Can't get my doses right! Is my Lantus dose too high?

[Catsymoo]

Hello all! I have an appointment with my diabetic clinic in a few weeks so I will discuss these problems then, but in the mean time just wondering if anyone can give me a bit of feedback.

Basically in the last year or so, I've completely lost any idea of what my insulin doses are. I have zero confidence and there's been weeks where I've seen my levels in the low 20s. My Novorapid seems very inconsistent. Sometimes 1 unit seems to cover nothing, other times it seems to cover up to 40g carb! I'm terrified of the medicine because hypos are one of my main triggers for anxiety. I run my levels higher because I'm that scared after having a really bad one an hour away from home in January.

My levels have been rubbish the last few weeks. Too high. I had a week where I didn't see it below 10 once. I was waking up on levels of 10-14, and I was starving because I was too afraid to eat proper meals to try and keep the level below 20. I went through a family death, a break up and now I've just lost my home because I can't afford to live alone in my flat. I think that week may have been hormone related. I'm on the mini pill and don't have periods, but the highs seemed to just dramatically stop the next day and I had a flipping hypo one morning when I woke up.

One day I woke up on 9.5. I engaged in sexual activity and tested afterwards, it went up to 12.7! Normally sex drops me like no tomorrow.

Now, the last few days my sugars have been behaving. The highest reading I've seen is 11. But the problem is, I feel I am dropping too much considering how little Novorapid I'm taking. I haven't eaten a proper meal since Thursday because I moved house and was too tired and simply haven't had any time to cook. I've been eating snacks and junk, funny enough. Normally I live off stir fry, usually without noodles because my levels can't handle it and I have no idea how much Novorapid I need. I've lost a TON of weight this year and I'm losing even more due to barely taking my Novorapid. I am too frightened to take a dose over 4 units. I'm currently taking 39 units of Lantus. 20 units at 5pm, 19 at 1am. It's a weird split but it works for me because one injection of 30 units was causing major issues months ago when my levels were hitting the 20s after dinner due to a rise around 3pm due to Lantus running out (I think).

Yesterday I ate 2 brownies for breakfast and took 1 unit, tested my sugar before leaving for work. I was on 6.8. My insulin had not peaked yet and I was worried of a hypo during the walk to work so I ate 1 more brownie and a bite of a flapjack. I went up to 9.7. I worked from 5pm to 9pm, And when I got dropped off at 9:30, my blood sugar was 5.8. I know my job is very physical but I feel like that is too much of a drop without any Novo apart from that 1 unit I took about an hour before I left. If I didn't eat anything I would have had a hypo at work for sure. And I shouldn't have to eat extra to prevent a hypo in an ideal world.

I was starving when I got dropped off, ate 10 chicken nuggets (30g carb without dip), 2 of these battered cheese bite things, walked to meet my boyfriend, walked home and ate a carrot and a brownie. (My mum made them and they're delicious lol). I took one unit. 2 hours later I'm at 11mmol. I was too tired to cook anything so I ate some lentil curls and a small donut. About 35-40g carb. Took 1 unit and went to sleep. I've just woken up at 6.6.

This sounds great, but what I don't understand is why my levels are "behaving" so well when I'm eating much higher carbs than I usually do. I never eat this kind of junk food. Ever. I think this was my first donut in over 4 years! I really feel like my Lantus dose is too high. There is no way my Novorapid would cover 35-40g per unit, when in the last few weeks I've sometimes taken 3 or 4 units for a low carb stir fry and a 15g carb yoghurt and then had my level go up to 17 post meal.

There was one day I took 1 unit for a milk tea drink I like, it's 24g carbs 18g sugar. 3 hours later my sugar level was pretty much what it was before drinking it. So I'm guessing 1 unit covers about 24g carbs for me??

I can't believe there was one point in my life where I needed 20 units of Novorapid for one meal. That's how much weight I've lost. Maybe my basal was off that entire time and I had no idea. 20 units would kill me now, probably. According to formulas by weight, I should be taking 47 units of insulin a day total and my ratio should be 1:10. That doesn't sound right to me lol considering 60% of your TDD should be fast acting, right? I probably take 39 units of Lantus and about 5-7 units a day of Novorapid...

 

[Deleted Account]

Sorry to read about your problems.

I would try to go back to basics and check my doses are correct.
I would start with the basal and do some basal testing - this is discussed on many threads but basically, don't do anything which should affect your BG (no food, exercise, little stress and no insulin apart from your basal) for about 8 hours and test regularly during this period. If your basal is correct, your BG should stay level. If your BG rises, you need more basal.
Then I would move on to the bolus where I would as accurately as possible calculate the carbs in a meal and take insulin for this and measure my BG after 4 hours (with no more eating, exercise, etc. during that time). My BG should be back to pre-meal levels. If not, I would adjust my bolus dose.

A few things to consider
- if my BG is high (for me this is above 15mmol/l), I become insulin resistant and need about twice my usual correction dose to bring me back down. You may be seeing this. And, make sure you are not high when testing.
- when we injecting, we are told to assume our insulin needs are the same throughout the day. Unfortunately, this is a simplification. As a result we may find we need a higher bolus ratio at some times of the day. Typically, morning ratios are high due to Dawn Phenomenon.
- the formulas by weight are guidelines but they are only guidelines and our insulin doses are affected by more than weight. I pay more attention to my BG levels and what my testing suggests I need rather than the formula.
- if you can get access to one, a Libre would help with your testing. If you are lucky, you may get them on prescription but, unfortunately, this is rare.

 

[Catsymoo]

Sorry to read about your problems.

I would try to go back to basics and check my doses are correct.
I would start with the basal and do some basal testing - this is discussed on many threads but basically, don't do anything which should affect your BG (no food, exercise, little stress and no insulin apart from your basal) for about 8 hours and test regularly during this period. If your basal is correct, your BG should stay level. If your BG rises, you need more basal.
Then I would move on to the bolus where I would as accurately as possible calculate the carbs in a meal and take insulin for this and measure my BG after 4 hours (with no more eating, exercise, etc. during that time). My BG should be back to pre-meal levels. If not, I would adjust my bolus dose.

A few things to consider
- if my BG is high (for me this is above 15mmol/l), I become insulin resistant and need about twice my usual correction dose to bring me back down. You may be seeing this. And, make sure you are not high when testing.
- when we injecting, we are told to assume our insulin needs are the same throughout the day. Unfortunately, this is a simplification. As a result we may find we need a higher bolus ratio at some times of the day. Typically, morning ratios are high due to Dawn Phenomenon.
- the formulas by weight are guidelines but they are only guidelines and our insulin doses are affected by more than weight. I pay more attention to my BG levels and what my testing suggests I need rather than the formula.
- if you can get access to one, a Libre would help with your testing. If you are lucky, you may get them on prescription but, unfortunately, this is rare.

I want to do basal testing but the problem is I'm too busy. I haven't had a day in weeks where I'm not working or packing etc. Even today I have a day off but I need to go out! It's so annoying. I just want 1 day where I can just blob and switch off from all of this. I can't unpack until next weekend because the boiler is broken where I've moved so I'm staying with my new boyfriend.

I definitely become resistant when high. I had a high of 22 last week, and 3 units took hours to bring it down to 14. I didn't want to stack correction doses so it's just a waiting game.

I have asked about a Libre but my clinic won't even let me have a pump, let alone a CGM. I asked if I could borrow one just to get my confidence back and they said no.

 

[Deleted Account]

I have asked about a Libre but my clinic won't even let me have a pump, let alone a CGM. I asked if I could borrow one just to get my confidence back and they said no.

The situation with Libre around the country is very frustration. My clinic are now offering them to some people instead of a pump!
Are you able to fund one yourself? This would allow you to do the basal testing with less effort.

 

[SamJB]

I suffered from hypo anxiety for years. I too was too scared to Roark high doses of Novorapid. The only thing that got me out of it was low carbing. It meant lower doses of insulin and less frequent and less severe hypos too.

As suggested, I think you need to go back to basics, start by getting your basal dose correct. The technique I use is from Gary Scheiner’s Think Like A Pancreas book. Don’t eat at least 3 hours before bed and for every 1.6nmol/l change in before bed and before breakfast readings, adjust your basal by 10%.

Then figure out your insulin ratios. If your basal is off then so will this be, so do in this order.

 

[bmtest]

Hi

You would have to check this out but when I was on a weeks dafne course, I remember being told most people have lantus dose too high. At the time I took 24 units before bed, I dropped this to the recommended 16 units as given to me by nurse running the course and yes it gave me more precise control and did not wake up with low blood sugars. No doubt it does wear off early evening but I combat with fast acting. Over 10 years later I am still on 16units of Lantus.

Its easy to get into your situation when a few negatives come together and readings do not behave as they should but step back and do some analysis and do some adjustments if you feel confident to do so. It is normal to loose nerve with doses after bad experience but dont be afraid to ask for medical help if only for peace of mind.

The answer lies in obtaining the minimal Lantus you can get away with and try it out go back to one dose and up it and split if needed, in my case I always forget if i have taken my lantus late at night especially if my routine is altered and play russian roulette with a half dose for good measure.

 

[SamJB]

Also, I should note that I take my Lantus in the morning at 10.30. This is so that I can be as dynamic as possible with my basal dose, as mine changes frequently. I follow the technique I mentioned, above; and change it almost on a daily basis. By taking it in the morning, I can be sure my basal is correct for the rest of the day, rather than waiting all day to fix it.