Basal Insulin Problem

noblehead said:

When you do a basal test you just miss one meal at a time, the following explains all:

http://www.salforddiabetescare.co.uk/index2.php?nav_id=1007

Your overnight drop in bg levels would mean a reduction in basal insulin is needed, but the mid-morning highs might just be that your experiencing a liver dump which is pushing your bg levels up, if I miss breakfast my bg levels can be in double figures two hours from waking.

Speak with your DSN and mention your results.

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mahola said:

Lantus has never lasted 24 hours for me. I've now split my dose (8am & 8pm) and it's given me much better results.

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noblehead said:

What I'm saying is, you went from 5pm to lunch the next day without eating, 19 hours is a long time to go without food.

Not sure if you have the book Think Like a Pancreas already, but if not it's worth purchasing, it goes into detail about basal testing and acting on the results.

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PhoebeFlorence said:

Hi,
Hadn't thought of it like that - it is a long time.
I am going on the BERTIE course on Monday and this is what I had to do before I go:

Do not eat carbohydrate from last meal (latest 8pm) - mine was 5pm - until midday
Miss Breakfast
Record Blood Glucose Levels Pre-Bed, On Waking and Midday.

Thought I had followed that but now you say, 19 hours is too long.

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rockape37 said:

Probably the best book you can buy. It has all the information you need and is written in such a way i would say easy to understand with a smattering of humour.
I wish i had read this years ago.

Chapter 5 Basal/Bolus Approach.
Chapter 6 Basal Insulin Dosing.

Regards

Martin

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donnellysdogs said:

It may be that you are getting liver dump. But this may be resolved by having a small bolus in the morning.

Due to stomach probs I only eat one small meal a day.

I have levemir now at 3 times a day to stagger the lows between 3am and 4am. However, I know as soon as my feet hit the floor my levels will rise huge.. Up in to the 20's without a bolus.

I didn't scientifically work out my morning bolus (no food). I just started at one unit and worked my way up.

I am lucky that I have tea in bed in the mornings (wonderful hubby). So he wakes me and I test & inject immediately. Then get up after I've drunk my tea.

I'm trialling myself on 3 levemirs to try and stop my levels dropping at 3am/4am. So I'm doing a 1.5 unit shot at 5pm and another 1 unit shot at midnight. Currently though even on those small doses I'm still crashing down.

Also, although books and others may disagree... When I basal test I carry on having my coffees and teas. The reason being I drink 500ml of milk in them a day.. That equates to 24.5 carbs. So if I tested and injected etc without milk when I went back to it my bloods would all be wrong as my basal insulin would have been adjusted to not having those relevent 24g of carbs from milk.

I only eat at 5 or 6pm each day due to stomach problems but effectively I am having 24g of carbs during day in my milk..

I personally would have done from 5pm to noon next day if I was basal testing my morning levels....

I even carry on if I go high.. Above 12 you shouldn't eat really anyway... So I just do a correction and not eat for another 5 hours to check if my correction factor is right...

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iHs said:

When I used Lantus back in 2002, I just injected it before bed, had a small snack to try to prevent a hypo at 2am and got up in the morning ok.. I usually always had a sharp rise in bg levels from 8am onwards so just adjusted the bolus a bit and used a carb ratio of 1u to 3g carb which worked ok for the morning until lunchtime. When I switched to Levemir, I realised that I needed to inject it at bedtime and in the morning. As a result, my breakfast carb ratio changed to 1u to 7g carb.

Think Like A Pancreas is good for MDI.

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Luke2709 said:

Hello @PhoebeFlorence! I completed the BERTIE course Monday last week in Bournemouth! Such a good course, all the staff are great and the course content is brilliant. I've been Type 1 for just over 18 years and since finishing the course, I've never felt so in control! You'll get right on track with it all I promise! All the best

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DunePlodder said:

Hi PhoebeFlorence. I used Lantus for 10 years or so & thought it seemed OKish. Latterly I found my bgs becoming increasingly erratic with no explanation, even in hindsight. I tried splitting the dose which didn't help - Lantus did appear to last 24 hours for me. After reading other people's positive experiences with Levemir I made the change to it. In part I think I felt it was just time to try something else.

I'm now glad I did, though it was like starting all over again. Not only sorting out basal doses - much confused by a holiday when I seemed to need much less - but also I've had to reduce my meal boluses (Humalog) which I wasn't expecting.

Levemir doesn't last 24 hours so I take 2 doses but I find this more flexible. If I'm going out for an energetic hike I can reduce my morning Levemir. With Lantus I had to think about it the evening before & reducing would lead to higher overnight readings.

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DunePlodder said:

Have you considered trying something like the Freestyle Libre? I use a Dexcom & it makes such a big difference, especially when changing insulins.
Of course it is expensive but may be worth doing for a month or even just a couple of weeks. The set up costs of the Libre aren't too bad.

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