Anyone know the difference between too high basal insulin and bolus absobtion issues.

[Deleted member 45091]

First off I know my sugars are rubbish, just wondering if anyone can point me in the right direction. Long story short, today I had 3 units of Nova rapid at dinner my sugars were around 17 i had around around 30 grams of carbs to see what I thought was happening, my sugars came down to around 8/9 on my bg meter an hour or so after although not hypo it says coming down fast I panicked and over did the lucozade. Having the same carbs to insulin how do I know if my background insulin in the morning is too high or sometimes the couple of correctional doses I have through the night may not be working and suddenly realising during the day. I have just increased my basal a couple days ago by 2 units in the morning. Just noticing iam even really sensitive in midday or somerhing is pulling it down in the afternoon. Any advice would be helpful thanks

 

[Deleted member 45091]

Sugars seem to crash eating same carbs too insulin in the afternoons, unsure if to keep reducing background insulin, have no bolus to carbs in the afternoon only, any ideas thanks.

 

[EllieM]

Hi @DannyH, it's good to see your bg go below 10 though I suspect you may be panicking too soon and treating hypos before you need to.....

Do you have reason to believe that you have absorption issues? Fatty lumps etc? I would be more inclined to assume that (usually) it's acting when it is supposed to. Just to make thinkgs worse, you can have different basal rates at different times of day, so I personally try to make my basal carry me through the night without needing corrections (because I like to sleep) and then reckon I may need more or less bolus during the day.

Do you have someone at your clinic you can talk to about this? Maybe a phone number...?

Hopefully someone more competent than me will be along to advise soon.

 

[Deleted member 45091]

Hi, after my tea iam notice I have a couple of correctional doses before bed so my ratios may be out at tea time, but when they do come down abit most of the time they do hold steady when the fast acting has wore off, then spike again in morning when getting up, breakfast seems not to bad, it's the afternoon I either eat more carbs than rapid insulin. IAM trying to get it so I am confident with what's happening in the afternoons, for example today I was at 14 and took no bolus insulin at all and had around 30 grams of carbs to see what it does. Ian sitting at 19 now which is high so il be having extra insulin at tea time to bring it down. Ian not sure if I am going to keep reducing the background insulin or maybe try eating well before the bolus insulin to try and stop the crashes, once I've found out what's happening I can have extra insulin to bring my levels down more, just been reluctant to at the minute, IE it is not a hypo but to come down like it did yesterday with food and only 3 units of Nova rapid seems unusual. And yes see a diabetic specialist etc very regular and Iam sort of just saying to her what iam trying at the minute.

 

[Deleted member 45091]

Thats my wonderful graph today, I got it down a bit at night again but panicked again and ate but I have put it down on the sensor. Just over treat non hypos too soon as when I see the downward arrow I don't know when it will stop and think dont want to be passing out on my own, something I need to stop doing, never used to be like this, on the two injections a day everything worked alot slower, but this regime although once I get the hang of it should be ok but does seem to work fast sometimes, I Had breakfast think around 20 grams and had 4 units of rapid which seems to have bought it down to around 14, so I've tried having no bolus today and had around 30 grams of carbs and holding around the 18. Expected it to be a little higher with no bolus, Il be having my tea around 4 so il have some extra insulin to carbs. But think I'm pretty sure I didnt need to eat in the night. There's not been a major crash today but obviously there too high too. I've reduced my background in the morning by 2 units to 16, and tomorrow il try having the exact insulin to carbs in the afternoon and see what that does. I would of thought after 32 years il have cracked it by now.

 

[Juicyj]

Hi Danny,

Insulin sensitivity can change throughout the day, I am more insulin resistant in the mornings so avoid carbs then, when more active later in the day then ok to eat carbs/stay in range, but I change my quick acting dosing as I need less then. My basal just covers basic body functions in periods of fasting so in between meals and when sleeping, I wouldn't change my basal unless i'd done some fasting tests to check it first.

Can you avoid eating carbs at 14 mmol/l ? Try to focus on getting levels down to below 9 with correction doses before eating carbs, if hungry then I just have protein, so omelette with mushrooms/ham/cheese.

I know you're struggling and I think I said this before - I can see a lot of anxiety in your posts attached to seeing a downward arrow, but it's not going to make you pass out, I know you live alone but you are safe at 5-6 mmol/l, you need to start trusting yourself and your levels more. I would play around with reducing my carb intake and insulin doses so that there is less insulin on board and getting myself down slowly from the high numbers and try to gradually work my way downwards to single numbers, eating more carbs = more insulin = more room for error. We all want to help as we know your struggling so much, it's in your power to own this, happy to chat on pm Danny,

 

[novorapidboi26]

Ive not been to the forum in a while so apoligies for not knowing your history........

What basal are you on? It sounds split......

To determine if your basal dose is right the only thing to do is a carb free test......

Do you have hypo unawareness or have you had a bad experience in the past with hypos...?

 

[Deleted member 45091]

Hi thanks for replies again, I've just reduced my levimir in the morning to 16 units was 18 and been high again all day, I've tried to fast I managed a little but I have my dinner at 4pm so it's along time to fast the next day too. I've been on 2 injections a day for around 30 years but control has gradually got worse. Been on the basal bolus regime over 12 months or so. IAM on 16 units in the morning 7.30am and 18 at 7.30pm I have various nova rapid, I usually have around 30 grams of carbs per meal, iam usually aiming at 1 unit to 10 grams of carbs. Today I've been high again all day so il be putting the basal up by 2 units tomorrow morning. I probably do panick, more so with the libre as I am scanning all the time and react too quick when I see I downward arrow. I never used to be like this, the swings sometimes can be quite fast. But this is what I've noticed overall. In the morning I do a 1 to 10 ratio, it hasnt work much today since I reduced my basal by 2 units. I had 4 units and 20 grams of carbs but not alot of diffence sugars around 20. I reduced the background yesterday as I had an couple days where my sugars came down quickly in the afternoon. Just for example my sugars were 17 I had 3 units and 30 grams of carbs and they came down to 8/9 within say an hour or so. So although not a hypo something else seems to be pulling it down in the afternoon. Then at tea time seems to go steady again. I scan through the night not getting much sleep. After tea I sometimes have a couple of correction doses only by on average a couple of units at a time, I probably do need to be abit braver with the insulin. But I also notice when my sugars do come down a little they do stay around the same untill around 7 o'clock when that dawn phenomenon kicks in then I am battling throughout the day to bring them down. Struggling to do a basal test because getting sugars into single figures is difficult at the minute. I don't eat things like rice, chips etc and eat alot more veg, low carb bread fish etc. It's trying to get some sort of action plan to where to start, as in my previous posts been struggling with one eye for a while and constantly having ops etc for bleeds, iam on think steroid eye drops constantly, iam also on one called fixapost and been told to start talking these in my good eye as the pressure has started going up in that eye too, but not sure with the dexafree and fixapost how much they are contributing to my sugars etc. I've asked about a pump etc because think it might help to combat things like the dawn phenomenon etc but being told there's along waiting list etc. Any advice etc or anyone can message me for a chat/ and ideas etc.

 

[RobertJ]

You mention your sugars were 17 and then it went down to 8/9 like that's a bad thing. I agree it's surprising for it to fall like that when you ate 30g of carbs at the same time but 8/9 is good. We are supposed to try and keep our sugars between 4 and 8 as much as we can.

The people at my clinic always say don't change the basal and bolus at the same time because then you don't know what's having what effect.

I would also suggest as much as possible trying to get it to 5-7 before you start eating to avoid big spikes.

(mod edit)

 

[Juicyj]

I reduced the background yesterday as I had an couple days where my sugars came down quickly in the afternoon. Just for example my sugars were 17 I had 3 units and 30 grams of carbs and they came down to 8/9 within say an hour or so. So although not a hypo something else seems to be pulling it down in the afternoon

Hi Danny,

It's not your background pulling your bg levels down it's your novorapid, basal doesn't have this effect on glucose levels, basal is there to keep you steady in the absence of food, not because of it. Novorapid will cause your levels to drop.

I am pleased you've highlighted the fact that the libre is causing this reaction within yourself, I think it's a great tool but over analyse it and you'll get dragged down by it, personally I would only scan before a meal, 2 hours afterwards then another 4 hours later or if i felt funny just to check, otherwise you will jump at the slightest thing which is why you have this knee jerk reaction.

Robert made a good point - don't go changing both things, otherwise you can't work out what did what, just adjust your basal for the time being, leave for a few days, then review.

Can you reduce your carbs when running high ? Eating carbs on high levels will keep you high, have a look at dietdoctor.com for ideas.

 

[Deleted member 45091]

Hi that's been my libre today, although still high during the night it stays pretty steady untill it spikes in the morning. this afternoon was around the 16 so just had a couple of units of rapid with a slice of low carb bread 10g, did have eggs bacon and tomatoes with it, so I am just seeing what happens. It looks like it is actually coming down very slightly so if that's the case I will be using more insulin tomorrow afternoon for any correction, and just assume now the crash I had the other day must of been an absorption thing, where I've probably injected into a fatty lump etc. Working out what to do about the dawn phenomenon thing, might have to have low carb breakfast etc or have a couple units early in the morning to counter act it, just trying at the minute to get my sugars more predictable and more stable and bring them down bit by bit. Although high they are coming down bit by bit and seeing the diabetic team tomorrow. for a small thing maybe a couple inches in size(the pancreas) we don't half have our work cut out us diabetics, but we keep trying.

 

[Juicyj]

Hi Danny,

Great plan for the DP, low carb brekkie and insulin correction should help to level this out, I try and eat as soon as I get up to cancel out the DP, so just a few spoons of plain yoghurt does the trick, but it's telling your liver to not do the dump as there is incoming food.

When you get into range more regularly you can stabilise your control more easily, at the moment running high you're giving yourself a big platform to fall from and the panic comes with seeing big moves on the graph, what would be ideal is to see small spikes/falls which will help build your confidence.

Slowly slowly though Danny - your getting your mindset refocused on this and it's best to do this slowly to avoid false hypos which are causing you to panic.

Have sent you a PM too

 

[jnk001]

Hi, after my tea iam notice I have a couple of correctional doses before bed so my ratios may be out at tea time, but when they do come down abit most of the time they do hold steady when the fast acting has wore off, then spike again in morning when getting up, breakfast seems not to bad, it's the afternoon I either eat more carbs than rapid insulin. IAM trying to get it so I am confident with what's happening in the afternoons, for example today I was at 14 and took no bolus insulin at all and had around 30 grams of carbs to see what it does. Ian sitting at 19 now which is high so il be having extra insulin at tea time to bring it down. Ian not sure if I am going to keep reducing the background insulin or maybe try eating well before the bolus insulin to try and stop the crashes, once I've found out what's happening I can have extra insulin to bring my levels down more, just been reluctant to at the minute, IE it is not a hypo but to come down like it did yesterday with food and only 3 units of Nova rapid seems unusual. And yes see a diabetic specialist etc very regular and Iam sort of just saying to her what iam trying at the minute.

What my specialist nurse got me to do was to have no carbs for 2 days as this is a way to see if your basel setting is right as you should be stable all day . You can eat full English breakfast ie egg bacon mushroom tomato , steaks etc . You do feel a bit hungry but it certainly helped my nurse get my basel settings right

 

[Deleted member 45091]

Hi thanks will try that, il get stocked up tomorrow on low carb food. Then eat next to no carbs through the next couple of days but probably have an evening meal as normal. And il see what my sugars do throughout the day. At night they seem stable it's just getting them down enough and then ride it out and see what it does.

 

[jnk001]

Hi thanks will try that, il get stocked up tomorrow on low carb food. Then eat next to no carbs through the next couple of days but probably have an evening meal as normal. And il see what my sugars do throughout the day. At night they seem stable it's just getting them down enough and then ride it out and see what it does.

I was told not to have any carbs for 2 days , it was difficult but well worth it afterwards, not sure it would work if you eat some carbs . You could try it for 24 hours which should give a good idea , if your sugars are OK then basel is right so its your insulin to carb ratio , I'm on a pump so if you arnt it won't work as well

 

[Deleted member 45091]

Yep not on the pump on a spilt dose of levimir, I've heard people have no carbs during different periods of the day over so may days and monitor it that way, il keep trying different things. Getting any access to a pump or see a consultant seems like getting a golden ticket from Charlie and the chocolate factory. What I don't get though is already losing a lot of vision in right eye, having them Lucentis eye injections in the other eye at a cost of £800 per injection. Now got too see a kidney specialist because getting protein in urine, and the amount of eye operations vitrectomys etc I've had this year alone is running up to tens of thousands of pounds in costs. But to get access to equipment that would cost far less is near impossible. I don't get how it all works so il keep trying with the stuff I've got.

 

[Andrew2018]

First off I know my sugars are rubbish, just wondering if anyone can point me in the right direction. Long story short, today I had 3 units of Nova rapid at dinner my sugars were around 17 i had around around 30 grams of carbs to see what I thought was happening, my sugars came down to around 8/9 on my bg meter an hour or so after although not hypo it says coming down fast I panicked and over did the lucozade. Having the same carbs to insulin how do I know if my background insulin in the morning is too high or sometimes the couple of correctional doses I have through the night may not be working and suddenly realising during the day. I have just increased my basal a couple days ago by 2 units in the morning. Just noticing iam even really sensitive in midday or somerhing is pulling it down in the afternoon. Any advice would be helpful thanks

Just remember, fast acting is just what it says, it's effect tapers off so at a guess, had you left it alone and taken readings, the speed of drop would have decreased, possibly even reversed if the carbs were still being digested and the insulin had worn off, which is where the basal insulin comes into it's own. Be very grateful that 3 units has that effect, these days I can end up taking three units of fast acting to 10g of carbs !, and its effect varies with the time of day and injection site.

 

[SKB_9]

Hi, I just want to say that i don’t necessarily agree that basal isn’t playing a role here. As you mentioned being on levemir, I was having real problems with levemir with hypos and eventually was told that it’s effect peaks after so many hours which explained the hypos I was having consistently on the commute home from work. I definitely second the recommendation of cutting out carbs completely to check your basal is correct. From there you can experiment with bolus ratios. It’s frustrating because it feels slow but I can’t tell you enough how much better I feel after I got my levemir right. Everything was just much more predictable (within reason!) overall your graph actually looks good it just needs moving down a few points overall.

I totally sympathise with the hypo anxiety and desperation to avoid it. I suggest you try and hold out and monitor closely with your libre when your correction kicks in. I also find with novorapid that the majority of a drop happens in the first two hours. Sometimes I correct before bed and set an alarm for 60 minutes so I can check how the correction is going.
Overall you’re doing great to try and make these changes, it doesn’t sound too much like your team is giving you the right level of advice or support, make sure you’re being really open with them about how you’re feeling. Also, as someone who just finished therapy with the psychologist in our team for anxiety and burnout, I highly recommend asking to speak to someone about your hypo anxiety, and the frustration you’re feeling, it really could help!

 

[hboyt]

Aww....your story sounds very familiar to mine in the days before my pump! I was on levemir 2 a day and then they decided 3 times a day. In the end the consultants decided levemir just wasn't working for me. Then went on a pump (you only are one continuous quick acting insulin) and and then 2 years ago the cgm. They were both miracles for me. I was used to living in the double digits and alot of 20s with my blood glucose and these days if I hit 14 I know there is something wrong. I never ever believed 6 years ago i could be one of the ones to keep under 10. Please preserve with your consultants at the hospital in trying to get a pump, it was a lifesaver for me. Hope you can get some help

 

[Glynis1]

Hi, I've been type 1 for 56 years. I have Levemir on waking with small dose of short acting to counteract dawn phenomenon. I have 20g carbs about 12 midday and will take short acting Fiasp depending on blood sugars.
I'm on Dexcome 6 and live alone so know your fears of hypo whilst alone. I manage to keep in range 85 to 90 percent of the time. I achieve this by being reactive to pre insulin reading and carbs I'm taking. So anything like crisps, potatoes, pasta or rice need a higher ratio insulin to carbs. I basically follow low carb high fibre diet.