Basal Insulin Help Plz!

[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!

NDT is a treatment for hypothroidism, isn't it? Hypothroidism should lower blood sugar, and hyperthroidism raise it. So if you were taking exactly the right amount of medication it should make no difference.

But.................that might be worth exploring. But I don't know much about this.

 

[Alison54321]

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...

I once studied economics, so learnt to think in graphs and curves, and to never trust experts! I just think in graphs.

But your more methodical approach is extremely valuable.

Only thing is, because @evej is injecting, she can't adjust "chunks" of the Lantus, because the most number of injections anyone would do is two a day. I think with a pump you can adjust the basal dose during the day, but we can't.

So if the basal insulin is behaving differently through different parts of the day the only option really is to change the ratio of the short acting insulin, to account for that.

 

[novorapidboi26]

I once studied economics, so learnt to think in graphs and curves, and to never trust experts! I just think in graphs.

But your more methodical approach is extremely valuable.

Only thing is, because @evej is injecting, she can't adjust "chunks" of the Lantus, because the most number of injections anyone would do is two a day. I think with a pump you can adjust the basal dose during the day, but we can't.

So if the basal insulin is behaving differently through different parts of the day the only option really is to change the ratio of the short acting insulin, to account for that.

I agree with that yeah.....that's hopefully the approach I am getting across.......but its not actually mine, its DAFNE...

I am pumping, but my approach to dose adjustment is DAFNE, which was for injections......

although you cant deliver separate basals with injections its still worth getting the full picture, which is the journey we are taking @evej on.........

I don't use Libre at the minute and that's basically because its not worth the money for me because I am old school with DAFNE dose adjustment principles......[and my doses are all right currently....]

When prescription comes for me, which I am confident it will, I hope to increase my basal rates from 7 up to well, more, with the data from the Libre.....and of course catch any lows or highs before they catch me.....but I am rabbling on a bit....

 

[evej]

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.

I would love to try Tresiba or Toujeo but my insurance doesn't cover either. Re: basal, I don't know a whole lot, but I would have to agree with novorapid in that basal should hold me steady. As I understand it, the Humalog is what would bring me down to a better level. The basal would hold me there (if at the proper amount).

 

[evej]

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.

Who knows? I am starting to think I'll never figure this out! I'm still fighting that rise... so probably won't be able to test lunch today.

It seems that if I get on top of it quickly enough, it's reasonably easy to get it to go down. If it gets away from me though, it's really hard to get it back in any decent range.

Unfortunately, this morning I had a needle tip malfunction, so didn't get my usual 3u at 6am.

 

[evej]

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...

So, I can't test lunch today because I'm too high, but hope I can test suppertime. Any thoughts on why my blood sugar started to rise at 3am last night? This was most unusual and I completely missed it. I only caught it when I checked at 6 and gave myself 2u. Unfortunately my needle malfunctioned, and the whole thing has gotten away from me. Still working on getting it down to a manageable level.

It actually rose a full 5mmol/L

 

[Alison54321]

I would love to try Tresiba or Toujeo but my insurance doesn't cover either. Re: basal, I don't know a whole lot, but I would have to agree with novorapid in that basal should hold me steady. As I understand it, the Humalog is what would bring me down to a better level. The basal would hold me there (if at the proper amount).

Not quite. You need sufficient basal insulin to achieve a reasonable blood sugar, even if you didn't eat anything all day. While the fast acting should allow you to eat a meal, and then return your blood sugar to the level the basal insulin keeps you at.

Of course none of it's that simple, because our insulin requirements vary over the day, and most long acting's have a action curve of their own, that does not resemble our requirements, so the theory is great, but the practical reality is not quite so easy to implement.

We just have to work within the limitations of reality.

 

[evej]

NDT is a treatment for hypothroidism, isn't it? Hypothroidism should lower blood sugar, and hyperthroidism raise it. So if you were taking exactly the right amount of medication it should make no difference.

But.................that might be worth exploring. But I don't know much about this.

Yes, it's a treatment for hypothyroidism, and you're right about raising / lowering blood sugar. I think even if taking exactly the right amount, it would make a difference because NDT gives a distinct increase in T3 around the 2 hour mark, then starts to decrease. It's the T3 apparently that affects blood sugar. I am just starting to look into this as a confounding factor, but it seems logical to me that it would cause some effect.

 

[Alison54321]

Yes, it's a treatment for hypothyroidism, and you're right about raising / lowering blood sugar. I think even if taking exactly the right amount, it would make a difference because NDT gives a distinct increase in T3 around the 2 hour mark, then starts to decrease. It's the T3 apparently that affects blood sugar. I am just starting to look into this as a confounding factor, but it seems logical to me that it would cause some effect.

It's another factor to add into this complex equation.

 

[evej]

Not quite. You need sufficient basal insulin to achieve a reasonable blood sugar, even if you didn't eat anything all day. While the fast acting should allow you to eat a meal, and then return your blood sugar to the level the basal insulin keeps you at.

Of course none of it's that simple, because our insulin requirements vary over the day, and most long acting's have a action curve of their own, that does not resemble our requirements, so the theory is great, but the practical reality is not quite so easy to implement.

We just have to work within the limitations of reality.

Agreed that we need to work within the limitations of reality and that insulin requirements vary during the day AND night.

I have to disagree though with "using sufficient basal to achieve a reasonable blood sugar", and would have to agree with novorapid that basal's function is to keep blood sugar steady during fasting.

Under your theory, I would need to increase night time basal to reduce my blood sugar. But, I've already shown through testing that if I raise my basal at night from 6u to 7u, I will decrease all night long, having a blood sugar by 3am that would be about 2 to 3mmol/L lower. If I would go to bed at a reasonable level, say 6mmol/L, by 3am I could be as low as 3mmol/L, and heading for a serious crash.

6u of Lantus keeps me steady during the night (albeit too high but this is because I'm going to bed too high).

 

[Alison54321]

Agreed that we need to work within the limitations of reality and that insulin requirements vary during the day AND night.

I have to disagree though with "using sufficient basal to achieve a reasonable blood sugar", and would have to agree with novorapid that basal's function is to keep blood sugar steady during fasting.

Under your theory, I would need to increase night time basal to reduce my blood sugar. But, I've already shown through testing that if I raise my basal at night from 6u to 7u, I will decrease all night long, having a blood sugar by 3am that would be about 2 to 3mmol/L lower. If I would go to bed at a reasonable level, say 6mmol/L, by 3am I could be as low as 3mmol/L, and heading for a serious crash.

6u of Lantus keeps me steady during the night (albeit too high but this is because I'm going to bed too high).

Agreed that we need to work within the limitations of reality and that insulin requirements vary during the day AND night.

I have to disagree though with "using sufficient basal to achieve a reasonable blood sugar", and would have to agree with novorapid that basal's function is to keep blood sugar steady during fasting.

Under your theory, I would need to increase night time basal to reduce my blood sugar. But, I've already shown through testing that if I raise my basal at night from 6u to 7u, I will decrease all night long, having a blood sugar by 3am that would be about 2 to 3mmol/L lower. If I would go to bed at a reasonable level, say 6mmol/L, by 3am I could be as low as 3mmol/L, and heading for a serious crash.

6u of Lantus keeps me steady during the night (albeit too high but this is because I'm going to bed too high).

Ok. But there are benefits to splitting equally, which is that it reduces the peaks, and makes it more stable. But it's up to you.

 

[evej]

Ok. But there are benefits to splitting equally, which is that it reduces the peaks, and makes it more stable. But it's up to you.

Yes, that does make sense. But then, in your opinion, what would I do, since increasing night time Lantus would make me crash in the middle of the night? And given that it seems as if I'm CLOSE with daytime, reducing daytime to be in line with night time would LIKELY mean not enough Lantus during the day?

I suppose I might settle out at 6u during the day, but I think unlikely...

I wish I had tried pushing my once daily dose to later in the day to see what happened to that dawn phenomenon.

Or.... I wish I could try Toujeo or Tresiba, but neither are covered by insurance. What do you use for basal?

 

[Alison54321]

Yes, that does make sense. But then, in your opinion, what would I do, since increasing night time Lantus would make me crash in the middle of the night? And given that it seems as if I'm CLOSE with daytime, reducing daytime to be in line with night time would LIKELY mean not enough Lantus during the day?

I suppose I might settle out at 6u during the day, but I think unlikely...

I wish I had tried pushing my once daily dose to later in the day to see what happened to that dawn phenomenon.

Or.... I wish I could try Toujeo or Tresiba, but neither are covered by insurance. What do you use for basal?

I use Lantus too. Lantus is ok, there is an issue with injection sites, that can cause it to act more like a fast acting insulin. So I tend to take my evening dose quite early, just in case. You should avoid sites that you have used too much, and have the wrong sort of fat.

This is why I switched to a split dose. I woke up at about 12.30 am, with a 1.7 mmol/L blood sugar. I did use Levimir a while ago, but at that time I was told it was a long acting, and it just didn't work. Now the recommendation is to use it twice a day. Is there any chance you could switch to Levimir.

After that experience I talked to the doctor, and we discussed injection sites. It might be worth you doing that too.

I thought Canada had a free health service?

I'm not sure about Toujeo. It sounds like a good idea, but it's made by the same process as Lantus, and if you injected in the wrong site, it could be nasty.Was your bad experience with Lantus at night, a one off, or regular?

My feeling is that if you could switch to 11 and 11, or 10 and 11, it would both iron out the peaks, and be safer, because if you injected it into the wrong site, correcting 11 is easier than 22.

But we can work towards achieving that. After my experience with a very low blood sugar, I took a while to get the Lantus to the current level, because it's just not nice having a hypo at night. So I can understand your nervousness about it. But I think an equal split would be better.

 

[evej]

I use Lantus too. Lantus is ok, there is an issue with injection sites, that can cause it to act more like a fast acting insulin. So I tend to take my evening dose quite early, just in case. You should avoid sites that you have used too much, and have the wrong sort of fat.

This is why I switched to a split dose. I woke up at about 12.30 am, with a 1.7 mmol/L blood sugar. I did use Levimir a while ago, but at that time I was told it was a long acting, and it just didn't work. Now the recommendation is to use it twice a day. Is there any chance you could switch to Levimir.

After that experience I talked to the doctor, and we discussed injection sites. It might be worth you doing that too.

I thought Canada had a free health service?

I'm not sure about Toujeo. It sounds like a good idea, but it's made by the same process as Lantus, and if you injected in the wrong site, it could be nasty.Was your bad experience with Lantus at night, a one off, or regular?

My feeling is that if you could switch to 11 and 11, or 10 and 11, it would both iron out the peaks, and be safer, because if you injected it into the wrong site, correcting 11 is easier than 22.

But we can work towards achieving that. After my experience with a very low blood sugar, I took a while to get the Lantus to the current level, because it's just not nice having a hypo at night. So I can understand your nervousness about it. But I think an equal split would be better.

What did your doc say about injection sites? I inject into my belly or hips. Canada's health service is free, but you have to pay at least partially for most medications. It would cost about $135/ month whereas I get Lantus covered by my insurance.

Your hypo experience sounds VERY scary! I've been as low as 1.5, but that was during the day.

I'm now at 14u and 6u. Let's assume we want to try to get it more even. I think I should stay at 6 tonight, but if my test today shows 14u is too much today, I would then try to reduce to 13 or 12 tomorrow. I suppose I could then try 7u again tomorrow evening. Make sense?

 

[Alison54321]

What did your doc say about injection sites? I inject into my belly or hips. Canada's health service is free, but you have to pay at least partially for most medications. It would cost about $135/ month whereas I get Lantus covered by my insurance.

Your hypo experience sounds VERY scary! I've been as low as 1.5, but that was during the day.

I'm now at 14u and 6u. Let's assume we want to try to get it more even. I think I should stay at 6 tonight, but if my test today shows 14u is too much today, I would then try to reduce to 13 or 12 tomorrow. I suppose I could then try 7u again tomorrow evening. Make sense?

It's not very good the health care doesn't cover medication. Hopefully things will improve. I see there's a bit of campaigning going on.

1.5 during the day isn't good. Do you think that might have been the Lantus behaving badly?

I had been using my stomach, for a while, and switched to using my thighs. The doctor's suggestion was to use my stomach for the Lantus, because I hadn't used it for ages, and that seems ok so far. I still use my thighs for the novorapid.

As long as you don't keep on using the same site it should be ok. In the past sometimes I've used the same site, because it's easy, but as you long as you avoid doing that, and make sure there's plenty of fat there, should be ok.

I find that once I know that Lantus can do that, then I keep an eye on it after I've injected, and that's helpful.

I think maybe reducing the day time, to about 10 or 11, and just expecting to have a high glucose while you do that, and then once that's done, start to gradually increase the night time, and see how it goes. Might be a way forward, because they you can be confident that the maximum you're taking at night is 11, and that should be ok. If you've found yourself with a 1.5 blood sugar, I can understand why you wouldn't like them much.

Be interesting to know what @novorapidboi26 thinks about this plan. He's the sensible one.

 

[evej]

It's not very good the health care doesn't cover medication. Hopefully things will improve. I see there's a bit of campaigning going on.

1.5 during the day isn't good. Do you think that might have been the Lantus behaving badly?

I had been using my stomach, for a while, and switched to using my thighs. The doctor's suggestion was to use my stomach for the Lantus, because I hadn't used it for ages, and that seems ok so far. I still use my thighs for the novorapid.

As long as you don't keep on using the same site it should be ok. In the past sometimes I've used the same site, because it's easy, but as you long as you avoid doing that, and make sure there's plenty of fat there, should be ok.

I find that once I know that Lantus can do that, then I keep an eye on it after I've injected, and that's helpful.

I think maybe reducing the day time, to about 10 or 11, and just expecting to have a high glucose while you do that, and then once that's done, start to gradually increase the night time, and see how it goes. Might be a way forward, because they you can be confident that the maximum you're taking at night is 11, and that should be ok. If you've found yourself with a 1.5 blood sugar, I can understand why you wouldn't like them much.

Be interesting to know what @novorapidboi26 thinks about this plan. He's the sensible one.

I didn't know Lantus could do that, but since I'm injecting in my stomach, should be ok. My 1.5 low was a long time ago - probably about 10 years ago and was before I was taking Lantus. I was on Humulin N and Humulin R at that time.

Yes, I'd like to see what novorapid thinks of this idea as well. I suppose I could do it one unit at a time instead, as I'm reluctant to take 10u Lantus at night since 7 made me drop 3.6mmol/L

Does it work to test both day and night on the same day?

I will probably start using my thigh for Humalog I think. Can you inject in your thigh one day and your stomach the next for Humalog?

Since I'm injecting Lantus at 7am and 7pm, the peak amount should be around noon - 2pm and midnight - 2am I think.

 

[Alison54321]

I didn't know Lantus could do that, but since I'm injecting in my stomach, should be ok. My 1.5 low was a long time ago - probably about 10 years ago and was before I was taking Lantus. I was on Humulin N and Humulin R at that time.

Yes, I'd like to see what novorapid thinks of this idea as well. I suppose I could do it one unit at a time as well. Does it work to test both day and night on the same day?

I will probably start using my thigh for Humalog I think. Can you inject in your thigh one day and your stomach the next for Humalog?

You can, people do say that absorption in the stomach is quicker, but I doubt it's that significant. I find using separate sites for the two insulins works well for me. I can't technically describe it, but the Lantus, when injected, is sort of suspended in the subcutaneous fat, in acid, and then released slowly. My tendency is to do quite a lot of corrections with the fast acting, and so I decided to use separate sites.

 

[evej]

You can, people do say that absorption in the stomach is quicker, but I doubt it's that significant. I find using separate sites for the two insulins works well for me. I can't technically describe it, but the Lantus, when injected, is sort of suspended in the subcutaneous fat, in acid, and then released slowly. My tendency is to do quite a lot of corrections with the fast acting, and so I decided to use separate sites.

I also do multiple corrections with fast acting, but sometimes I think I wait too long

 

[evej]

Ok... I forgot my Lantus tonight. Took it two hours late. I am totally burning out. Between still feeling sick from my thyroid issues to trying to fix my blood sugar, I just feel like I cannot do this anymore.

 

[Alison54321]

I also do multiple corrections with fast acting, but sometimes I think I wait too long

I do find that if you can catch a too high blood sugar early, that helps.

Ok... I forgot my Lantus tonight. Took it two hours late. I am totally burning out. Between still feeling sick from my thyroid issues to trying to fix my blood sugar, I just feel like I cannot do this anymore.

Sorry to hear that @evej .

Just stick with the dose you have for now, and let that settle down. It seems to be working quite well, apart from the afternoon dip, but as you know about it, then it's ok.

Then when you feel better you can make some more changes. It can be stressful worrying about diabetes, so better not to worry about it for a bit.