Basal Insulin Help Plz!

[Alison54321]

Hello @evej I just had one other thought. This takes us into quirky medicine territory, not the sort of thing doctors tell us.

But, according to research, and it's real research not quirky stuff, high blood sugars mean that we lose more magnesium than normal, in our urine. Now I move on to the quirky stuff, that might be having an impact on your cortisol levels. So as well as having a few carbs for breakfast, and melon is great, it might be worth thinking about this, you can find stuff online.

I only found this out a few years ago, when I tried to take a vitamin d supplement, and by late April, when we getting real vitamin d, I started to feel quite weird, and then I remembered that the advice was don't take a supplement without magnesium. So I found out more about it, and saw the research about high blood sugars, and put two and two together.

 

[novorapidboi26]

First round of daytime testing.

7:45: Last bolus 2u Humalog
11:45: 12.9 @ Libra trending across. 11.8 @ blood
12:45: 11.8 Libre trending across
1:45: 10.3 Libre trending across. 9.7 @ blood
2:15 9.2 Libre trending slow down

I had nothing to eat after 7:45. I stopped the test at 2:15 because I've dropped 3.6mmol/L in 2.5 hours. I would assume my daytime Lantus is too high. I took 14u this morning. So do I go to 12u or 13u tomorrow morning? Will stay at the 6u tonight.

Thanks!

I agree with you......looking to be too much during the day.......

did the blood test say 3.6 at 2:15 compared to the libres' 9.2 or did the hypo come after 2:15?

Best practice would be to repeat the test with 14 units just to make sure, even though it is pretty obvious whats happening...

so when your happy to do so, take it down to 13 units......13 units because the drop in BG has been slow by the way you are describing it....

good job...

 

[Alison54321]

I agree with you......looking to be too much during the day.......

did the blood test say 3.6 at 2:15 compared to the libres' 9.2 or did the hypo come after 2:15?

Best practice would be to repeat the test with 14 units just to make sure, even though it is pretty obvious whats happening...

so when your happy to do so, take it down to 13 units......13 units because the drop in BG has been slow by the way you are describing it....

good job...

I understand the theory here, but how does @evej get her blood sugar down to within a normal range if she decreases the basal? Yes, the trend over lunch is downwards, but there could be a number of reasons for that. I wouldn't dream of reducing my basal if the lowest point is 9 mmol/L, even if a finger prick test is lower,it's still only just touching normal. But anyway, I'll leave you to get on with it!

I

 

[novorapidboi26]

I understand the theory here, but how does @evej get her blood sugar down to within a normal range if she decreases the basal? Yes, the trend over lunch is downwards, but there could be a number of reasons for that. I wouldn't dream of reducing my basal if the lowest point is 9 mmol/L, even if a finger prick test is lower,it's still only just touching normal. But anyway, I'll leave you to get on with it!

I

The process for my basal testing is to find the dose that holds you steady within plus or minus 2mmol......trial and error.....

I agree that the drop that @evej had from 12pm till 2:15pm may be down to something else, hence why the test should be repeated at the 14 units, before any reduction in basal is done....

I am pretty sure a hypo occurred, which resulted in the test stopping early....so I don't know where the 9mmol is coming from...

 

[Alison54321]

I agree with you......looking to be too much during the day.......

did the blood test say 3.6 at 2:15 compared to the libres' 9.2 or did the hypo come after 2:15?

Best practice would be to repeat the test with 14 units just to make sure, even though it is pretty obvious whats happening...

so when your happy to do so, take it down to 13 units......13 units because the drop in BG has been slow by the way you are describing it....

good job...

No I don't think it was a hypo, she stopped because her blood sugar had dropped BY 3,6mmol/l, not TO 3.6 mmol/L.

I understand the idea is to hold it steady, but injecting is so much less flexible, compared to pumps, and so the ability to adjust is much more limited. So there has to be a bit of trade off, when it comes to the basal insulin. To some degree the average bg level that is achieved, is more important than stability.

Toujeo, is apparently more stable, it's new. Don't know anything about Tresiba, but both Levemir, and Lantus have peaks.I read that Lantus can also have a kick in the tail. I found this out one night, when I thought I might have accidentally taken too much, and I read that somewhere.

I used to experience a kick in the tail about 4 pm,when I was doing one daily dose. Her evening hypo, the other day, could be the kick in the tail, or just some random thing, that seems to happen so often.

 

[novorapidboi26]

No I don't think it was a hypo, she stopped because her blood sugar had dropped BY 3,6mmol/l, not TO 3.6 mmol/L.

I understand the idea is to hold it steady, but injecting is so much less flexible, compared to pumps, and so the ability to adjust is much more limited. So there has to be a bit of trade off, when it comes to the basal insulin. To some degree the average bg level that is achieved, is more important than stability.

Toujeo, is apparently more stable, it's new. Don't know anything about Tresiba, but both Levemir, and Lantus have peaks.I read that Lantus can also have a kick in the tail. I found this out one night, when I thought I might have accidentally taken too much, and I read that somewhere.

I used to experience a kick in the tail about 4 pm,when I was doing one daily dose. Her evening hypo, the other day, could be the kick in the tail, or just some random thing, that seems to happen so often.

You're right it was a drop by 3.6 and not to 3.6, apologies.....

a drop of 3.6mmol during a basal test does warrant adjustment though.....

we know that injections isn't going to be able to satisfy the whole day or night, but you need to establish a base line, and the basal is most important when it comes to getting the dose right...

the super long acting insulin's seem good for some people....its never something I personally experienced.....as I was on considerably different doses of basal from day to night......similar it seems to @evej

when you say kick in the tail, so you mean a shirt period of stronger basal....?.......that certainly wouldn't go with the behaviour we all expect from Lantus....

 

[Alison54321]

You're right it was a drop by 3.6 and not to 3.6, apologies.....

a drop of 3.6mmol during a basal test does warrant adjustment though.....

we know that injections isn't going to be able to satisfy the whole day or night, but you need to establish a base line, and the basal is most important when it comes to getting the dose right...

the super long acting insulin's seem good for some people....its never something I personally experienced.....as I was on considerably different doses of basal from day to night......similar it seems to @evej

when you say kick in the tail, so you mean a shirt period of stronger basal....?.......that certainly wouldn't go with the behaviour we all expect from Lantus....

 

[Alison54321]

Ok, what happened there? I was trying to write a reply, and the website gremlin decided to post my non-reply.

Anyway, @novorapidboi26

At about 20 hours the Lantus action curve shows a mini peak, and then it starts to fade away. This should, theoretically, be about 3 am, I suppose. While the evening dose would peak earlier than that. Depending on time taken.

It would be interesting to look at the daily patterns to see what shape the average curve is.

I think that once the dawn phenomenon is under control, that there is clearly a case for reducing. But because @evej blood sugar, is only just reaching normal territory by that time, I would not be very keen to reduce the basal. Unless it was to increase the night time a bit more, and make the split more equal.

Lantus is far from perfect, there are absorption issues, and it has funny little ways, but it's what is being used at the moment, so we have to work with it.

I'm just concerned that the dawn phenomenon is making so much of the rest of the day too high, and so I don't see what is achieved by a morning basal reduction, at the moment, as it would just make the afternoon a bit higher. Which might make the basal curve more stable, but a stable curve at too high a blood sugar, isn't really much use.

 

[evej]

Are there any other factors that might impact on blood sugar, like more physical activity at that time of day? It does look like it's trending downwards in the afternoon, but that might be because your cortisol levels are going down. It also might be a Lantus peak.

I haven't done a basal test, because to me there are so many other variables that I'm not sure how meaningful it is. For someone using a pump the basal insulin is far more adjustable, than for someone injecting. At the moment your blood sugars are still quite a lot higher than you want, so if you lower the Lantus, you are going to have to increase your ratios for short acting insulin, and that will bring with it a more zig zaggy effect.

So I would leave it unadjusted for now, but bank that information, for when you get into a more normal range. Which you will.

Nothing else I can think of. I made sure not to exercise. You're right could be a lantus peak though. And I do have other variables. Perhaps I need to take into account when I take my thyroid meds. I'm on NDT, so the T3 would affect my blood sugar. Arghhhh!

 

[evej]

Ok, what happened there? I was trying to write a reply, and the website gremlin decided to post my non-reply.

Anyway, @novorapidboi26

At about 20 hours the Lantus action curve shows a mini peak, and then it starts to fade away. This should, theoretically, be about 3 am, I suppose. While the evening dose would peak earlier than that. Depending on time taken.

It would be interesting to look at the daily patterns to see what shape the average curve is.

I think that once the dawn phenomenon is under control, that there is clearly a case for reducing. But because @evej blood sugar, is only just reaching normal territory by that time, I would not be very keen to reduce the basal. Unless it was to increase the night time a bit more, and make the split more equal.

Lantus is far from perfect, there are absorption issues, and it has funny little ways, but it's what is being used at the moment, so we have to work with it.

I'm just concerned that the dawn phenomenon is making so much of the rest of the day too high, and so I don't see what is achieved by a morning basal reduction, at the moment, as it would just make the afternoon a bit higher. Which might make the basal curve more stable, but a stable curve at too high a blood sugar, isn't really much use.

Ok. I will work on the dawn phenomenon. But.... I had a weird night last night. For the first time in a long time, my blood sugar started to rise at 3am. Just a slow steady upswing, but I didn't expect it. Have to look at why... cuz right now I have no idea!

 

[evej]

Hello @evej I just had one other thought. This takes us into quirky medicine territory, not the sort of thing doctors tell us.

But, according to research, and it's real research not quirky stuff, high blood sugars mean that we lose more magnesium than normal, in our urine. Now I move on to the quirky stuff, that might be having an impact on your cortisol levels. So as well as having a few carbs for breakfast, and melon is great, it might be worth thinking about this, you can find stuff online.

I only found this out a few years ago, when I tried to take a vitamin d supplement, and by late April, when we getting real vitamin d, I started to feel quite weird, and then I remembered that the advice was don't take a supplement without magnesium. So I found out more about it, and saw the research about high blood sugars, and put two and two together.

I am not taking magnesium, but think I perhaps should. Will look into that.

 

[Alison54321]

Nothing else I can think of. I made sure not to exercise. You're right could be a lantus peak though. And I do have other variables. Perhaps I need to take into account when I take my thyroid meds. I'm on NDT, so the T3 would affect my blood sugar. Arghhhh!

Don't worry. I had quite a good HbA1c before I got Freestyle Libre, but after I got it I got a much better picture of what was really going on. But it has taken weeks to get a more stable blood sugar, it's so much trial,and error, and tweaking things, and so many variables.

I reckon if someone with diabetes makes it to 50 years, they shouldn't just get a medal, but also an honorary maths degree, for all that work with graphs/.

 

[Alison54321]

Ok. I will work on the dawn phenomenon. But.... I had a weird night last night. For the first time in a long time, my blood sugar started to rise at 3am. Just a slow steady upswing, but I didn't expect it. Have to look at why... cuz right now I have no idea!

That could be a stress response to missing lunch. If you're back to normal meals today, hopefully that will be a one off.

Though diabetes is always unpredictable.

 

[evej]

I took 14u Lantus again because I'd only taken it for 1 day. Will try to test daytime again. BUT... totally different graph this morning. At 3am I started a gentle rise, which is proving difficult to stop. Looks like my Humalog pen needle didn't work for my 6am 2u correction though, so I've just taken another 3 units.

The only thing I can think of that was different last night is that I ate a small free snack at 9:30, but that shouldn't have affected my blood sugar at 3am.

I guess the other thing that was different is I forgot one of my Thyroid pills and so had to take it quite late - around 11pm or so. I wonder how much my thyroid is affecting my blood sugar. Have just been reading that T3 does affect blood sugar, and I'm on NDT which has T3 in it.

 

[evej]

That could be a stress response to missing lunch. If you're back to normal meals today, hopefully that will be a one off.

Though diabetes is always unpredictable.

Would a stress reponse to missing lunch happen at 3AM?

 

[evej]

Don't worry. I had quite a good HbA1c before I got Freestyle Libre, but after I got it I got a much better picture of what was really going on. But it has taken weeks to get a more stable blood sugar, it's so much trial,and error, and tweaking things, and so many variables.

I reckon if someone with diabetes makes it to 50 years, they shouldn't just get a medal, but also an honorary maths degree, for all that work with graphs/.

HAHA!! well I'm almost 60, so should get two medals??

 

[evej]

One further thought. Freestyle Libre has a very nice daily patterns graph, how does that look?

I think at this point patterns graph might be a bit useless, as I'm rather all over the map! Patterns map does shows widest variation from suppertime to bed time. But... I was using a 1:10 ratio there before I switched to twice daily Lantus and that clearly needs to be adjusted.

 

[evej]

I agree with you......looking to be too much during the day.......

did the blood test say 3.6 at 2:15 compared to the libres' 9.2 or did the hypo come after 2:15?

Best practice would be to repeat the test with 14 units just to make sure, even though it is pretty obvious whats happening...

so when your happy to do so, take it down to 13 units......13 units because the drop in BG has been slow by the way you are describing it....

good job...

Thanks! I stayed at 14 today because I'd dropped from 15 the day before. I will try the test again at 14u. There was no hypo. Just a 3.6mmol/L DROP from 2.5 hours before.

 

[Alison54321]

Would a stress reponse to missing lunch happen at 3AM?

I don't know, I was just trying to think of a reason to not worry about it. But adrenal activity starts a few hours after midnight, and then keeps rising, so maybe the adrenal glands were particularly active last night.

 

[novorapidboi26]

I think that once the dawn phenomenon is under control, that there is clearly a case for reducing. But because @evej blood sugar, is only just reaching normal territory by that time, I would not be very keen to reduce the basal. Unless it was to increase the night time a bit more, and make the split more equal.

I don't really understand your train of thought......

Have you done DAFNE or anything similar?

From previous days, basal tests overnight have resulted in a dose which @evej could conclude is pretty much spot on....

so the next step is during the day, which includes several chunks of time that in reality could all need different amounts of Lantus.....

so each of those chunks need to be tested and then adjusted if needed....an adjustment in the lunch to dinner chunk could create problems for the dinner to bed chunk and the same could apply with the breakfast to lunch.....so a happy medium must be found......any issues after that can be dealt with by adjustment to the bolus ratios...

I've just got back in the office, so maybe wasn't prepared for the detailed response you gave, but the truth is, its went right over my head, talking about peaks and curves etc....

Methodical approach to dose adjustment is the way I was taught and still applies to me now as a pump user, and in the future, a libre user...