Lost hypo awareness?!

[donnellysdogs]

In which case you need to split your basal as suggested by @tim2000s yesterday. As you needed to eat again during the night this indicates that perhaps 5 units are needed at night. However, you must give yourself some basal in the morning...

Tim is very good. His help sorted me out fantastically.

You cannot lower your evening basal more if you are not going to give yourself the morning basal.

Tim knows how basal profiles work... He suggested a basal this morning but you have done your own thing and ignored... If you wish to stop your levels lowering at night and stop the rises during the day you must split the dose of levemir. It is very important.

We will talk to you further how you can basal test etc but theres no point in running before you walk.

If you're at Uni then you are bright and can master this as much as your studies and I believe you want to do so.

I know you are seeing your nurse so you are going to have to balance DSN opinion against ours and weigh up options. We're only speaking as experienced persons who have also fought off night hypo's and rollercoasters that can happen.

We will support you all the way but I think if you are advised by an experienced diabetic that has really analysed the profiles of various insulins and how they work etc that you can't just not follow his guidelines...

 

[TooMuchGlucose]

Yeah I do think I need some basal in the morning, I think I will try to do two 5 units I wanted to see today if having 6 units and none in the morning would give me huge swings up or down as I had yesterday. I went from 13.6 to 6.3 to 10.7 I would have definitely gone hypo with some basal this morning considering I'd taken less bolus at that meal to keep myself from dropping.

 

[robert72]

If you want to try basal testing, there are good instructions here:
http://www.salforddiabetescare.co.uk/index2.php?nav_id=1007
written for pump users but just as useful for MDI

 

[TooMuchGlucose]

If you want to try basal testing, there are good instructions here:
http://www.salforddiabetescare.co.uk/index2.php?nav_id=1007
written for pump users but just as useful for MDI

Thanks for this, I will definitely try it I have an appointment soon anyway so can tweak things further then after I decide something with my dsn tomorrow.

 

[tim2000s]

I don't know if you read my topic about basal earlier @TooMuchGlucose , but I find that I need 8u overnight and 14u throughout the day to give me duration and keep me flat. It sounds as though you have a similar profile with a lower amount required overnight. Basal testing will certainly help.

 

[TooMuchGlucose]

I don't know if you read my topic about basal earlier @TooMuchGlucose , but I find that I need 8u overnight and 14u throughout the day to give me duration and keep me flat. It sounds as though you have a similar profile with a lower amount required overnight. Basal testing will certainly help.

Hmm, I may need a 5 to 8 split that would make more sense considering I was on 14 but obviously the half unit pens would definitely help with fine tuning it.

 

[donnellysdogs]

The swings today are indicating that you need to do some basal testing. This would allow you to then check if your quantity of injection for foods is right or wrong. The link that @robert72 has given is excellent.

It must seem like a daunting hell to you at the moment but we are trying to give you details that are often overlooked by DSN's as they take things much slower paced really. Basal testing helps enormously. By getting my basal right with these chaps help with splitting doses then it has enabled me to keep eating just my one meal in the evening.

My concern here is... Tim mentioned 6 units basal for the morning.. That was his advise with your levels. You have sunk today from your bolus given... But you are still wanting to increase your basal dose against Tims advice to 8...
He splits his, for his lifestyle. He has recommended a dose that is less to keep you safe. I would personally recommend that you stay with Tims initial advice of 6 tomorrow morning and do another decrease tonight to 5 units until you can get a 1/2 unit pen.

 

[TooMuchGlucose]

The swings today are indicating that you need to do some basal testing. This would allow you to then check if your quantity of injection for foods is right or wrong. The link that @robert72 has given is excellent.


My concern here is... Tim mentioned 6 units basal for the morning.. That was his advise with your levels. You have sunk today from your bolus given... But you are still wanting to increase your basal dose against Tims advice to 8...
He splits his, for his lifestyle. He has recommended a dose that is less to keep you safe. I would personally recommend that you stay with Tims initial advice of 6 tomorrow morning and do another decrease tonight to 5 units until you can get a 1/2 unit pen.

He also said that he thinks that 0.14 units per kg works well which would be around 8 for me and also that he takes 8 at night and 14 in the morning so his morning dose is 75% more than his evening one so based on this split 75% increase of 5 would be 8 and I think this would make more sense giving a total of 13 for the day rather than going down by possibly 4 or 3 units it would only be 1 unit.

 

[iHs]

Like I said in my msg TooMuchGlucose, its all about you using yr discretion and getting the correct basal balanced up with the bolus. Most consultants start off with a 50 50 approach based on bodyweight kg and using the 1u to 10g carb ratio and then the rest is about testing bg every 2-3hrs and adjusting the bolus if bg go high or low after 2hrs and adjusting the basal if bg go high or low at 3hrs. Eventually with bg tests and trial and error, diabetics are able to get the right bolus ratio and the basal working a bit better.

On Lantus without any real guidance I was injecting 12u to begin with and then as time went on after a year, I needed about 19u to be ok through the night as my bg levels started rising from 4am fairly quickly. My need for background from midnight to 3am was low so I needed to eat a snack or hypoland I went.

On Levemir I was advised to inject it twice daily so I halved the Lantus dose and used 9u at night and 9u in the morning. I eventually through bg testing adjusted the daytime Levemir to be about 12u and the night time to 8u and also adjusted the carb ratios.

You will get there in the end, just keep bg testing and adjusting till you get the right balance.

 

[donnellysdogs]

I see your logic @TooMuchGlucose.

I am just concerned that like today after your bolus you dropped again significantly. By increasing basal to 8 tomorrow from the suggested 6 puts you more at risk of hypo. Only from my own personal experience I would start off lower and increase if there was just the tiniest % chance of a hypo that I could avoid. To me its safer to adjust insulin from higher bg's for a short period of time.

I see what you mean though. Its Only my fear of hypo's that makes me over cautious!! Inrespect your logic and thoughts and still maintain my well done on your learning and acceptance etc... It takes a strong personality to take this all on board whilst at Uni!!

 

[TooMuchGlucose]

I see your logic @TooMuchGlucose.

I am just concerned that like today after your bolus you dropped again significantly. By increasing basal to 8 tomorrow from the suggested 6 puts you more at risk of hypo. Only from my own personal experience I would start off lower and increase if there was just the tiniest % chance of a hypo that I could avoid. To me its safer to adjust insulin from higher bg's for a short period of time.

I see what you mean though. Its Only my fear of hypo's that makes me over cautious!! Inrespect your logic and thoughts and still maintain my well done on your learning and acceptance etc... It takes a strong personality to take this all on board whilst at Uni!!

It does make more sense to use less units rather than risk going low a few times a day. Not at uni at the minute had to take time out hopefully going back this month but that depends on if things can get sorted.

 

[donnellysdogs]

Hey, you can get things sorted!!!

Still takes a strong personality though to be on here asking questions... So many leave it until they've been hospitalused a few times either due to DKA or severe assisted hypos and ending up in A&E.
You're tackling things quickly in comparison. It is good that you are asking questions and wanting to help yourself and you are also ahead of the game in your thinking because you are asking advice from experienced long term T1 diabetics and not reliant upon the advice from NHS people.

Credit due to you.... and also you most certainly can get back to Uni if you want to...

Hope levels wil be better tonight and please keep us updated. All of us want you safe and doing all the things you want to do....

 

[iHs]

TooMuchGlucose

What helped me achieve the right balance of bolus and basal was to limit my carb meals to 30g. That way, if I made a mistake on my calculations, the carb and insulin would not take my bg levels up too high. Once I figured out the correct bolus ratio using targets, I could then use the ratio to eat more carb if I wanted without going really high.

 

[TooMuchGlucose]

So today had my appointment with the DSN and a consultant they have agreed I have definitely started to honeymoon again which makes sense also it's unlikely I've lost hypo awareness just that instead of being aware at 3.8 more likely 3.2 and lower. I got a half unit pen as well as someone suggested. I will be on low amounts of Levemir for a few days and I may be switched to a different long acting (a better one they said it's more expensive so nice to know there's no cost cutting) this one does not have a peak period like Levemir does to stop potential night time hypos switched to morning injections so at least I'm awake then. There's obviously still a lot of trial and error right now just very annoyed with my pancreas as I'm sure everyone is with theirs

Thank you to everyone who has helped and supported me over the last few days

 

[robert72]

So today had my appointment with the DSN and a consultant they have agreed I have definitely started to honeymoon again which makes sense also it's unlikely I've lost hypo awareness just that instead of being aware at 3.8 more likely 3.2 and lower. I got a half unit pen as well as someone suggested. I will be on low amounts of Levemir for a few days and I may be switched to a different long acting (a better one they said it's more expensive so nice to know there's no cost cutting) this one does not have a peak period like Levemir does to stop potential night time hypos switched to morning injections so at least I'm awake then. There's obviously still a lot of trial and error right now just very annoyed with my pancreas as I'm sure everyone is with theirs

Thank you to everyone who has helped and supported me over the last few days

Sounds like you might be getting Tresiba. I can thoroughly recommend it

 

[TooMuchGlucose]

Sounds like you might be getting Tresiba. I can thoroughly recommend it

I can't remember the name they said it lasted a full 24hrs about an hour to take effect and is pretty steady all the way through, it came on the market last year.

 

[robert72]

I can't remember the name they said it lasted a full 24hrs about an hour to take effect and is pretty steady all the way through, it came on the market last year.

Ah Tresiba's been around for a couple of years. I've been on it for a year now. Lasts up to 42 hours.

 

[TooMuchGlucose]

Ah Tresiba's been around for a couple of years. I've been on it for a year now. Lasts up to 42 hours.

Well if it doesn't have a peak it's already better than Levemir it's hard to get a prescription for it, by consultant only so hopefully I can get it. Would definitely help considering my pancreas might think during the 4-8 hours Levemir isn't working it might decide it is alive or my liver would pump out a bit too much sugar, to have a constant stream would obviously help a lot.

 

[donnellysdogs]

How have levels been today though? Are they ok with you splitting your dose? Did you split it today?

Good that they are considering tresiba. If CCGs actually work the costings out- it does work out cheaper as you need less insulin...

 

[TooMuchGlucose]

How have levels been today though? Are they ok with you splitting your dose? Did you split it today?

Good that they are considering tresiba. If CCGs actually work the costings out- it does work out cheaper as you need less insulin...

It last 24hrs so robert72 said it's not Tresiba I've been pretty stable today 8-11 pretty much all day so I'm getting my bolus ratio about right as well, so things are already getting better.