How long should I wait before changing basal?

[Diakat]

Hi all, lowered my basal back in Jan and had been happy with my numbers until this Sunday. Since Sunday I've been plummeting from 8.3 to 3.2 in under an hour, eating for Europe and still taking an hour to be safe to drive. Do I give things a bit longer to settle or do I reduce basal by 1u and see how I go? I'm on mdi and very insulin sensitive.

 

[dancer]

If you've been running low for 3 days (and you're sure it's your basal that's the problem), it's time to reduce. If there's a chance your bolus doses could be part of the problem, do a basal test to see what's happening.

 

[himtoo]

agree with above -- 3 days results to see if there is a pattern
always let your DSN know you are making changes too.

 

[Diakat]

Thanks. Yes it's three days now (fòurth today). I can't lower my bolus anymore as only using half a unit and that is taking me hypo with 40g carbs! Stupid numbers

 

[himtoo]

so that means a fast acting ratio of 1/2u per 40 carbs ?
that is really low !

another thought would be have a chat with your DSN and just take background perhaps ?

 

[Diakat]

Thanks. I'll call her today and ask for advice. Yes my radio is low anyeay, half a unit to 30g. But this week it's been silly. Yesterday lunch was 34g with 0.5u. Went hypo at 4.50, had 3 glucose tabs I'm under 8 stone) nothing shifted, then a cereal bar with more glucose tabs, it was still over an hour before I was safe to drive home. Night before was the plummet from 8 to just over three - that was sitting in bed reading!

 

[himtoo]

any other diabetic meds ? tablets etc ??

 

[Diakat]

No. Nothing else.

 

[himtoo]

wow !!
what happens if you don't take any fast acting for a meal ?
do you spike badly ?

 

[Diakat]

Yes. I tried once with 17g and ended up at 19. Otherwise I'd happily be sailing the river in Egypt.
By the way, are you in North Wales, saw on the Cymru thread that you are a long way from Cardiff?

 

[himtoo]

so no insulin ( fast acting) spikes you horribly and 1/2 unit causes hypo on 34g carb .

that is pretty **** tight on numbers.

what has your DSN advised as regards I:C ratio ?

stupidly to me it sounds as though you should eat a wee bit more ( try 45 carbs for your lunch )

yes -- I am in north wales -- I assume you must mean my possibly coming to a meet up in cardiff.
I would like to if it gets off the ground - just awaiting that it is going to happen.

 

[Diakat]

DSN has not said much, I was pretty much left to myself on that front. Consultant says if this sensitivity remains long term he'd consider me for a pump (not convinced as I in no way meet NICE guidelines). It was the dietician that reduced my bolus last time and another dietician that suggested the half unit pen. I struggle to get hold of DSN.

Read about the meet up because I am Welsh but live in SE England now, as an Anglesey girl I still read things with Cymru in the title!

 

[tim2000s]

@Diakat, if you are that sensitive to insulin, you really ought to be on a pump. The increments on some pumps go as low as 0.05u. I would be having a conversation with your DSN and Consultant about this approach before anything else.

 

[himtoo]

in a bizarre twist of events ( harking back to the days when therapy was all about fixed dose) and therefore eating to your insulin
it would almost seem sensible for you to up your food to match the 1/2 unit as that is pretty much the minimum you can take

as for NICE guidelines-- i would let your consultant take the lead and just follow if he can wangle 1

longer story for me -- born in canada -- parents both welsh and emigrated - dad born in Llanrug - mum in Mold
happy days I returned here 29 years ago to live

anglesey is nice like moelfre and red wharf

 

[Diakat]

@Diakat, if you are that sensitive to insulin, you really ought to be on a pump. The increments on some pumps go as low as 0.05u. I would be having a conversation with your DSN and Consultant about this approach before anything else.

Thanks. Will see what can be done. Know from your experiences that this may not be easy.

 

[tim2000s]

Thanks. Will see what can be done. Know from your experiences that this may not be easy.

You're in a much better position than I was. You can't avoid hypos due to the effects of even the smallest doses available via a pen. Should be immediate go ahead really.

 

[Diakat]

Phoned DSN, mine not there. Another nurse said to go and do my usual excercise today following a snack with no insulin and see how I go. If it drops hugely they want to look at basal as that is all I'll have on board.

 

[himtoo]

Phoned DSN, mine not there. Another nurse said to go and do my usual excercise today following a snack with no insulin and see how I go. If it drops hugely they want to look at basal as that is all I'll have on board.

ok -- well it is a start -- but the phone must become a "hotline" with nice polite pestering until something can be sorted for you.
you can't balance on that sort of a knife edge for a long time.