Taming the Roller Coaster! Starting with Basal testing

[linda321]

I have been on MDI (Lantus and Humalog) for 6 months. I'm afraid to say that my Hb1Ac is still not within the correct range. I got my Freestyle Libre 2 weeks ago and am coming to the end of my first sensor. OMG! The daily graphs look like a very fast rollercoaster! I am surprised at how quickly my blood sugar rises after eating and then how long it takes for the rapid acting insulin to kick in and bring it down. The graph is a series of higher and higher spikes during the day!

I have to do something about it, and reading this forum realise that I should do proper basal testing. My blood sugar usually falls over night so I am thinking that my basal is a bit high. I did my first basal test on Friday night, and sure enough my blood sugar fell by 3.5mmol/l. So I have reduced from 23u of Lantus (taken first thing in the morning - about 7.30am) to 21u. I have already reduced from 25u. I will do another test tonight.

When I first started on lantus, the nurse at my GP surgery told me to increase the Lantus until my fasting blood sugar was in target. This is different advice from basal testing as linked on this forum isn't it?

But, now I have reduced my basal, although the graph is flatter, my blood sugar it is still generally above 9mmol/l. What can I do to lower the graph?

 

[Garr]

Hi Linda, this might help to lessen the peaks on the roller coaster.....
http://www.diabetesselfmanagement.com/managing-diabetes/blood-glucose-management/strike-the-spike/

 

[dylt1]

But, now I have reduced my basal, although the graph is flatter, my blood sugar it is still generally above 9mmol/l. What can I do to lower the graph?

Hi Linda,

If it's flat why don't you give yourself some fast acting insulin to bring it down to a nice range? If it's flat at 9 then it should also stay flat if you're 5, 6 or 7 mmol/l.

 

[linda321]

Thanks for your replies Garr and dylt1. So far so good today! I'm in target range. Just waited 20 mins after injecting fast acting before eating, hoping to smooth out the spike after lunch.

 

[azure]

To try to deal with spikes after eating, I find having my bolus insulin earlier works extremely well eg when I was on Humalog, if I bolused just before breakfast my BS two hours later could be as high as 13. However, bolusing half an hour before breakfast (same dose, same breakfast) gave me a two hour BS of around 5.5 to 6.5. A huge improvement.

If you try this, move your bolus forward gradually.

Edited to add that a friend has to have Her bolus for some meals as far in advance as 45 mins, so it can vary a lot and is a case of experimenting meal by meal.

 

[Diamattic]

As mentioned above - if your basal graph is flat at 9, giving yourself a small bolus to lower it to 5 or 6 would allow you to remain flat at that lower number. You should now reassess your bolus to ensure that you are injecting enough ie - if you are at 5 pre meal and 4 hours post you end up at 9 and stay flat it means you miss counted your carbs or your bolus dose needs to be adjusted to bring you back down to 5.

 

[noblehead]

To try to deal with spikes after eating, I find having my bolus insulin earlier works extremely well eg when I was on Humalog, if I bolused just before breakfast my BS two hours later could be as high as 13. However, bolusing half an hour before breakfast (same dose, same breakfast) gave me a two hour BS of around 5.5 to 6.5. A huge improvement.

If you try this, move your bolus forward gradually.

Edited to add that a friend has to have Her bolus for some meals as far in advance as 45 mins, so it can vary a lot and is a case of experimenting meal by meal.

It also depends on high your bg levels are before your meal, Gary Scheiner says (in the book Think Like a Pancreas) that the higher you are the longer you should leave the gap between bolusing and eating.

Personally I find 15-20 mins is enough to reduce the postprandial spikes for most meals.