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Adjusting basal and bolus amounts

T

thomc_82

Member
Messages
13
Type of diabetes
Type 1
Treatment type
Insulin
Hi all! I'm new here, I'm 34 and I have had type 1 diabetes for 7 years now.

Recently I'm having trouble figuring out the right amount of levemir to take, and would appreciate some help. I take 10 levemir at night and 10 units of novorapid per day (insulin to carb ratio 1:10).

I have lost 1kg weight (now 51kg) and since then it seems the levemir is too strong at night.

My hba1c is always 7.4 or so, so I reckon the over all amount of novorapid and levemir I take is correct enough; but I think the basal/bolus balance is wrong now, i.e. the levemir needs to come down and the novorapid needs to go up.

Before bed I have to eat around 20g of carbs and some fat or I will wake up with a low the next morning. Even with the 20g of carbs before bed (at 23:00) the blood sugar gradually lowers throughout the night: e.g. last night my blood sugar only rose from 10.7 at 00:30 to 12.7 at 3:30, and then dropped to 10.7 by 5:30, then to 8.5 at 7:30, to 7.2 at 9:00. So, if I had fasted I would definitley have went low.

I drank one 330 ml bottle beer with the evening meal. Could such a small amount cause the drop? Or is it more likely to be quicker absorption of levemir due to summer heat?

Also, is levemir as strong as novorapid per unit, but just absorbed more slowly? Does anyone know a way to gradually lower the amount of levemir while making up that reduced amount by adjusting the novorapid/ increasing the insulin to carbs ratio?

I appreciate your help! I hope that's not too much to ask. ; )

Thanks,

Thom
 
Hello and welcome:)

Your I:C ratio should remain the same and not be adjusted unless you're finding that you're consistently running high/low after meals whilst using 1:10?

Reductions of 10% for basal insulin is the recommended approach. I'd start with doing this on the evening dose until you are waking with a BG within 2mmol/L of your bed time reading.

Your day time basal sounds fine as there is no mention of you running low during the day?

Alcohol does tie up the liver's ability to trickle glucose into the blood stream, but one beer shouldn't affect you a great deal.

As far as I'm aware, the concentration properties of basal and bolus insulin are the same, but as you said - the absorption rate of basal is a lot slower.

If finances permit, the Libre is a fantastic tool - especially for getting those overnight basal doses tight! I - and many others - would recommend it highly!

Grant
 
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Hi Grant, thanks for your help!
I only take levemir once per day and it seems to be fine during the day. Since it doesn't cause any drops during the day, it seems even more strange that the levemir would be strong enough to cover 20g of carbs at night, without any bolus. If I decrease my levemir by 10%, will the novorapid have to gradually increase per meal, to compensate for the reduction in over all daily insulin?
(I really should know this by now, but it's never been an issue until now.) Thanks again, I really appreciate it!
 
It is likely that your Levemir is not lasting 24 hours. This means you are less likely to go low during the day as it fades, whilst it is at full strength during the night. Have you considered splitting your dose in two as & I & many other people do?
 
Hi. Be aware that the Levemir is slow-acting and not intended to cover specific food or drink input - it's there to balance the liver's background glucose output. I also take my Levemir once a day at night. It doesn't last 24 hours but I have decided not to split it but take account of the need for bit more Bolus in the evening as it runs out. Your HBa1C is too high; it needs to be below 7% and nearer to 6.5%. You should be aiming for a fasting blood sugar level between 5 and 7 mmol. Many of us find we can go down to 4'ish without a problem but you shouldn't drive at that level and may start to have hypo symptoms. It sounds like you need to increase the Bolus ratio and possibly the Basal although your figures don't really show a Basal problem?
 
Thanks guys!

You’ve given me some good perspective about what could be going on.

I do reckon the levemir is running out about 3 hours before the next dose is due – my evening meals have always been late in the evening and sometimes I need an extra unit of novorapid 2 hours after the meal. Perhaps that extra bit of novorapid is still working in my sleep too.

To start, I’ll try to compensate for that with an extra unit of novorapid before the dinner – so absolutely no fast acting is running during sleep. I’ll do any exercise earlier in the evening, at least 4 hours before bed and will see how that affects the sugar pre-bed, rather than during sleep. No alcohol at all, just in case it has a little effect that combines with other factors which may bring the blood sugar down in the morning. Then hopefully, I’ll get a more clear picture of what the levemir is actually responsible for at night. Then I can make any adjustments.

I kind of adapted my levemir some years ago to allow 10g carb supper so I wouldn’t be burning my limited fat supply as much at night. Even before I was diabetic I would wake up really hungry, so I could never imagine fasting in the sleep.

I definitely would like my hba1c to be around 7, but my diabetic nurse has suggested that since I am so thin I should concentrate on weight gain before trying to lower it, also, because I have been at risk of lows in the night. (I sort of see the logic in that, not entirely sure though).

I’m slowly gaining back the weight I lost, so I’m hoping that will help balance the insulin sensitivity back out. Summer is over and maybe any quicker absorption of insulin due to heat will get back to normal, too and perhaps the levemir will last a bit longer as a result.

Cheers,
Thom
 
thomc_82 said:
Hi Grant, thanks for your help!
I only take levemir once per day and it seems to be fine during the day. Since it doesn't cause any drops during the day, it seems even more strange that the levemir would be strong enough to cover 20g of carbs at night, without any bolus. If I decrease my levemir by 10%, will the novorapid have to gradually increase per meal, to compensate for the reduction in over all daily insulin?
(I really should know this by now, but it's never been an issue until now.) Thanks again, I really appreciate it!
Click to expand...
Hello,

As suggested splitting your Levemir dose would be a good place to start. An even split of 5u in the morning and 5u at night is a good starting point. You may need more during the night and less during the day time when you're more active - but you can fine tune this after the even split dose if need be. You may want to talk to your DSN before doing this though.

You shouldn't need to take more bolus insulin (increase your I:C ratio) if you're BG is in the target range post meals.

You say you take 10u daily with an I:C of 1:10. So every day you eat exactly 100g carbs?

Everyday is a school day with diabetes so it's not a case of "you should already know it". You've come to the right place for advice:)

Grant
 
Hi Grant,

I eat around 120g carbs per day. My breakfast ratio is ever so slightly different: I take 4 novorapid for 35g, lunch and dinner is 3 novorapid for 30g at each meal. Then the 15g or 20g carbs before bed without any novorapid, depending on exercise done that day. Also, I eat more carbs per meal if I’ve done some exercise, i.e. 1:15 ratio. (I now think that the dinner ratio should probably be more like the breakfast ratio, i.e. 4 novo for 35g carbs).

I guess there are probably carbs I’m not accounting for in the meals such as in avocado, but the amount is minimal. I’ll maybe have to be stricter with that and take those sneaky carbs into account too.

I will need to have a chat with my nurse about splitting the levemir dose. I fear what would happen due to each smaller dose being stronger/more efficiently absorbed than if it’s taken all in one dose.

I am considering basal testing, but can’t do it until I put on more weight.

Ah … the joys of having diabetes! ; )

Thanks,

Thom
 
Hi Thom and welcome.

I was in a similar position to you and used to snack before bed to avoid night time hypos.

For information, with the guidance of my diabetes nurse, I split my Levemir into two (12 hours apart), gradually reducing the evening dose.

This worked well for me and without a supper, I usually wake with a BG around 6, which is ideal for driving to work AND I haven't had any hypos.

I now only eat at bedtime if my BG is too low at that time.

Good luck.
 
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