Confused with Basal insulin

[SherwoodT1]

Hi all. I'm hoping you can all help and impart your collective knowledge to hopefully help me better understand what I'm experiencing.

I've recently swapped from abasaglar to toujeo for my mdi long acting insulin. I've also titrated my dose up to try pin point where I should be. All well and good.

But, I've found the dose I'm at now seems to nudge me down into range, and then I sit there, stable. For example, last night I went to bed at 13.0 mmol/l. I had no rapid acting insulin on board, and injected my long acting dose. By 3am, I was down to 5.0, but then I sat there, stable.

I'm not sure if this is what I should aim for, or if my basal is too high, but finding equilibrium while in range. Or I'm still experiencing a waning honeymoon period, and my basal is actually spot on. I'm 1.5(ish) years into diagnosis.

This sounds silly to be confused about given that I'm in range. But I guess I feel uncomfortable that I'm experiencing something that I can't explain. Last night, for example, I refrained from doing a correction dose to observe my basal action. I'm now hesitant to correct any highs overnight now given that I seem to naturally find my way in range on this basal dose. I wondered what everyone else's experiences are. Thanks all!

 

[Louise12216]

Hi, so I am on tougeo as well and once you have found the dose that works best for you it does sit there overnight quite happy and stable. I am different being a type 2 so although I also use a bolus of trurapi I don’t generally have to do a correction dose before bed. I would say though when (and it did happen over Christmas) I had something to eat that kept me higher for longer the overnight numbers came down but not all the way to their normal resting numbers which for me is about 5.8 so for instance one night my sensor showed I stayed around the 8 mark all night, which is fine for me once in a while but you would have to decide for yourself if you would be ok with that. I have not used anything else but tougeo as a bolus, but have been very happy on it.

 

[Ipodlistener]

Hi all. I'm hoping you can all help and impart your collective knowledge to hopefully help me better understand what I'm experiencing.

I've recently swapped from abasaglar to toujeo for my mdi long acting insulin. I've also titrated my dose up to try pin point where I should be. All well and good.

But, I've found the dose I'm at now seems to nudge me down into range, and then I sit there, stable. For example, last night I went to bed at 13.0 mmol/l. I had no rapid acting insulin on board, and injected my long acting dose. By 3am, I was down to 5.0, but then I sat there, stable.

I'm not sure if this is what I should aim for, or if my basal is too high, but finding equilibrium while in range. Or I'm still experiencing a waning honeymoon period, and my basal is actually spot on. I'm 1.5(ish) years into diagnosis.

This sounds silly to be confused about given that I'm in range. But I guess I feel uncomfortable that I'm experiencing something that I can't explain. Last night, for example, I refrained from doing a correction dose to observe my basal action. I'm now hesitant to correct any highs overnight now given that I seem to naturally find my way in range on this basal dose. I wondered what everyone else's experiences are. Thanks all!

I'm on Abasaglar once every 24hrs. Basically basal insulin as I understand it. Is to counter the glucagon your liver produces. I try to be above 7. But below 10 when hitting the hay. I find having my levels drop through the night no lower than 5 are best. I'm an active person. But also not scared to experiment. Which is what diabetes is. I always give any adjustment 48hrs to see the true benefits or not. It doesn't happen instantly. Good luck!

 

[In Response]

If you Google something like “Toujeo profile”, you will find a graph that shows how active Toujeo is over time after injecting.
An “ideal” basal has a flat profile. Tresiba is quite a good example of this.

Toujeo profile is not as flat and does not last as long. You will see in the Toujeo graph that the activity of Toujeo start falling away after 12 to 18 hours. As a result, if You inject it every 24 hours, you will be injecting at a time when you have little active Toujeo in your body - the dose from the previous day will have mostly “worn off”. The activity will then start rising which may coincide with your nudging down into range. It will then hold steady for some time.

You may find it interesting to compare the profiles of Toujeo and Abalgasar.
But, bear in mind, these profiles are averages: your body may react slightly different.

 

[IanA123]

Hi all. I'm hoping you can all help and impart your collective knowledge to hopefully help me better understand what I'm experiencing.

I've recently swapped from abasaglar to toujeo for my mdi long acting insulin. I've also titrated my dose up to try pin point where I should be. All well and good.

But, I've found the dose I'm at now seems to nudge me down into range, and then I sit there, stable. For example, last night I went to bed at 13.0 mmol/l. I had no rapid acting insulin on board, and injected my long acting dose. By 3am, I was down to 5.0, but then I sat there, stable.

I'm not sure if this is what I should aim for, or if my basal is too high, but finding equilibrium while in range. Or I'm still experiencing a waning honeymoon period, and my basal is actually spot on. I'm 1.5(ish) years into diagnosis.

This sounds silly to be confused about given that I'm in range. But I guess I feel uncomfortable that I'm experiencing something that I can't explain. Last night, for example, I refrained from doing a correction dose to observe my basal action. I'm now hesitant to correct any highs overnight now given that I seem to naturally find my way in range on this basal dose. I wondered what everyone else's experiences are. Thanks all!

I am the other way, dose up with insulatard and sit stable until 3am , then without fail I go from 6 to 16 by time I wake up at 6am. If I increase basal by 1u I will drop within 30mins to 4, so the balancing act for me is a bloody nightmare

 

[Antje77]

I am the other way, dose up with insulatard and sit stable until 3am , then without fail I go from 6 to 16 by time I wake up at 6am. If I increase basal by 1u I will drop within 30mins to 4, so the balancing act for me is a bloody nightmare

At what times do you take your insulatard?
Insulatard (NPH) is the shortest acting of basal insulins, so it could be you're not only looking at Dawn Phenomenon/Foot on the Floor effect, but also at your last dose of Insulatard declining.

NPH isn't a very usual insulin for T1's anymore, most of us are on newer insulins like Tresiba, Lantus, or Levemir. Have you ever tried a different basal?

 

[IanA123]

Take insulatard at 10pm and 6am every day. Tried the new analog basal, me and analog do not get along too well.
Tried Tresiba dawn phenomenon was worse and dose was triple what I take with insulatard, same for glargine. Up until 3yrs ago I was still on actrapid during tha day, full 8hrs cover. Noticed the dawn phenomenon more when moved to Humilin s, similar profile to actrapid but just 6hrs strength to it.

 

[Antje77]

I am the other way, dose up with insulatard and sit stable until 3am , then without fail I go from 6 to 16 by time I wake up at 6am. If I increase basal by 1u I will drop within 30mins to 4, so the balancing act for me is a bloody nightmare

Take insulatard at 10pm and 6am every day.

So you start to go high in the morning 8 hours after taking your insulatard. Are you seeing something similar in the late afternoon/early evening?

 

[IanA123]

No I go high 5hrs after taking it at night, if I add 1 extra unit on a night then I drop massively within 30mins. During the day there isn't an issue, my basal and bolus on a morning settle it down and rarely see 10.