Basal Insulin Help Plz!

[evej]

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....

Hmmm novorapid. I had also read 1.7 was the cutoff, but didn't realize that was for pumping and not necessarily injections. I will stay at 12 | 6 for a few days and see what happens with that. I stopped the test at 2mmol/L difference, but the arrow had recently changed from straight across to trending slowly down.

I guess I would also like to see what happens if I get the two doses closer together, eg. 10 | 8. But maybe I shouldn't bother. I'd like to get to some conclusion at some point lol.

 

[novorapidboi26]

Hmmm novorapid. I had also read 1.7 was the cutoff, but didn't realize that was for pumping and not necessarily injections. I will stay at 12 | 6 for a few days and see what happens with that. I stopped the test at 2mmol/L difference, but the arrow had recently changed from straight across to trending slowly down.

I guess I would also like to see what happens if I get the two doses closer together, eg. 10 | 8. But maybe I shouldn't bother. I'd like to get to some conclusion at some point lol.

Would you like the doses to be close together?

They certainly don't have to be, its just whatever you need that dictates the dose....

Are you using blood test data for these basal tests....?

 

[evej]

Would you like the doses to be close together?

They certainly don't have to be, its just whatever you need that dictates the dose....

Are you using blood test data for these basal tests....?

I will use whatever I need to, but would like to see what happens if I do. I haven't yet tested 12 | 6 of Lantus during the day, and can't today. Will do that tomorrow.

I am using CGM data for the basal tests. Do I need to use blood?

 

[novorapidboi26]

I will use whatever I need to, but would like to see what happens if I do. I haven't yet tested 12 | 6 of Lantus during the day, and can't today. Will do that tomorrow.

I am using CGM data for the basal tests. Do I need to use blood?

I wouldn't say you do need to use blood test data, certainly not for pump basal rates once they are already partially established....

but for injections, the argument could be that the blood test gives a much more accurate before and after picture which would make adjustments more effective, and would highlight that you may not need to adjust....

I suppose they both have pros and cons, so doing what you're doing now is fine....

 

[evej]

I have an issue with my bolus that I could use some help with. I am using 1:8 ratio for lunch and 1:11 for supper. I am waiting 15 minutes before eating.

So, typically what's happening is I start to drop between my shot and eating, and continue to drop after eating by about 2mmol/L over half an hour. My blood sugar continues to drop until the 1 hour mark when it starts to rise. Around the 2 hour mark, I have to give myself a small dose of 2 to 3u or I will rise too high. This stops the rise, turns it around, but then I end up crashing half an hour to an hour later.

It's a bit of a roller coaster, and I'm not sure how to turn this around.

 

[evej]

I wouldn't say you do need to use blood test data, certainly not for pump basal rates once they are already partially established....

but for injections, the argument could be that the blood test gives a much more accurate before and after picture which would make adjustments more effective, and would highlight that you may not need to adjust....

I suppose they both have pros and cons, so doing what you're doing now is fine....

Cool. I will keep on with the CGM, and could verify with blood once I feel I'm really close. This particular sensor is pretty close, within 1mmol/L to blood. I usually check two or three times a day.

 

[novorapidboi26]

I have an issue with my bolus that I could use some help with. I am using 1:8 ratio for lunch and 1:11 for supper. I am waiting 15 minutes before eating.

So, typically what's happening is I start to drop between my shot and eating, and continue to drop after eating by about 2mmol/L over half an hour. My blood sugar continues to drop until the 1 hour mark when it starts to rise. Around the 2 hour mark, I have to give myself a small dose of 2 to 3u or I will rise too high. This stops the rise, turns it around, but then I end up crashing half an hour to an hour later.

It's a bit of a roller coaster, and I'm not sure how to turn this around.

If you are dropping before you eat then you could assume that the insulin is starting to work before digestion is taking place....

The normal behaviour is a rise up to the 1.5-2 hour mark, then a steady drop back down in to range.....

You say after 2 hours that it will continue to rise, which suggest there may be some delay to the digestion/glucose absorption....

I would say that bringing the shot to immediately before eating would be a good place to start...then look at the Libre data and see what's happening, without, if you can manage, a correction...

Obviously you would have to consider what you are eating and what the fat/protein content it....as well as carbs...

 

[evej]

If you are dropping before you eat then you could assume that the insulin is starting to work before digestion is taking place....

The normal behaviour is a rise up to the 1.5-2 hour mark, then a steady drop back down in to range.....

You say after 2 hours that it will continue to rise, which suggest there may be some delay to the digestion/glucose absorption....

I would say that bringing the shot to immediately before eating would be a good place to start...then look at the Libre data and see what's happening, without, if you can manage, a correction...

Obviously you would have to consider what you are eating and what the fat/protein content it....as well as carbs...

I think if the arrow is down trending I should eat earlier than 15 minutes after my shot. If it's going up, I should wait 15 minutes. If straight across, who knows lol?

If I have a delay in the digestion/glucose absorption, should I split my shot, eg. if I would be taking 6u, take 4u before I eat, and 2u after?

Right now, I am eating exactly the same thing for lunch, so this would be a good place to start - a ham sandwich on 10 grain bread and a yogurt. The carbs are 46 grams. I'm uncertain how to tell what the protein content is. There's protein in the ham and the yogurt. Do you figure it out by percentage?? And how do you figure out the fat content? There's butter on the sandwich.

 

[novorapidboi26]

I think if the arrow is down trending I should eat earlier than 15 minutes after my shot. If it's going up, I should wait 15 minutes. If straight across, who knows lol?

If I have a delay in the digestion/glucose absorption, should I split my shot, eg. if I would be taking 6u, take 4u before I eat, and 2u after?

Right now, I am eating exactly the same thing for lunch, so this would be a good place to start - a ham sandwich on 10 grain bread and a yogurt. The carbs are 46 grams. I'm uncertain how to tell what the protein content is. There's protein in the ham and the yogurt. Do you figure it out by percentage?? And how do you figure out the fat content? There's butter on the sandwich.

As a non libre user I may be talking rubbish I wouldn't put too much faith in the trending arrow....as long as you know what you active insulin you should be fine....

The issue seems to be how quickly the insulin starts....ten to fifteen minutes usually is the norm but everyone is different....so it's definitely worth exploring with the lead in times.....

 

[novorapidboi26]

Right now, I am eating exactly the same thing for lunch, so this would be a good place to start - a ham sandwich on 10 grain bread and a yogurt. The carbs are 46 grams. I'm uncertain how to tell what the protein content is. There's protein in the ham and the yogurt. Do you figure it out by percentage?? And how do you figure out the fat content? There's butter on the sandwich.

My reference to fat and protein was because high fat meals can cause a delay in absorption.

But a sandwich and yoghurt will digest normally for most folk.....

 

[evej]

As a non libre user I may be talking rubbish I wouldn't put too much faith in the trending arrow....as long as you know what you active insulin you should be fine....

The issue seems to be how quickly the insulin starts....ten to fifteen minutes usually is the norm but everyone is different....so it's definitely worth exploring with the lead in times.....

I find the trend arrows very valuable, and find they're very accurate in predicting where blood sugar is going. The only confusing one is the straight across, which means you're not rising or dropping very fast.

My ratio is probably still not right either. Things have changed a lot over the past week or so.

 

[evej]

My reference to fat and protein was because high fat meals can cause a delay in absorption.

But a sandwich and yoghurt will digest normally for most folk.....

Yeah, and it should for me too, but it does seem I have a delay. I've read thyroid can have an effect with absorption. I am hypothyroid on desiccated thyroid. Possibly that's a confounding issue?

 

[novorapidboi26]

Yeah, and it should for me too, but it does seem I have a delay. I've read thyroid can have an effect with absorption. I am hypothyroid on desiccated thyroid. Possibly that's a confounding issue?

I wouldn't count that out for sure....

 

[becca59]

As a non libre user I may be talking rubbish I wouldn't put too much faith in the trending arrow....as long as you know what you active insulin you should be fine....

The issue seems to be how quickly the insulin starts....ten to fifteen minutes usually is the norm but everyone is different....so it's definitely worth exploring with the lead in times.....

I would have agreed TIL I started with the Libre. I injected an hour before eating this morning before a downwards trend started and 30 minutes at lunch. The insulin action is taking far longer than I imagined it would do. It’s helped stopped post meal lows and given less peaks by doing this. Was starving at breakfast though!

 

[novorapidboi26]

I would have agreed TIL I started with the Libre. I injected an hour before eating this morning before a downwards trend started and 30 minutes at lunch. The insulin action is taking far longer than I imagined it would do. It’s helped stopped post meal lows and given less peaks by doing this. Was starving at breakfast though!

So do you leave an hour between injection and breakfast every morning.....?

I haven't heard such a length of time but if that's what you need to keep the spike down that's what you need...

45 minutes is the longest I have used......30 minutes is where it seems to have settled for now.....

 

[evej]

I will try doing two doses at lunch today, but.... chinese food = BAD!!! I ended up using twice the insulin as normal for supper and STILL had trouble bringing sugars down!

 

[evej]

I would have agreed TIL I started with the Libre. I injected an hour before eating this morning before a downwards trend started and 30 minutes at lunch. The insulin action is taking far longer than I imagined it would do. It’s helped stopped post meal lows and given less peaks by doing this. Was starving at breakfast though!

Becca, I find the same thing. Although I've been having some trouble going too low before the meal kicks in - looks like sometimes I wait too long. I take my Humalog, and wait until I see a downtrend in the arrow. I mostly have to wait 20ish minutes.

I don't wait if I'm in target and the arrow is down-trending.

 

[evej]

So do you leave an hour between injection and breakfast every morning.....?

I haven't heard such a length of time but if that's what you need to keep the spike down that's what you need...

45 minutes is the longest I have used......30 minutes is where it seems to have settled for now.....

I generally take two shots in the morning - one to stop the DP around 6:00 or 6:30. Then a second about an hour later - I wait about 15 or 20 min after the second shot for breakfast. If I was more organized, I'd be able to combine them. I eat boiled eggs and a small carb (about 10g), and always forget to prepare the eggs the night before lol.

 

[evej]

I am trying to figure out what 1 unit of Humalog does to my blood sugar. I've tried several times, and it seems to do absolutely nothing?? It seems I have to give at least 2 in order to move blood sugar down at all.

 

[becca59]

So do you leave an hour between injection and breakfast every morning.....?

I haven't heard such a length of time but if that's what you need to keep the spike down that's what you need...

45 minutes is the longest I have used......30 minutes is where it seems to have settled for now.....

Most mornings. I tend to have resistance in the morning and find if I eat too soon there is a knock on effect with higher levels. I wouldn’t care but I only eat 10 carbs of rasps/yoghurt. I had to give up my preferred Shredded Wheat as I couldn’t get an acceptable reaction to it even with a pre bolus.