, if it was a combination, it should at least partially take care of it?

I assume I should wait to test daytime until I'm finished testing nighttime, or can I test them both at the same time?

Thank you soooo much for your help!

Your recent test of the 5units at 7pm showed that you held steady up until about 5 am, when it started to rise....that's a good sign of DP in my opinion....you can, with the libres help, quite accurately work out how long the Lantus is working....but it doesn't need to be to the minute accuracy, as its still an injection at the end of the day, which has its limitations, when compared to pumping for example.....

to keep things simple you should finish the overnight testing first as there is chance the overnight will run into the morning.....you could comfortably test overnight and then from noon onwards though I would think.....

any professional would say wait......

no one wants to wait days and days though...

 

[novorapidboi26]

Its clear you have a decent grasp of the basal testing already by the way.....well done....

 

[evej]

Your recent test of the 5units at 7pm showed that you held steady up until about 5 am, when it started to rise....that's a good sign of DP in my opinion....you can, with the libres help, quite accurately work out how long the Lantus is working....but it doesn't need to be to the minute accuracy, as its still an injection at the end of the day, which has its limitations, when compared to pumping for example.....

to keep things simple you should finish the overnight testing first as there is chance the overnight will run into the morning.....you could comfortably test overnight and then from noon onwards though I would think.....

any professional would say wait......

no one wants to wait days and days though...

Ok, I will wait to test daytime (but I gotta say I'm tempted to test from noon onwards as well). I am testing 6u at night, and I hold steady until around 5am, but there is a definite, slight uptrend. If I want to try 7u at night, would I reduce my daytime from 15u to 14u??

I have looked at past graphs, which would suggest it maybe lasts 20 hours for me. But... that may be confounded by the DP. I am sorry I didn't try to move my single Lantus dose from 7am to perhaps noon to see what that did.

 

[evej]

Its clear you have a decent grasp of the basal testing already by the way.....well done....

Thank you! I have been diabetic for 16 years, and have to say, the education I've gotten from my doctor, endocrinologist and diabetic educator has been sorely lacking! All they ever did was look at a few numbers and tell me to increase my Lantus. The last couple of weeks of research plus forums such as this one with people such as yourself have been far more helpful.

 

[novorapidboi26]

Ok, I will wait to test daytime (but I gotta say I'm tempted to test from noon onwards as well). I am testing 6u at night, and I hold steady until around 5am, but there is a definite, slight uptrend. If I want to try 7u at night, would I reduce my daytime from 15u to 14u??

I have looked at past graphs, which would suggest it maybe lasts 20 hours for me.

You wouldn't need to reduce the daytime no....not until the data suggests you need it...