How to set basal level?

chrysalis

Newbie
Messages
3
Type of diabetes
Type 2
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Insulin
Hi all, I realised this morning that I had forgotten (never before) my basal injection completely last night! I took half of my usual dose early this morning as a 'better than nothing' kind of thinking but my BS's have been rocketing all day - over 20! I haven't eaten for fear of driving it further up but I am feeling like I need to eat - I'm hungry! I have taken 5 separate injections of my bolus insulin through the day but it's not coming down much. Any ideas ... anyone? Incidentally, there are no keytones present, thankfully.
 

chrysalis

Newbie
Messages
3
Type of diabetes
Type 2
Treatment type
Insulin
If it's Lantus that you take at night, then not a good idea to take it 12 hours later, better to leave it altogether and do what you've done and rely on extra bolus. Some people may disagree with me though.
Anyway, IMO it's not that important, indeed I've forgotten to take mine more than once. It really depends on the dose that you normally take as to the amount of extra bolus to have instead. I only take a small dose of Lantus, 8 units, so if I forget, then it's not difficult to compensate with extra Novorapid. You can inject quite a few extra units of Novorapid if you wish, but it depends on hypo awareness and how often you are prepared to check your BG. For example, on one occasion I had a BG of 32 mmol/l and so I injected 20 units of Novorapid .....but I do have a large stock of Lucozade in the house, plus a good supply of BG test meters and strips. The rate of descent from 32 down to 12 was not as alarming as I expected, and to this day I have no idea why it was so high nor why it didn't rapidly descend to zero LOL. Needless to say, this does go with a very big warning !!!!
Thank you Brian, for your thoughts. I take 45u of Lantus at night. I have already had 4 different shots of Novorapid 8u/5u/10/8u in an attempt to get it down but it's still at 22.5! I worry that the Novorapid will build up and cause a sudden downturn resulting in a bad hypo. I seem to become extremely insulin-resistant when I have very high BS levels - maybe that is common to most people?
 

Daibell

Master
Messages
12,653
Type of diabetes
LADA
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Insulin
My DN accepts that the Basal needs will change a bit day by day. Because I go to the gym some days during the week she was worried about the effect of the exercise on my bloods and suggested I have some fruit just before the gym which makes sense. I adjust my units slightly depending my whether I'm driving or not during the day to either reduce the hypo risk or make my blood sugar slightly better on average that day. I check my morning fasting every week or so to see whether my Basal needs changing but I'm lucky as it has always been very predictable
 
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chrysalis

Newbie
Messages
3
Type of diabetes
Type 2
Treatment type
Insulin
45 units is a lot to compensate for with Novorapid. Lantus works for 24 hours (allegedly) so you might experience an overlap tonight. If you took 22 units this morning, then I think (think being the main word) that you need to add a further 10 to 20 units of Novorapid in total onto your bolus injections. Don't forget that Novorapid lasts for up to 6 hours, so if you wanted to replace 40 units of Lantus with multiple doses of Novorapid, then you would need to inject 5 to 10 units of Novorapid every 6 hours. That is a very rough calculation, it's only meant as a concept, no-one should go on this advice unless they are prepared to test BG every hour AND are also hypo aware. Otherwise, I hope it gives the correct concept, though someone might correct me on that concept.
Brian, I actually took 20 units of Lantus @06:00 when I realised my error. My BS is now at a very pleasing 5.6, however, I am not sure what might happen tonight? I will check my BS at 22:00 and if all OK, I will take my 45 units and hope that it all works out. Thanks again. C
 
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mrman

Well-Known Member
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2,419
Type of diabetes
Type 1
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Pump
Brian, I actually took 20 units of Lantus @06:00 when I realised my error. My BS is now at a very pleasing 5.6, however, I am not sure what might happen tonight? I will check my BS at 22:00 and if all OK, I will take my 45 units and hope that it all works out. Thanks again. C

If you take your full 45 units tonight, and usually take this 24 hours apart, then, cause of this mornings dose you will have in effect the 45 units plus this mornings 20, working for 12 hours making 65 units basal going through the night. Eitger have some extra carbs to last you through the night or test through the night using your alarm to wake you or, put in only 25 units and make the diff up with qa tomoz to then be on only your usual 45 basal tomoz night.
Stay safe, a right pia to sort out!

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donnellysdogs

Master
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13,233
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People that can't listen to other people's opinions.
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Brett.. Glad to see you also wear your pump on your arm... Do you normally wear sets in arm too?


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Katiemorag

Member
Messages
16
Type of diabetes
Type 1
Treatment type
Insulin
To test basal basically set a time to eat/inject qa say 8am. hard bit is to not eat for 5 hours. (some would say 4 hours but me thinks qa can last up to 5). This is to make sure all carbs eaten at 8am have fully digested and all qa insulin has been used. If you need to treat a high/low abandon test.
Assuming all is good till 1pm, no other food/sugary drinks consumed take a reading at 1pm. Hopefully it will be between 5 and 8. Record readings every hour from 1pm till 5pm. You wil then see what effect your basal has on your levels. I do 4 hours fasting as you can then split the 12 hour day into 3, 4 hour slots.
Only miss 1 meal a day as going much longer during the day would give inaccurate readings as the liver would overcomponsate.
To do morning basal test best just to wake up at your usual time and record readings every hour till lunch if poss till 1pm.
To do evening meal have lunch at say 1pm, test every hour from 6pm till 10\11pm. During any test abandon if needing sugar/carbs or correction bolus. Adjust qa next time for meal previous depending on results and try to repeat test another time. Doing the above would give you fasting readings for the while day. Doing this will give your fasting day time readings on different days from 8~1, 1~6, and 6 till 10/11pm giving a whole day profile pic your basal.
The night time one involves eating at say 6pm, again consuming nothing till 11pm. carry on starving and take readings every 2 hours through the night as 1 hourly can be exhausting.
Same way applies to pump and mdi, however pump easier to componsate for changes needed as can be done hourly without effecting other parts of the day.
For example on mdi you may find you need more basal in the middle of the day, but, if you increase your basal you would be having too much through the night.
Hope that explains it, anything unsure of just ask


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Thanks for the walk through. Have done daytime tests twice now. Never below 4 (although 4.2 often) but was up to 7.8 once.

Need a quiet day to do the night one as I'm terrible with broken sleep. I suspect this is where my problem lies as I usually wake with 8 or sometimes 9.

If not a 50:50 split, is more taken during the day or night? It appears to me that I may need more at night, but this feels wrong ... I'm sleeping, not up and about doing stuff???
 

mo1905

BANNED
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Thanks for the walk through. Have done daytime tests twice now. Never below 4 (although 4.2 often) but was up to 7.8 once.

Need a quiet day to do the night one as I'm terrible with broken sleep. I suspect this is where my problem lies as I usually wake with 8 or sometimes 9.

If not a 50:50 split, is more taken during the day or night? It appears to me that I may need more at night, but this feels wrong ... I'm sleeping, not up and about doing stuff???
It's quite common to wake up a little high to be honest. Maybe yours is at the top end but many have problems with dawn phenomenon or liver dump. Depending on your night test results, no reason why you can't split your basal an have different amounts ? You'd need to discuss with your DSN though as it's not a good idea to suggest changing meds via a forum. Good luck !
Mo


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