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No idea what I'm doing - advice needed!
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<blockquote data-quote="StewM" data-source="post: 2390512" data-attributes="member: 538114"><p>So let's deal with your bullet points first.</p><p></p><p>1) Yeah, the HBA1C is an average so it is hypothetically possible to get a "good" HBA1C from bad results. That said, the 70% in target suggests you're doing pretty well. Of course, 70% in target doesn't preclude you from being out of target from time to time. </p><p>2) Hypothetically 15g shouldn't be a problem if your Basal is set at a certain level. However, I find if my Basal is set to that level, more often than not I NEED that snack to prevent my blood sugar from dropping low. This isn't actually entirely dissimilar to what I had to do using mixed insulin. There's also the issue not all carbs are created equal and will affect your Blood Sugar at completely different speeds. It might be worth trying different 15g snacks to see if the same thing happens. </p><p>3) It's possible on a low-carb meal your body's reacting to the protein content in the meal. </p><p>4) Experience Tresiba user here, Tresiba be like that. Though, I've had worse experiences with other Basals. Generally, what I've resigned myself to doing is setting the dose to where I'm most able to deal with the issues that dosage creates. I've yet to find the perfect dose of Tresiba. Long story short, Tresiba has extremely flat action (where most Basals have peaks and troughs). However, the body's insulin requirements are not generally speaking flat, and very hour to hour. They also vary massively from person to person. One of the keys to getting your basal correct is learning what your peaks and troughs are (Libre trends help a lot with this). For instance, I've found that I need more insulin between 7am-9am and less between 12:30 and 2:30 pm. So, I kinda have to work round this whatever I'm doing with my Basal. So my imperfect choice is to set my Tresiba high to help deal with the morning needs, and just be ready to take extra carbs when my Insulin needs drop in the middle of the day. </p><p></p><p>Your questions</p><p></p><p>1) I do my best to avoid them, but I feel it must be stressed I could do everything that worked today and it just doesn't work tomorrow. Diabetes be like that. </p><p>2) Basically, yes. However, the thing that has to be taken into account is your Bolus requirements will change due to any number of factors, so errors are almost unavoidable cause I doubt it's possible for anyone to consider all the variables all the time. I just try to catch mistakes fast, and correct them equally fast. I've found generally the earlier you catch a high or a low the easier it is to resolve. Libres help a lot with this. </p><p>3) People do. But generally splitting Insulin works best on non-Tresiba Insulins. Tresiba has such a long action time there shouldn't be any need to split. Splitting is usually done for Basal with shorter actions times which are unlikely to last the full 24 hours. Tresiba tends to more than 24 hours, so in a weird sort of way it is already split by having it once a day, if you see what I mean.</p></blockquote><p></p>
[QUOTE="StewM, post: 2390512, member: 538114"] So let's deal with your bullet points first. 1) Yeah, the HBA1C is an average so it is hypothetically possible to get a "good" HBA1C from bad results. That said, the 70% in target suggests you're doing pretty well. Of course, 70% in target doesn't preclude you from being out of target from time to time. 2) Hypothetically 15g shouldn't be a problem if your Basal is set at a certain level. However, I find if my Basal is set to that level, more often than not I NEED that snack to prevent my blood sugar from dropping low. This isn't actually entirely dissimilar to what I had to do using mixed insulin. There's also the issue not all carbs are created equal and will affect your Blood Sugar at completely different speeds. It might be worth trying different 15g snacks to see if the same thing happens. 3) It's possible on a low-carb meal your body's reacting to the protein content in the meal. 4) Experience Tresiba user here, Tresiba be like that. Though, I've had worse experiences with other Basals. Generally, what I've resigned myself to doing is setting the dose to where I'm most able to deal with the issues that dosage creates. I've yet to find the perfect dose of Tresiba. Long story short, Tresiba has extremely flat action (where most Basals have peaks and troughs). However, the body's insulin requirements are not generally speaking flat, and very hour to hour. They also vary massively from person to person. One of the keys to getting your basal correct is learning what your peaks and troughs are (Libre trends help a lot with this). For instance, I've found that I need more insulin between 7am-9am and less between 12:30 and 2:30 pm. So, I kinda have to work round this whatever I'm doing with my Basal. So my imperfect choice is to set my Tresiba high to help deal with the morning needs, and just be ready to take extra carbs when my Insulin needs drop in the middle of the day. Your questions 1) I do my best to avoid them, but I feel it must be stressed I could do everything that worked today and it just doesn't work tomorrow. Diabetes be like that. 2) Basically, yes. However, the thing that has to be taken into account is your Bolus requirements will change due to any number of factors, so errors are almost unavoidable cause I doubt it's possible for anyone to consider all the variables all the time. I just try to catch mistakes fast, and correct them equally fast. I've found generally the earlier you catch a high or a low the easier it is to resolve. Libres help a lot with this. 3) People do. But generally splitting Insulin works best on non-Tresiba Insulins. Tresiba has such a long action time there shouldn't be any need to split. Splitting is usually done for Basal with shorter actions times which are unlikely to last the full 24 hours. Tresiba tends to more than 24 hours, so in a weird sort of way it is already split by having it once a day, if you see what I mean. [/QUOTE]
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