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New to Basal-Bolus Injections...

M

mattwicks87

Newbie
Messages
4
Location
Bucks
Hello..
After some lack of help from my diabeties center as well as a lack of information, I decided to join up to seek some advise and help.

So I was put on the 4 injections a day. Basal - Bolus, Novorapid and Levemir. I was given some default injection levels.
Levemir - 30
Rapid:
Breakfast: 15
lunch: 15
dinner 15

So I tried these for a day or so and discovered that they were a bit enthusiastic with there levels...
After missing my appointment at the group counting carbs ect... thanks again to the hospital who sent my appointment to the wrong address again, and then I got it the day after... helpful...
So I lowered some of the levels until I could find a level that worked. Levemir to 22 / 23, an Rapid to 8, 8 and 15 evening.

Problem I am discovering is night times.
Back in April 2012, after a busy day in London I did my normal routeen, only then to wake up in Hospital after having a fit, which I have no record of in my memory. So quite understandably Im a bit paranoid about nights... this was back on the Novomix 30.

My levels on the Basal - Bolus, are getting on the high side to say the least.. tonight as I type this.. 11.7
Night before 18.2... managing to reduce that to 15.9... night before that 17.1 night before that 12.4.

I inject my Levemir the 24 hour injection about 00:15 in the morning, Im seeing some alarming to me, drops.. loosing around 5 - 7 units over night... and Im concerned.
A) becoming paranoid again... lacking alot of sleep due to me worrying and watching the levels.
B) Help from the DB Center.. is proving... well useless...

II would like to know from anyone who uses these injections, How can I firstly get the levels down to a suitable level, and How if at all can I stop the massive drop over night (When I do eventually get some sleep.) Can that be done through the level of the Levemir? or somthing else.
I woke up on the first day with a level of 5.2 which sort of rung alarm bells in my mind.

Any help or advice or direction would be greatfully received.
And if I don't get taken to a Hospital over night I will get back to you all.

Thanks in Advance.
 
Quick, maybe daft, question.
What do you before going to sleep and how much?
I'm concerned about possibly being on basal+bolus myself and have 2 weeks to decide.
I asked just 10 mins before your post for experienced basal+bolus users for experiences since the 'change'. Is there anything else you have noticed?
Maybe post a reply to get the ball rolling and we can both get some answers :) cheers
Mart.
 
Hello

Honestly same as every other night which is pretty much nothing sitting in front of a computer, do some work, putting videos together ect... nothing really worth noting.
Indeed they have been trying to push me on to the Basal Bolus for over a year... I was on Novomix 30 for 4 years... and after my slight episode in April last year, they seemed to up the pressure... I myself, I am thinking did I just say yes to get rid of them asking.... because my levels had come down and started to become stable again... least I know what my body would do with that.

I haven't really expirenced any of changes... Its just that 1 part, the Day time every goes quite fine, levels are 6 - 7's so i cannot complain there... its just evenings... and they said it was more flexible..
Apart from that the only other change lack of sleep... and extremely grumpy... mainly caused by the lack of sleep.

oh well got an appointment on the 24th to go back to the Hospital and tell them what I think... which won't be pleasent for them.
 
Me again, Matt.
I meant to say what do you EAT before going to bed. Maybe if you ate a decent portioned meal or a bit more than normal that would (a) boost your carb intake, (b) allay your fears about dropping below range overnight (c) the worry being negated would allow you to get a decent nights sleep (d) you'd get up refreshed and not grumpy.
I may be talking a load of old balls, but if you either lower your last bolus dosage of the day or eat a few more carbs than you are now at night that may prevent you dropping below range.
I see my consultant on the 19th and it's make your mind up time for me. Do you know anyone on basal-bolus who finds it advantageous? I have boold tests every wednesday as I also have portal vein thrombosis, which complicates insulin intake as it is, as I had 2 mtrs of bowel removed last year as I had a blood clot which cut off my blood supply to my already underworking panceas. The op went fine, but I was given a 30% chance of coming through it alive and a 50% chance of having a colostomy bag. Thankfully my surgeon was wicked and I'm both alive and did not require a colostomy! Have a massive 20" scar, but it's healing nicely. Hope you give the doctor what for and they sort you out. They don't seem a very professional or responsible bunch where you are! Which hospital do you go to, mate, out of interest?
Hope they sort you out properly next time. Hypos are bloody terrifying, aren't they!?!? All the best
Mart :)
 
Hi. I'm on Levemir only once a day at night 10 units. My DN told me to aim for around 6mmol in the morning which made sense. In practice I'm nearer 4 which we agreed was OK as long as I keep an eye out for hypos. My suggestion for you, but we are all different, would be to get your basal right i.e. target 6 in the morning before breakfast. It's not clear from your email what morning readings you are getting? I guess you may have to reduce your rapid insulin a bit or perhaps miss the evening one whilst you are adjusting your basal. I understand it can take up to 3 days for insulin changes to settle. Once the basal is giving morning readings in the region of 6 you can then adjust the bolus to minimise meal spikes. I'm not an expert so you may want to discuss all this with your diabetes support. Whatever you do take care with any increases of insulin units to avoid any more hypos.
 
Mart

Got ya now, I don't eat anything much these days especial nights, as usually the reading is over 10.. appart from tonight where its around 5.2... which im trying to increase at this moment due to the drop over night.

Daibell readings in the mornings, This morning
06/04/13: 4.1... went to sleep at 11.1.. you see what I mean when I say drops like a tone of bricks...
07/04/13: 15.9 night... Morning:10.2
04/04/13 11.2 night.. Morning 4.3
03/04/13 12.4 Night... morning 5.4

What can I do to not go to sleep on such a high to be sure I actually wake up in the morning?
I have discussed with the Diabetic people at my local hospital or attempted to but I get no reply.. or we will call you back...

Like hell they will.
Its been over 3 days now on the new stuff.

To reduce the risk of waking up on a hypo do i lower the 24 hour Levemir... as the rapid only lasts for 2 hours or so they told me, and I have that for evening meal at 6pm daily.. so would of run out by 10 - 12pm when i check again before sleep.

I understand the principle of the Basal Bolus... I just don't understand why its taking 5 - 6 units overnight, which is slightly alarming... Seeing as my Diabetic center are unwilling or can't be bothered to answer my questions... do i reduce the Levemir? will that slow it down? Will it reduce the rate of units being taken overnight? even though I know the Levemir lasts for 24 hours.

Sorry many question... I know but not easy when the people you want to get answers out of won't answer them.
 
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