Basal Insulin Help Plz!

[evej]

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


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.

Thanks Alison. I am probably trying to do too much at once. I'm doing 14u and 6u again today. But, I do want to try 13u and 7. Maybe tomorrow... but I don't think I'll do any testing today. Yesterday's 14 | 6 test seemed ok. Pretty much a flat line during the test period of 3:15 to 6:15. I just couldn't fast anymore than that lol.

Managed to stop the DP this morning.

 

[Alison54321]

Hello @evej that sounds good. Have a rest from the stress of it, trying to sort out these badly behaved insulins that won't do anything we want them to, can get stressful. Sorting out the DP this morning though, sounds good.

 

[evej]

Trying 13u 7am, 7u 7pm today. Will see what overnight is with trying to get the two Lantus' more even. Is it DP though - is there anything else it could be? It only starts at 6amish, not 3am. I'm nice and flat until right around 6. I never go low at night, so can't be Symogyi (however you spell it lol). It would have to be either DP, or my Lantus is hitting its low point at 6am... correct?

Or.... my liver is releasing glycogen because I need breakfast?

The only way to correct it seems to be 2 or 3 units of Humalog as soon as I see the 'up' arrow on my Libre.

 

[Alison54321]

Trying 13u 7am, 7u 7pm today. Will see what overnight is with trying to get the two Lantus' more even. Is it DP though - is there anything else it could be? It only starts at 6amish, not 3am. I'm nice and flat until right around 6. I never go low at night, so can't be Symogyi (however you spell it lol). It would have to be either DP, or my Lantus is hitting its low point at 6am... correct?

Or.... my liver is releasing glycogen because I need breakfast?

The only way to correct it seems to be 2 or 3 units of Humalog as soon as I see the 'up' arrow on my Libre.

That sounds good. If you're having no hypos at night, and it's only rising at 6 am, it might be worth seeing that as success. Maybe leaving it a bit lopsided isn't such a bad idea if it's work.

I found this yesterday, it includes a simplified version of the Lantus action curve, real life ones are more complicated, but it gives an idea.

https://sites.google.com/site/diabetesmapp/insulin-action-curves

It rises, and has a peak after about 4 hours, so at night that's the biggest risk for hypo, so if that is well in the safety zone, then that's a success. That's where mine goes wrong. It dips quite a lot around 12.30 am, unless it's in a bad mood, and then it rises.

But if you've got a relatively steady overnight coverage, I might just leave it there.

That might explain why your afternoon blood sugars are lower, because Lantus probably peaks around the time you're having lunch, so the fasting acting/carb ratio will be different to the rest of the day.

Anyway, it's sounding good.

 

[evej]

That sounds good. If you're having no hypos at night, and it's only rising at 6 am, it might be worth seeing that as success. Maybe leaving it a bit lopsided isn't such a bad idea if it's work.

I found this yesterday, it includes a simplified version of the Lantus action curve, real life ones are more complicated, but it gives an idea.

https://sites.google.com/site/diabetesmapp/insulin-action-curves

It rises, and has a peak after about 4 hours, so at night that's the biggest risk for hypo, so if that is well in the safety zone, then that's a success. That's where mine goes wrong. It dips quite a lot around 12.30 am, unless it's in a bad mood, and then it rises.

But if you've got a relatively steady overnight coverage, I might just leave it there.

That might explain why your afternoon blood sugars are lower, because Lantus probably peaks around the time you're having lunch, so the fasting acting/carb ratio will be different to the rest of the day.

Anyway, it's sounding good.

Too late for today. I'll see what happens with the 13 and 7. Last time I tried 7 at night though, I had a down-trend all night. Can you add Humalog to Lantus? Might want to try adding 2 units to my morning dose to save myself one shot lol. Also, have you ever tried Tresiba or Toujeo?

Can you go just a touch off the 12-hour split? Example, could I do the Lantus at 6:30 am and 7pm?

Or... maybe I should move my Lantus to 11am and 11pm to see whether I can get the Lantus peak closer to 6am?

Nice charts btw. I don't think Levemir is for me. It would peak at night. Too bad there isn't a Tresiba and Toujeo chart.

 

[Alison54321]

Too late for today. I'll see what happens with the 13 and 7. Last time I tried 7 at night though, I had a down-trend all night. Can you add Humalog to Lantus? Might want to try adding 2 units to my morning dose to save myself one shot lol. Also, have you ever tried Tresiba or Toujeo?

Can you go just a touch off the 12-hour split? Example, could I do the Lantus at 6:30 am and 7pm?

Or... maybe I should move my Lantus to 11am and 11pm to see whether I can get the Lantus peak closer to 6am?

Nice charts btw. I don't think Levemir is for me. It would peak at night. Too bad there isn't a Tresiba and Toujeo chart.

See what happens tonight. A downward trend overnight might have some advantages, as it would reduce the impact of the DP. So lets see what happens. The thing to avoid is a middle of the night hypo.

Yes, it would be nice to have more charts, but they are only a guide.

 

[evej]

See what happens tonight. A downward trend overnight might have some advantages, as it would reduce the impact of the DP. So lets see what happens. The thing to avoid is a middle of the night hypo.

Yes, it would be nice to have more charts, but they are only a guide.

I sooooo wish I would have tested moving once daily Lantus to a different time of day!

 

[Alison54321]

I sooooo wish I would have tested moving once daily Lantus to a different time of day!

It might have worked, but you would then have moved the time period when it starts to run out to maybe just before lunch. So you would still have to have dealt with that drop in basal insulin, just at a different time of the day.

However, if you don't like the split, you can try that out.

 

[evej]

It might have worked, but you would then have moved the time period when it starts to run out to maybe just before lunch. So you would still have to have dealt with that drop in basal insulin, just at a different time of the day.

However, if you don't like the split, you can try that out.

This is true. I'm not moving back to single dose now. It just would have helped me figure out whether it was DP or my Lantus was running out.

 

[evej]

See what happens tonight. A downward trend overnight might have some advantages, as it would reduce the impact of the DP. So lets see what happens. The thing to avoid is a middle of the night hypo.

Yes, it would be nice to have more charts, but they are only a guide.

I would prefer not to have a downward trend overnight. I realize it'll never be perfect, but what I'd like to see is basal neutrality, both day and night.

 

[Alison54321]

I would prefer not to have a downward trend overnight. I realize it'll never be perfect, but what I'd like to see is basal neutrality, both day and night.

The latest change should create greater day time neutrality, while reducing night time neutrality, so you'll have to see what you prefer.

 

[evej]

First day EVER with no blood sugar above 13.3, which means no yellow on the chart. Woohoo!!!

Question: I took 6u Humalog for 36 carbs at 11:45, and ate lunch at noon. The Humalog should be wearing off between 4 and 5pm. At 3:30 I had to eat 14g of carbs, and at 5pm I had to eat another 12g carbs in order to stop lows. I took 13u Lantus at 7am, which should have peaked around noon.

Either I took too much Humalog at noon and need to adjust my ratio, or I'm taking too much Lantus (13u) in the morning, or both. I know I didn't fast, but I was going lowish and would have crashed if I didn't eat when there should have been very little to no Humalog left from my noon-time dose. Was it Humalog or Lantus or both??

 

[Alison54321]

First day EVER with no blood sugar above 13.3, which means no yellow on the chart. Woohoo!!!

Question: I took 6u Humalog for 36 carbs at 11:45, and ate lunch at noon. The Humalog should be wearing off between 4 and 5pm. At 3:30 I had to eat 14g of carbs, and at 5pm I had to eat another 12g carbs in order to stop lows. I took 13u Lantus at 7am, which should have peaked around noon.

Either I took too much Humalog at noon and need to adjust my ratio, or I'm taking too much Lantus (13u) in the morning, or both. I know I didn't fast, but I was going lowish and would have crashed if I didn't eat when there should have been very little to no Humalog left from my noon-time dose. Was it Humalog or Lantus or both??

 

[Alison54321]

That looks very good, well done. I might be inclined to reduce the ratio of the humalog first, to see what happens. Because the lunch time peak, after eating, isn't that high, which would suggest the ratio could be reduced a little bit.

If you're getting better blood sugar control you might find your insulin resistance reduces, and you start to need less, so keep an eye for that. But I think I'd reduce the humalog first, then if you're still getting low blood sugars in the afternoon reduce the morning Lantus. I suspect you will have to do that, as the new lower blood sugar regime becomes established, anyway.

But, obviously do what feels right for you.

 

[evej]

That looks very good, well done. I might be inclined to reduce the ratio of the humalog first, to see what happens. Because the lunch time peak, after eating, isn't that high, which would suggest the ratio could be reduced a little bit.

If you're getting better blood sugar control you might find your insulin resistance reduces, and you start to need less, so keep an eye for that. But I think I'd reduce the humalog first, then if you're still getting low blood sugars in the afternoon reduce the morning Lantus. I suspect you will have to do that, as the new lower blood sugar regime becomes established, anyway.

But, obviously do what feels right for you.

Thanks! I did take 13u Lantus again this morning. Am going to try to test that over lunch. What's a normal peak after eating?

 

[Alison54321]

Thanks! I did take 13u Lantus again this morning. Am going to try to test that over lunch. What's a normal peak after eating?

There isn't a lot of consensus on this, as far as I can tell, but you had quite a small rise. This is a good thing. But reducing the Lantus has more knock on consequences than reducing the Humalog, so I would recommend trying that first.

 

[evej]

Tested 13 | 6 units of Lantus yesterday at lunch. I dropped 2mmol/L in about 2 hours, so will try 12 | 6 today. I did increase during the night last night though by about 2mmol/L, starting at about 4am. Does this mean I should change my ratio to 11 | 7??

 

[Alison54321]

Tested 13 | 6 units of Lantus yesterday at lunch. I dropped 2mmol/L in about 2 hours, so will try 12 | 6 today. I did increase during the night last night though by about 2mmol/L, starting at about 4am. Does this mean I should change my ratio to 11 | 7??

That might be worth doing. I think with Lantus it's supposed to take a few days to sort of settle down after changing, so you might want to try 12/6 for a few days, and see if the overnight rise is a regular pattern, before making another change.

Maybe. But do what feels right for you.

 

[novorapidboi26]

Definitely give the Lantus a couple of days.....

Also, 2mmol isn't significant.......when fine tuning the basal testing on pumps you would only make a change if it fluctuated by more than 1.7mmol.....you certainly cant achieve those levels of accuracy on injections, so a 2mmol fluctuation could be ignored for now....

 

[evej]

That might be worth doing. I think with Lantus it's supposed to take a few days to sort of settle down after changing, so you might want to try 12/6 for a few days, and see if the overnight rise is a regular pattern, before making another change.

Maybe. But do what feels right for you.

Yeah Alison, I read that as well. Have been changing things up every 2 days instead of every day.