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Help with getting basal dose right

S

SophiaW

Well-Known Member
Messages
1,015
Type of diabetes
Type 1
Treatment type
Pump
We have changed my daughters insulin regime from Novomix30 to a Levemir/Novorapid basal bolus regime. I'm having concerns that our morning basal dose is not right, please can others share their opinion and help me confirm if I'm right.

She gets 12 units of Levemir in the morning at 8am. I have done a fasting test to see what is going on. I gave her 12 untis Levemir at 8am. Her waking reading was 8.6. She didn't have any breakfast or Novorapid, just the Levemir. I did give her 3 strawberries to prop her along at 10am as she was hungry. At lunch (12:00) her reading had dropped to 4.6. On other days we've tested to see what was happening in the afternoons. Typically she has lunch and 2 hours later her reading is 8.0 (2pm) starting with a reading of 4.7 before lunch. By 4pm she will be hypo (3.6) unless she has a snack at 3pm to carry her through the afternoon. Sometimes by 6pm her pre-dinner reading is edging too low once again. These readings were taken on a day with no exercise.

Diabetes team say that her carb:insulin ratio (Novorapid) is not right and I should reduce her Novorapid with each meal, but I think an incorrect basal might be interfering with her control.

Overnight her readings are fairly stable. 4 Units Levemir at 8.30pm, she wakes with a slightly higher reading than going to bed with but having woken every few hours through the night the climb happens around 6am. For example a typical night will be: bedtime 7.2, 2am - 5.8, 3am - 5.4, 4am - 6.0, 6am - 7.5, 8am - 8.6.
 
Hi Sophia,

I think maybe you're right to suspect the basal dose. I'd be tempted to take a couple of units off the morning Levemir and add it to the evening dose and see how you get on from there.

All the best,
timo.
 
SophiaW said:
We have changed my daughters insulin regime from Novomix30 to a Levemir/Novorapid basal bolus regime. I'm having concerns that our morning basal dose is not right, please can others share their opinion and help me confirm if I'm right.

She gets 12 units of Levemir in the morning at 8am. I have done a fasting test to see what is going on. I gave her 12 untis Levemir at 8am. Her waking reading was 8.6. She didn't have any breakfast or Novorapid, just the Levemir. I did give her 3 strawberries to prop her along at 10am as she was hungry. At lunch (12:00) her reading had dropped to 4.6. On other days we've tested to see what was happening in the afternoons. Typically she has lunch and 2 hours later her reading is 8.0 (2pm) starting with a reading of 4.7 before lunch. By 4pm she will be hypo (3.6) unless she has a snack at 3pm to carry her through the afternoon. Sometimes by 6pm her pre-dinner reading is edging too low once again. These readings were taken on a day with no exercise.

Diabetes team say that her carb:insulin ratio (Novorapid) is not right and I should reduce her Novorapid with each meal, but I think an incorrect basal might be interfering with her control.

Overnight her readings are fairly stable. 4 Units Levemir at 8.30pm, she wakes with a slightly higher reading than going to bed with but having woken every few hours through the night the climb happens around 6am. For example a typical night will be: bedtime 7.2, 2am - 5.8, 3am - 5.4, 4am - 6.0, 6am - 7.5, 8am - 8.6.
Click to expand...

Hello Sophia

Looking at yr message I would also say that you should increase the Levemir up by one unit at bedtime and maybe give your daughter a small snack like a cracker with some peanut butter on it depending on what her bg levels are. This should hopefully stop her dipping too much in the early hours but have a more lasting effect to counteract the rise up that you are seeing from 4am onwards. This happens with loads of people. I am also the same. You might not need to increase the Levemir in the morning though as your daughter's bg levels will be lower than 8.6 with any luck. Using basal/bolus does take some time to get the doses correct and there will be many days where you will think that everything is all ok and then find that everything goes belly up :?

Many people usually find that they have to adjust their bolus doses in keeping with the effect that the basal insulin is having. Therefore it's quite probable that your daughter will need a slightly higher insulin to carb ratio for the morning (while the basal insulin gets going) then a lower one from lunchtime to evening meal and then maybe a higher one for evening meal.
 
Did I read that right - 12 Levemir in the morning and 4 at night? That's a huge difference between the two. I think you're right, looks like she needs less Levemir if it's bringing her down from 8.6 to 4.6 by lunchtime. May need to increase Novorapid ratio to compensate when she eats.
 
Thanks everyone for your helpful replies. This morning I've given her a smaller dose of Levemir and I'll do a fasting test over the next few days to see how it goes. Once I get the daytime dose fixed then I'll work on tweaking the night time dose if necessary.
 
To test your basal, its good to skip one of your meals if possible

Initially I would test at night, test at 3am, test in the morning to get your overnight results

Skip breakfast, test at lunch and see if the basal is holding. If its lower at lunch then cut morning basal a bit

Skip lunch one day, test and see if basal holds etc etc

I think basal is likely off a bit but novorapid tends to cover what your basal doesnt
John Walsh's Using Insulin is a good book for this kind of stuff - worth buying
 
Hi again everyone. I just wanted to update you and thank you all for your replies and help. I have adjusted my daughters Levemir and I think we've got there now. She gets 6 units in the morning and 5 units in the evening. We have tried some fasting tests at various times through the day and her readings are holding steady, going down by only fractions of a mmol each couple of hours. Her carb:insulin ratio has changed now so I may still need to make a few little tweaks but that's looking pretty good too. Overall she is taking on board less insulin each day and not having to snack to "feed the insulin" during the day. We are both much happier and less worried about running into hypos, she has much more predictable BS's now.
 
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