Adjusting insulin

[Michele01]

Hello. I’m a type 1.5 (insulin dependent for about 10 years). I have a libre3 sensor and love it but what it’s shown me is how much my levels are bouncing around. Even in between meals they’re either heading up or down (usually too far down) and I can’t seem to get a nice straight(ish) line. Despite this my control is at around 66% in the green but I’m sure it would be better if I could eliminate the roller coaster. As I’ve never had a course on how to do this, I don’t know where to start. Should I start with the basal or bolus? My gut feeling is that if the basal (which I think is the morning and evening Levemir not the one I take before meals) was correct it would keep me more stable but am I wrong? I’m also dyslexic so I find it really difficult understanding it all - if just doesn’t seem to compute in my head so I need to find a easy(ish) solution. Thank you for all your help.

 

[In Response]

Firstly, everyone's BG goes up and down.
But if you want to review your insulin dose, the usual advice is to start wit the basal. I think of it as the foundation and if this is not right, no tweaks on the "bricks and mortar" (bolus and food) would result in a stable house.
You can check your basal with a basal test - basically, eat and do nothing that could affect your BG for 8 hour stints and see what your BG is doing. Your basal should keep your levels stable(ish) - don't expect a straight line. Yes, Levemir is your basal. You may find you need to adjust the morning to evening ratios. It is difficult to see from your graph but it seems to have an upward trend towards the end of the day so maybe you need more in the evening. You will learn more from your basal testing.
Once you are comfortable with your basal, then on to the bolus. Bear in mind this could be different for different meals. I would start with one meal - breakfast is usually the easiest because most people eat the same thing each day. If your levels return to your "normal" but take too long, the dose is likely to be correct but the insulin peak is too late for the digestion peak so you may need to pre-bolus earlier. If your levels do not return to normal (they stay high), you need more and if they go too low, you need less.

Do not expect perfection. Do not expect 100% in range. Do not beat yourself if you hypo or go high sometimes, I believe the recommendations are 70% in range with no more than 5% too low. 66% in range is not far off so you may not need many tweaks.

 

[Michele01]

Firstly, everyone's BG goes up and down.
But if you want to review your insulin dose, the usual advice is to start wit the basal. I think of it as the foundation and if this is not right, no tweaks on the "bricks and mortar" (bolus and food) would result in a stable house.
You can check your basal with a basal test - basically, eat and do nothing that could affect your BG for 8 hour stints and see what your BG is doing. Your basal should keep your levels stable(ish) - don't expect a straight line. Yes, Levemir is your basal. You may find you need to adjust the morning to evening ratios. It is difficult to see from your graph but it seems to have an upward trend towards the end of the day so maybe you need more in the evening. You will learn more from your basal testing.
Once you are comfortable with your basal, then on to the bolus. Bear in mind this could be different for different meals. I would start with one meal - breakfast is usually the easiest because most people eat the same thing each day. If your levels return to your "normal" but take too long, the dose is likely to be correct but the insulin peak is too late for the digestion peak so you may need to pre-bolus earlier. If your levels do not return to normal (they stay high), you need more and if they go too low, you need less.

Do not expect perfection. Do not expect 100% in range. Do not beat yourself if you hypo or go high sometimes, I believe the recommendations are 70% in range with no more than 5% too low. 66% in range is not far off so you may not need many tweaks.

Thank you so much. I appreciate your help. I actually don’t eat breakfast so if I take my basal in the morning and wait 8 hours would that be a good way to test?
I get a morning surge on waking - which I correct with a small amount of bolus. Would that mean my basal test wouldn’t be accurate?

Does the morning surge suggest my evening basal needs increasing? I do use more basal in the morning and less in the evening.

Sorry so many questions.

 

[EllieM]

Does the morning surge suggest my evening basal needs increasing? I do use more basal in the morning and less in the evening.

A lot of people have something called the dawn phenomena, where their livers pump out sugar first thing in the moment (to give them energy to go and hunt a mammoth or something ). This means they can need a bit of bolus even if they don't eat breakfast.

I'd be more concerned as to whether your line is flat at night as regards the evening basal.

 

[In Response]

Thank you so much. I appreciate your help. I actually don’t eat breakfast so if I take my basal in the morning and wait 8 hours would that be a good way to test?
I get a morning surge on waking - which I correct with a small amount of bolus. Would that mean my basal test wouldn’t be accurate?

Does the morning surge suggest my evening basal needs increasing? I do use more basal in the morning and less in the evening.

Sorry so many questions.

The morning surge suggests, like most of us, you experience Dawn Phenomenon (DP) - a glucose dump from your liver to give you energy to start the day.
I don't know the "rules" on basal testing but I would start the day time test after your morning correction bolus.

Something else to throw into the pot - have you tried eating a small breakfast?
If we don't eat, our body thinks we are starving and will continue with the DP glucose dump. If I eat something small (a handful of nuts or half a tub of yoghurt), my liver dump stops as it realises I am ok.

My DP dump is also far more significant if I have not exercised for a couple of days. I assume this is because my body has used up my "glucose stores" whilst at the gym (or climbing wall or hiking route or ...) so has less available to dump.
(Most people will probably say it is less significant after they have exercised but I do something 5 days a week so it is more rare not to exercise.)

 

[Michele01]

A lot of people have something called the dawn phenomena, where their livers pump out sugar first thing in the moment (to give them energy to go and hunt a mammoth or something ). This means they can need a bit of bolus even if they don't eat breakfast.

I'd be more concerned as to whether your line is flat at night as regards the evening basal.

Good news about the mammoths! They’re growing in numbers in Manchester

I often have a hypo at night so no, my line isn’t flat at night. Very occasionally it is but more often than that, no.

 

[Michele01]

The morning surge suggests, like most of us, you experience Dawn Phenomenon (DP) - a glucose dump from your liver to give you energy to start the day.
I don't know the "rules" on basal testing but I would start the day time test after your morning correction bolus.

Something else to throw into the pot - have you tried eating a small breakfast?
If we don't eat, our body thinks we are starving and will continue with the DP glucose dump. If I eat something small (a handful of nuts or half a tub of yoghurt), my liver dump stops as it realises I am ok.

My DP dump is also far more significant if I have not exercised for a couple of days. I assume this is because my body has used up my "glucose stores" whilst at the gym (or climbing wall or hiking route or ...) so has less available to dump.
(Most people will probably say it is less significant after they have exercised but I do something 5 days a week so it is more rare not to exercise.)

No a breakfast isn’t something I can do but I get what you’re saying about the Dawn dump. Thank you.

 

[EllieM]

I often have a hypo at night so no, my line isn’t flat at night. Very occasionally it is but more often than that, no.

In theory, if you go to bed at a normallish level and long enough from your evening meal for no food or bolus to be on board, you should be able to increase it if it's going up and decrease if it's going down. But I haven't used levemir so I don't know whether your morning dose is still in your system in the first part of the night. And honestly, night time hypos are the worst. I'd work very hard to eliminate them.

My team did offer me a pump at one stage because of my dawn phenomena, though I've managed to make my basal (lantus) work much better for me now that I split it.

I'll tag in @Jaylee who has a basal testing link.

Also, if you can't get your clinic to send you on DAFNE , which is supposed to be a really good course, you could try bertie

Welcome - BERTIE Online

www.bertieonline.org.uk

 

[Jaylee]

I'll tag in @Jaylee who has a basal testing link.

This one?

How To Successfully Test Your Basal Rate

Are you looking for basal rate information and testing instructions? Perfect! You're in the right place!

www.mysugr.com

Hope it helps.