The right insulin number

[Erin]

Hello insulin users,

I woke up to a hypoglycemic state last night, a bit disoriented and stumbling around like a
"Raid" mosquito. It was the middle of the night and I was too panicked to take a blood sugar test, so I ate a variety of decadent stuff, until I stabilized, and then fell asleep fast. Not surprisingly my blood sugar is high this morning, but I can adjust that by not eating until it goes down. I do have the typical post hypo adjustment headache. I know the cause: I increased my insulin from 40 to 42 last night as my numbers were high yesterday. I will take it down again and just watch my diet instead. This has been a problem for me as I am not sure what the correct insulin dose should be. Is there a formula I can use? Or is it just feedback that you should follow?

 

[EllieM]

This has been a problem for me as I am not sure what the correct insulin dose should be. Is there a formula I can use? Or is it just feedback that you should follow?

Is this basal you are talking about?

Speaking as a T1 (so I appreciate it isn't the same) but I personally just play it by ear and curse when it isn't right (frequently).

Honestly, I find I just tweak my doses - if it's the same in the morning (before my dawn phenomena rise) as at night, then it's probably right.

But I am very fortunate in that I can afford a dexcom cgm, so I get a warning when my bg starts to go low (mine is set at 4.4) and then normally only need a couple of glucose tablets to raise my levels. I am pretty insulin resistant so if I ate as much as I wanted to when hypo I'd end up sky high (and have in the past but cope much better since I've had the dexcom).

Having said all that, it might be worth pestering your DN/clinic to see if there is a formula you can use (and I would be very interested to hear about it if there is).

A couple of other thoughts
1) injection sites - are you confident that your high begs weren't caused by using an overused site?
2) lantus - is that your basal? (I have some rants I could give but may not be applicable).


Good luck - I hate hypos.

 

[Fenn]

Yikes I hate night time hypos the most, like being awake but asleep at the same time, just awful.

I am totally mystified by correction doses, I don't tend to change the Levermir or long lasting (sorry I can never remember which is which basal/bolus) as adjusting that wrongly makes it wrong for longer, I will tend to try to adjust with Novorapid as less damage seems to be done, one day 2 units makes me hypo, the next day 2 units has zero effect, plus I'm nervous about stacking, the novo can affect me for five+ hours and I will likely be eating and wanting to inject again by then.

Such a tricky business.

I hope you find an answer, best wishes.

 

[Erin]

Is this basal you are talking about?

Thanks for your careful answer Ellie. I appreciate your advice. I don't know what "basal" is.


Speaking as a T1 (so I appreciate it isn't the same) but I personally just play it by ear and curse when it isn't right (frequently).

Me too, I imagine T1 is more challenging.

Honestly, I find I just tweak my doses - if it's the same in the morning (before my dawn phenomena rise) as at night, then it's probably right.

I tweak too. Usually my target is spot on, but changes do result in unexpected numbers, as happened last night. Because of a knee injury I have not been exercising as much and have to rest my muscles from a fall. Hence, the numbers being higher should not be a surprise.

But I am very fortunate in that I can afford a dexcom cgm, so I get a warning when my bg starts to go low (mine is set at 4.4) and then normally only need a couple of glucose tablets to raise my levels. I am pretty insulin resistant so if I ate as much as I wanted to when hypo I'd end up sky high (and have in the past but cope much better since I've had the dexcom).

dexcom-- I have to look that up.

Having said all that, it might be worth pestering your DN/clinic to see if there is a formula you can use (and I would be very interested to hear about it if there is).

My previous dr. did assign a nurse for me, but it was a shortened (a few months) because she got ill.
I am basically relying on personal feedback, and reading the manual of HUMULIN N. Usually that works and there are some inconsistencies.

A couple of other thoughts
1) injection sites - are you confident that your high begs weren't caused by using an overused site?
Maybe, sometimes one area of the thigh is fatter than another, but this time an increase in dose is a no-brainer.

2) lantus - is that your basal? (I have some rants I could give but may not be applicable).

I am not familiar with this terminology. I'm OK; with no breakfast the number is quickly reaching normal (i.e. from 19.8 to 8.9. I will wait a bit longer to reach say 4-6 before eating.

Thank you for the URL's below, very kind.

Cheers


Good luck - I hate hypos.

 

[Erin]

Yikes I hate night time hypos the most, like being awake but asleep at the same time, just awful.

I am totally mystified by correction doses, I don't tend to change the Levermir or long lasting (sorry I can never remember which is which basal/bolus) as adjusting that wrongly makes it wrong for longer, I will tend to try to adjust with Novorapid as less damage seems to be done, one day 2 units makes me hypo, the next day 2 units has zero effect, plus I'm nervous about stacking, the novo can affect me for five+ hours and I will likely be eating and wanting to inject again by then.

Such a tricky business.

I hope you find an answer, best wishes.

I am satisfied with HUMULUS N, but I agree that adjustment is tricky. Variables always have an effect for me: e.g. exercise, diet, other meds, dose of glyclazide, dose of insulin, sugar, and area of the body upon injection. Take care.

 

[Deleted member 527103]

Is it possible to get pens for your basal that have one or half units so you can make smaller adjustments than 2 units?

 

[EllieM]

I am satisfied with HUMULUS N,

Aha, according to my googling, humulin N is an intermediate acting insulin,
Humulin N (insulin isophane) is a man-made form of a hormone that is produced in the body. Insulin is a hormone that works by lowering levels of glucose (sugar) in the blood. Insulin isophane is an intermediate-acting insulin that starts to work within 2 to 4 hours after injection, peaks in 4 to 12 hours, and keeps working for 12 to 18 hours.

Am guessing you take it once or twice a day? Is it your only insulin?

Most T1s (and many T2s) take basal and bolus insulins. Basal insulin is a long acting background insulin, which you attempt to adjust to keep your levels normal when you aren't eating. Bolus is short acting, which can be used to counteract carbs in meals and also as a correction dose when your levels are high. There are formulae for calculating the bolus amounts (which vary drastically for each individual according to how sensitive they are to insulin) while the basal generally gets adjusted manually till your levels stay the same when you aren't eating. It allows a lot of flexibility in meal timings and amounts.

People on intermediate acting insulins tend to have to have a more rigid routine, though it can work very well, but you've got less scope for adjusting your dose, as if you want to increase the dose because eg you're running high after a meal, you can end up hypoing at night. Definitely one for talking to your DN about.

 

[Erin]

Is it possible to get pens for your basal that have one or half units so you can make smaller adjustments than 2 units?

Anything is "possible" That method, too may succumb to the variables I wrote above. My hypos do not happen that often as I avoid them from bad experiences. I think I have had about 3 or 4 in the past year. On the other hand targeting within the safe range, not going hyperglycemic, requires vigilance. I am so tired of vigilance. :-(

 

[EllieM]

I think I have had about 3 or 4 in the past year.

Whatever you are doing, keep doing it. As a T1, the thought of only 3 hypos in a year makes me incredibly envious.

 

[Erin]

Whatever you are doing, keep doing it. As a T1, the thought of only 3 hypos in a year makes me incredibly envious.

I'm sorry you have more hypos Ellie. I've never really felt better on account of other people feeling worse; not always anyway . My own opinion is that a slight hyperglycemia is not as risky as a hypo; because hypos can affect your heart and your brain. So, I would err on the side of caution if that is true.

 

[NicoleC1971]

Anything is "possible" That method, too may succumb to the variables I wrote above. My hypos do not happen that often as I avoid them from bad experiences. I think I have had about 3 or 4 in the past year. On the other hand targeting within the safe range, not going hyperglycemic, requires vigilance. I am so tired of vigilance. :-(

We all hate hypos especially the night time ones!
You are doing pretty well as Ellie M says on 3-4 times a year.
As to why you occasionally have them other than things mentioned such as consistency of meals and timing, jab sites another variable may be exercise even if this was hours before the hypo event. Your muscles can be drained of glucose/glycogen then re supply themselves with the aid of insulin causing too great a drop.
There's no formula for basal but weight loss/gain will change insulin resistance so that is a longer term factor.

 

[Erin]

We all hate hypos especially the night time ones!
You are doing pretty well as Ellie M says on 3-4 times a year.
As to why you occasionally have them other than things mentioned such as consistency of meals and timing, jab sites another variable may be exercise even if this was hours before the hypo event. Your muscles can be drained of glucose/glycogen then re supply themselves with the aid of insulin causing too great a drop.
There's no formula for basal but weight loss/gain will change insulin resistance so that is a longer term factor.

Thank you for the reply Nicole. I look forward to my knee (fell flat on my face) recovery so I can resume my exercises in walking, which really helped me lose weight and control my blood sugars. Take care