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Basal Insulin Problem

P

PhoebeFlorence

Member
Messages
22
Location
Bournemouth
Type of diabetes
Type 1
Treatment type
Insulin
Dislikes
Snakes and any reptiles
Hi everyone,

I have completed 3 days of basal testing and am definately not happy with the results!
Day 1 - last meal 5pm with NovoRapid insulin 6 units.
At 10pm I took my Lantus dose of 6 units.
BGL 11pm 9.2
BGL 3am 7.4
BGL 7am 5.4
BGL 9am 12.2
BGL 11am 23.4
I then gave up my fasting test which was supposed to run till midday and took NovoRapid 8 units to bring my levels back down.

Day 2 and Day 3 were very similar although I gave up the test and took my NovoRapid insulin earlier at 9.30 on reaching a BGL of 14.

I understand that Lantus lasts for 24 hours so why do you think this is happening please?

I have been type 1 for 40 years now but this is the first time I have tested this.
I don't know what I should do?
 
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.
 
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.
Click to expand...


Hi,
Thanks for your reply.
I did just miss one meal - breakfast. My lunch would have been at midday. Can I go lower than 6 units of Lantus?
I will speak with my DSN.
Thanks again
 
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.
Click to expand...
Thanks Mahola,
I am thinking the same now. It only seemed to work for 9 - 10 hours. I have been on Lantus for 15 years so perhaps I need a change.
 
PhoebeFlorence said:
Hi,
Thanks for your reply.
I did just miss one meal - breakfast. My lunch would have been at midday. Can I go lower than 6 units of Lantus?
I will speak with my DSN.
Thanks again
Click to expand...

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.
 
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.
Click to expand...

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.
 
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.
Click to expand...


I hadn't heard of that book but I have just been on amazon and purchased it.
Thanks for your help.
 
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
 
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...
 
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.
 
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.
Click to expand...
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
 
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
Click to expand...

Thanks Martin,

I will read those chapters when I get it.
 
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...
Click to expand...

Hi,
Thanks for your info.

I have taken 2 units of Lantus this morning to give it a go but for some reason my levels are high already. I have the Libre System so I can see that I was 7.1 at 3am and then started climbing to 12.4 at 7am
Thats what I struggle with - its so unpredictable isnt it.
I will try out different times and doses and see if I can get more stable.

Thanks again.
 
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.
Click to expand...

Hi,

I see that quite alot of people have changed or been changed from Lantus to Levemir. Is that a better insulin do you think?
Just wondering if I should suggest changing to it - be good to be more stable.
Thanks for your reply.
 
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
Click to expand...

Hi Luke

That is so good to hear. I too am going to the Bournemouth course so I hope I feel the same as you do!
Thanks for your reply - you have cheered me up!
 
@PhoebeFlorence

For me.....changing to Levemir twice daily from Lantus once daily, made me depend a tiny bit more on the background effect of Levemir controlling my bg levels a bit more evenly and the hypo feeling becoming a tiny bit milder so less severe.
 
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.
 
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.
Click to expand...

Hi DunePlodder,

Thanks for replying.

I think its about time I gave Levemir a go. I don't think it is possible for it to be more erratic than the Lantus I am on so nothing to lose. I was hoping it would be a smooth switch over but having read your message looks like it might not be!
Thanks for your help.
 
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.
 
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.
Click to expand...
Hi DunePlodder,

Yes I have had the Freestyle Libre system for 3 months now and, yes it is expensive but it has definately made me more aware.

What is the Dexcom please? Is that the same sort of thing?
 
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