Type 1 Please Help With Basal Insulin

[LornaFarrell]

I’m pretty sure my basal needs to be a lot higher, and bolus lower. I’m swinging from hyper to hypo and back again (yesterday saw 3.5 and 16) and always get a fasting of 12-14. I also seem to rise in the late afternoon/evening regardless of what I’ve eaten, would that suggest splitting the basal would be a good idea?

I know you normally judge basal dose by comparing bedtime (3-4 hours after any food) with morning. My problem is that we eat very late. We don’t particularly want to eat late but that’s what circumstances dictate. So bedtime might not even be an hour after I’ve eaten my evening meal. Which leaves me without a reading for comparison. Any suggestions?

 

[EllieM]

1) What's your basal insulin?
2) Could you set an alarm for 4 hours after you eat just to get the comparison level?
3) Have you considered self funding a cgm (freestyle libre) for a couple of weeks to see what's happening overnight?

 

[LornaFarrell]

1) What's your basal insulin?
2) Could you set an alarm for 4 hours after you eat just to get the comparison level?
3) Have you considered self funding a cgm (freestyle libre) for a couple of weeks to see what's happening overnight?

Hi, thanks for your help.
1) currently 30 lantus, which I do in the morning.
2) I have considered that, but it would be 1-2am and I have a six month old who wakes in the night and a two year old who sometimes wakes so I’d prefer to maximise sleep. If it’s the only option I’ll do it though. It might also only be 3-4 hours before my fasting reading so I’m not sure if it’s long enough?
3) I’d love to but I simply don’t have the resources.

 

[EllieM]

Hi, thanks for your help.
1) currently 30 lantus, which I do in the morning.
2) I have considered that, but it would be 1-2am and I have a six month old who wakes in the night and a two year old who sometimes wakes so I’d prefer to maximise sleep. If it’s the only option I’ll do it though. It might also only be 3-4 hours before my fasting reading so I’m not sure if it’s long enough?
3) I’d love to but I simply don’t have the resources.

Hmm, I take it you've tried contacting your clinic for advice? (Maybe they'd give you a cgm for a fortnight just to sort it all out?)
Could you blood test when you child(ren) wake to give some night time readings? (Just want to rule out a night time hypo.) There's also the dreaded dawn phenomena (sign), which is another possible reason for a breakfast raise.
There's also the possibility that your lantus isn't quite lasting 24 hours... (You could swap to a night time dose...)
Or if you did a mid night read you could skip/delay breakfast to see what's happening?


Hopefully others will make some more suggestions. Good luck, I remember those desperate sleep deprived days of yound children and am just grateful that mine are now in their 20s.

 

[LornaFarrell]

Hmm, I take it you've tried contacting your clinic for advice? (Maybe they'd give you a cgm for a fortnight just to sort it all out?)
Could you blood test when you child(ren) wake to give some night time readings? (Just want to rule out a night time hypo.) There's also the dreaded dawn phenomena (sign), which is another possible reason for a breakfast raise.
There's also the possibility that your lantus isn't quite lasting 24 hours... (You could swap to a night time dose...)
Or if you did a mid night read you could skip/delay breakfast to see what's happening?


Hopefully others will make some more suggestions. Good luck, I remember those desperate sleep deprived days of yound children and am just grateful that mine are now in their 20s.

I have tried but the clinic are currently unhelpful. I’m in limbo waiting for test results and they won’t do much until they come in, been waiting 4 weeks now.

 

[Daibell]

Hi. From what you say there is a hint that the Basal is a bit low? After fasting for a few hours your BS should remain the same as the start if the Basal is roughly balanced. If it's rising then that implies the Basal might need an increase. If you can't get any quick/easy support from your team then you could try making small changes to the Basal but keep them small and leave a 2-3 day gap between any change so you can check the effect. Obviously test as frequently as needed to avoid a hypo and the Bolus ratio might need a slight tweak. Note that there might be other factors at play that I'm not in a position to be aware of. Many split their Basal. My DN said not to and I actually agree with her as it means an extra injection and it makes balancing the Basal more difficult. Towards the end of the 24 hr period when the Basal is running out I use a slightly different Bolus ratio to compensate. Do discuss with the DN.

 

[LornaFarrell]

Thanks @Daibell

My fasting number is always high (between 11 and 15) and it keeps rising. This morning for example it was 13.4 when I woke up and 14.7 an hour later when I had breakfast.

I also find I consistently get my numbers creeping up in the afternoon and during the evening, starting about 9 hours or so after I take the lantus. I wonder if this could just be because the dose is too low? Eg today after lunch was 6.9, three hours later 8.2 and two hours after that 12.

I can’t do a bedtime reading to compare as we eat so late that it would be right after a meal. Although I wonder if it would be ok if it was a meal with no carbs at all? My team have said I can keep increasing every few days so I’m doing that, I just want to be sure I’ll know when I get it right! And currently I’m basically using novorapid to correct so I’ll presumably need to reduce that.