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Changing Basal Insulin - Observing what happens and hopefully providing some "lessons learned"

Discussion in 'Insulin' started by tim2000s, Jan 8, 2015.

  1. tim2000s

    tim2000s Type 1 · Expert
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    One of the great things about continuous data is that you have a large enough data set to see decent Standard deviations.

    Now I don't know whether this is wholly down to the Levemir change, but my SD on Lantus over a 2 month period was 3.3 and now on Levemir it is 2.6.

    That has to be a result and seems to fit my gut feeling that my variance had dropped.
     
  2. tim2000s

    tim2000s Type 1 · Expert
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    Been a while since I posted on this topic, but I feel it needs an update.

    Over the past month or so, I've been seeing some interesting goings on with overnight glucose levels in relation to my dosing. After going to the gym, I've found I've had to take my low overnight dose down even lower to manage bg levels as I've been seeing to large a drop and waking up to hypos.

    This resulted in a post gym drop to 5iu. There is an unfortunate consequence of this change, which is that at my size, the Levemir simply runs out at about 7am. It simply isn't possible to get it to last long enough, so I end up with a couple of hours of fast acting "topping up". I could apply a larger dose of daytime Levemir at this point, but I am well aware that this will put me at undue risk of basal hypos during the day.

    As a result, I have now requested a pump of my DSN as this is starting to get silly!
     
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  3. bhk

    bhk Type 1 · Well-Known Member

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    Same issues happen with my as I do a lot of sports and as I have a very challenging diabetes. - and as I am a levemir/humalog user

    Here is my tip...

    Issue: Your levemir acts too much during the night, the dose is quite small and doesn't cover enough time.

    Resolution: Take a larger amount of levemir (and according to pharmaceutical notice, the bigger the dose, the longer the effect) without having a low.

    How? : Reducing the effect of the insulin on your cells. I see two ways, and it depends on when is the low. If the low happens 2-3 hours after injection, I'd try to take some regular carbs (rice, cereals, bread, etc.). If the low happens 4-6 hours after injection, then I suggest that you take a strong lipid intake (lots of almonds and nuts, for example) as when it reaches plasma (4-6 hours later) it blocks a big part of the effect of insulin. If you are still in hypoglycemia, try taking a carb intake with the fat source (almonds with honey or simply chocolate as it is the perfect product to raise sugar and diminish the effect of insulin 4-6 hours after intake).

    It has taken a long time for me to notice that - especially the effect of lipids blocking the insulin work - but now my diabetes is so well controlled compared to before...

    Cheers!
     
  4. tim2000s

    tim2000s Type 1 · Expert
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    @bhk, thanks for the comment. Unfortunately, I don't want to take insulin and feed it, which is what you are suggesting. That's the wrong way of doing things in my book. I'd actually look to a 3x daily injection model before I do that.
     
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  5. LucySW

    LucySW Type 1 · Well-Known Member

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    But now you're using the injection ports, isn't injecting so very often less of a problem? Isn't an early morning correction dose the lesser of two evils?

    Thinking seriously about I- ports ...
     
  6. tim2000s

    tim2000s Type 1 · Expert
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    It's just a pain in the bum Lucy. While it doesn't affect the number of skin penetration so have to do, I do have to remember to administer insulin.

    Whilst a pump isn't easy, it does make automating this stuff a lot more straightforward. Really it's just another way of administering insulin, all be it automated, and that's what I see as being beneficial. Ultimately I'd be happy to use a pump alongside basal to give a level of protection you don't get with a pump alone, but I think that's venturing far off the beaten track for many people.
     
  7. LucySW

    LucySW Type 1 · Well-Known Member

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    Yes, it is. I find - does this ring a bell with you? - that after a long phase of optimal control, I go thro a follow up phase of just being fed up with having to bother. So I forget, I delay. And predictable results. Then I pull myself together. Repeat.

    You? You've been doing this 20-odd years, cf my one.
     
  8. tim2000s

    tim2000s Type 1 · Expert
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    I tend not to suffer so much with good control then letting it go, then good, then letting it go, although as a kid I used to hate finger pricking and made up most of my log book results for the diabetic clinic, using different pens and including enough randomly high results to justify a higher Hba1C that I was fairly sure was coming.

    The advent of memory meters resolved that little game.

    What I tend to find is that I'll run well for a period then change something that results in a set of higher results, e.g. really tough training session causing the next 48 hours to have high insulin resistance, drink too much wine causing a day of lows afterwards, etc. When I do a look back it's usually obvious as to what the trigger is, but it is usually thoroughly annoying,.
     
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  9. tim2000s

    tim2000s Type 1 · Expert
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    Well the Libre is proving it's worth once again. Having had a summer being reasonably relaxed about food, we hit the start of September and back to the gym on a more regular basis and not eating giant food portions. Macro levels are unchanged though, and all of a sudden my insulin sensitivity has shot up. I'd been happily living on 14-18u daytime basal and 6-8u overnight.

    My overnights are now much more insulin sensitive - I have had to reduce my non-gym overnight levels to the same as I previously used after the gym, and correspondingly, the post gym levels have also dropped. There's nothing explaining why this should be though, other than a lower level of body fat at the start point of this round of work.

    Astonishing to see the change though, as now I am looking at 13-14u for daytime and something like 4-6u for overnight, although I am concerned about dose longevity now. The three shots a day may soon be on the way.

    I'm looking at long acting levels that are as low as at any time I've been diabetic in the past 27 years. Even when I was on two shots of NPH in the honeymoon!
     
  10. LucySW

    LucySW Type 1 · Well-Known Member

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    Isn't that brilliant! So there's a lot we can do ... Power to you Tim.

    Lucy
     
  11. tim2000s

    tim2000s Type 1 · Expert
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    It's interesting. The Personal Trainer and I are observing the effect of different types of weight programmes. He is marginally RH. There are different types of things you can do that have different impacts. Certain weights patterns cause massive muscle inflammation (as I have mentioned before) that triples my insulin resistance. Other things just seem to up sensitivity.

    Once you know this kind of thing you can factor it into a training programme for non-diabetics.The last thing you want to do is increase insulin resistance for non-diabetics, especially when you are working on reducing body fat. I'm not sure what's going to come of it, but it's very interesting "research". I suspect one or the other of us will write a paper on it.
     
  12. cz_dave

    cz_dave Type 1 · Well-Known Member

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  13. djwesttexas

    djwesttexas Type 1 · Newbie

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    I know this is posting to a "old" thread, but I'll try anyway. I am T1D for 56 years and have tried and switched through several treatment methods (2 different pumps, MDI, different insulins, etc). About 6 weeks ago I started using Tresiba for basal control. It is the best thing that has ever happened for level control with no peaks and valleys in intensity. I take one shot at supper each day, have no night-time lows, no peaks or drops. I can skip a meal if I want and sugar stays level. What a joy! I have noticed that many others on different forums and threads have had a similar experience with Tresiba.
     
  14. tim2000s

    tim2000s Type 1 · Expert
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    My issue with Tresiba is exercise. From what I've been able to find, exercise induced hypos in relation to Tresiba are are about as frequent as those from Insulin Glargine (lantus) so given my issues with Glargine, I'll stay away!
     
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