No more pumping for now.

[robert72]

New day....woke up to 5.5!!!!

At the moment honest... I haven't got a clue!!

My acting times and off set were spot on with my pump..
Apart from a huge spike in mornings they basically levelled off for 18 hours..

Bolus I know novorapid was basically 4 hr 15mins. My offset time for it to work to start bringing my levels down was 90mins!!

Its going to be differnt today.

Working: so: this what I've done:
15 unuts L last night
10 units L this morn
2 units NR.
So started ok.
First full day of Levemir and working so can I watch today and test and time to see when it goes bad today??

I wonder whether probs were from old lantus pen???

5.5 is a good waking figure I think there is a problem in doing the morning basal test due to your waking rise - I have the same issue. I've now figured out that I need 5u Novorapid just to get out of bed. I guess you'll need to titrate your waking bolus until you find what stops your spike and keeps you level until lunchtime.

 

[candi-girl]

I really hope this is not true. Can you imagine the effects if the manufacturer just changed the strength of an insulin? Basically disrupting the control of millions of users of that insulin and precipitating maybe hundreds of thousands of hypos? They would probably lose their FDA licence, and quite rightly.

If a manufacturer was going to change the strength of an insulin I am sure they would issue it under a new name. Levemir Plus or something like that. And on medical safety grounds they would need a strong marketing and communications campaign to distinguish the new stronger insulin from the older weaker version.

Very good point in a book using insulin when levemir had just come out said it was weaker. But just my experience tells me its not weaker than lantus at all.

And DD yes i change day time lev doses for days off work as i do an active job.

 

[donnellysdogs]

4.9 one hour later!! No pattern.. Rises last two days!!

 

[tim2000s]

Agreed. I'm sure if Levemir was weaker they couldn't call it U100. Having said that, I did need about 30% more Levemir than Lantus during the 3 months that I tried it, so not sure how they go about defining strengths. When I was first diagnosed there were different strengths of insulin - U20, U40, U80 until everything was standardised to U100, which saved a lot of calculations for us

I remember a trip to Italy in the early nineties when they were still on U40 and I was using U100. I had to get replacements due to dropped vials and do the conversion.

Levemir isn't "weaker" than Lantus, but it operates differently, and I suspect this is what drives different dosage requirements in different people. I have a strong suspicion that those that require more Levemir than Lantus have issues with the way that Levemir is protein bonded and potentially their bodies breakdown the protein bonding differently resulting in greater expulsion of the insulin as unused waste. However that's a physiological level that I have no evidence for and have seen no research into.

 

[donnellysdogs]

Small update..

I really think that my autopen24 after 5 years non use has led to majority of my problems..

Today with new pens. New insulin, new needles - the following!!!!

Today so far with 10Lev and 2 NR

And I'm physically gardening (break now).

7.00 5.5
9.00 5.3 injections
9.47 4.9
10.42 5.0
11.29 3.9 (22 pineapple juice as working)
12.46 5.2
13.05 4.2 (22 pineapple juice)

So I only needed 1 Unit NR as low 2.5 hours after.

Possibly lower to 9 units levemir for morning dosage on workdays?

This is an believable change...

I can only put this down to
Autopen24..
Old needles
Insulin with only one month left..

Would you say to lower my 15 unit Levimir to 14 unit tonight??

My corrections worked last night..

Think I have to see whats going on tonight after food. Its white fish n salad n pecan thing n fresh fruit salad tonight with flax n chia seeds and 2 sq choc...

Happier now!!!

 

[donnellysdogs]

And DD yes i change day time lev doses for days off work as i do an active job.

As I get up later, and do slightly less activity on days off..

Q1... Give 1 unit levemir more the evening before? Or leave same?

Q2.... Give 1 unit extra levimir in morning as well??

 

[candi-girl]

with me, if i am less active, at the weekend, i leave my over night basal the same otherwise i go hypo but i add 2units to my 8am dose on a saturday and sunday. on a monday i am my most active and i give 6u and the rest of the days 7u. the thing with levemir is it seems to be very flexible with changes.

 

[tim2000s]

Your day/night split on the basal confuses me a little. I've found I need less basal overnight and more in the daytime, presumably because when active, my body produces more glucose from the liver during the day than when sleeping (which I confess I thought would be the norm).

 

[candi-girl]

i would def lower your levemir tonight. it seems to get quite potent once you've been on it 3 days and it has established itself into your body. i think you will have a few adjustments as yet but going in the right direction. good stuff!

 

[donnellysdogs]

Mmmm... You are right @tim2000s. I did have lower rates overnight in my pump but at 3am my basal rates used to double and then triple hourly for 5 hours....

The thing I had in my head was that if I take the levemir higher dose at say 10pm that it will be most potent at 6amish when I am needing it?? Or have I got that totally wrong??
I've not used Levemir and I haven't researched it properly to be honest... So I'm a bit thick after 5 years on the pump!!

Today has proven 10 units this morn too much..despite drinking another carton of juice and no bolus I went to 3.9 again by 15.40.

Hugely different to yesterday and day before using the lantus and autopen...

Thinking now is I will drop it to 8.5 units for the morning levemir and 1 unit of bolus when I'm working.

Last nights 15 Levemir and the correction I had to do got me to 5.5 this morn.. So is my thinking on the qty, and acting time and attacking my rises wrong? Its just that my basals on pump jumped from .45 up to 1.25 from 3am so I'm trying to counteract the huge rises I get when waking at 7 or 8am??

 

[robert72]

Mmmm... You are right @tim2000s. I did have lower rates overnight in my pump but at 3am my basal rates used to double and then triple hourly for 5 hours....

The thing I had in my head was that if I take the levemir higher dose at say 10pm that it will be most potent at 6amish when I am needing it?? Or have I got that totally wrong??
I've not used Levemir and I haven't researched it properly to be honest... So I'm a bit thick after 5 years on the pump!!

Today has proven 10 units this morn too much..despite drinking another carton of juice and no bolus I went to 3.9 again by 15.40.

Hugely different to yesterday and day before using the lantus and autopen...

Thinking now is I will drop it to 8.5 units for the morning levemir and 1 unit of bolus when I'm working.

Last nights 15 Levemir and the correction I had to do got me to 5.5 this morn.. So is my thinking on the qty, and acting time and attacking my rises wrong? Its just that my basals on pump jumped from .45 up to 1.25 from 3am so I'm trying to counteract the huge rises I get when waking at 7 or 8am??

You had a very good waking level this morning so maybe leave the evening levemir as is and then no waking bolus if your waking level is the same tomorrow and you're working. If you can wake up 3 times in the 5s then look at your daytime levemir to avoid hypo.

Levemir has a different trajectory depending on the size of the bolus. I'm sure @tim2000s can tell you more.

 

[tim2000s]

@donnellysdogs Was just looking for this helpful trace:

Basically,during the day for me I give 0.15u/Kg and over night I'm at around 0.09u/Kg. At this level, the duration of Levemir in a clamp is roughly 11 hours in the first case and about 10 in the second. It also doesn't have a huge peak, and this is 2-4 hours in. Assuming you are around 60kg, at 15u you would be seeing a nightime peak starting to kick in at about 3-4am and lasting through until around 6-8am, which may be why you are managing your DP with it.

Your duration (if you are 60kg) of that 15u dose looks like somewhere around 16 hours (although I find the duration in reality to be lower than the clamp graphs). It might be interesting to do a proper basal test and see what your bg levels at 2, 4 and 6am are, because this profile suggests you may be pushing lower ahead of a DP action starting.

In line with that, if your 15u is lasting about 16-18 hours, then it would explain downward pressure on your bg between 10am and 4pm as you would have had overlapping basals, although the 15u would be petering out. This would suggest that perhaps you needed less in your daytime dose, and at a slightly later time.

Don't know if that helps or makes sense?

 

[donnellysdogs]

Totally makes sense. Thank you so much for taking the time to work that out for me. I'm 57 kilo so not a bad guestimate!!

Tonight has been:

5.3 17.00
4.4. 18.05 bolused
-- 18.30 ate
4.7. 19.30
4.7. 21.30

Going to basal now- 14 units.
Going to basal morn- 8.5 units

Running too low today!! (For me!!)

What a difference to Mon n Tues!! I'm sure it was a duff pen...

If I could keep a little bit higher with this I wouldn't go back to pump.

Accuchek are sending me tenderlinks as a priority when they are available next month to try them.

Its so lovely though to jump in bath, sleep so well and feel some freedom of pumping.

If I can get the same for my day off on Sunday it would be brilliant. Just hope I don't raise sugnificantly!!

Thank you so much @robert72 for spending your time caring so much about my dilemma. Can't believe you've done that for me. Thank you...

 

[robert72]

Totally makes sense. Thank you so much for taking the time to work that out for me. I'm 57 kilo so not a bad guestimate!!

Tonight has been:

5.3 17.00
4.4. 18.05 bolused
-- 18.30 ate
4.7. 19.30
4.7. 21.30

Going to basal now- 14 units.
Going to basal morn- 8.5 units

Running too low today!! (For me!!)

What a difference to Mon n Tues!! I'm sure it was a duff pen...

If I could keep a little bit higher with this I wouldn't go back to pump.

Accuchek are sending me tenderlinks as a priority when they are available next month to try them.

Its so lovely though to jump in bath, sleep so well and feel some freedom of pumping.

If I can get the same for my day off on Sunday it would be brilliant. Just hope I don't raise sugnificantly!!

Thank you so much @robert72 for spending your time caring so much about my dilemma. Can't believe you've done that for me. Thank you...

DD - always happy to help if I can. I also hardly eat any carbs until dinner and seem to have the same waking rise.

 

[donnellysdogs]

In fact, thanks to everybody!!

Monday and Tuesday I thought.. "Never going to get level!!" - well today has proved I can get vastly improved and towards levels on a parbwith the pump... And quickly too all things considered.

@Spiker thank you for bearing with me hijacking this post. I think I should have started my own to be honest now-reflecting back. I hope that you are okay and getting better levels too...

@robert72.. Could never figure those graphs out-lol!! So glad you can! Thank you again.

I'm so very grateful for @Spiker giving me the courage to say "enoughs enough with the pump" and for bearing with me.

 

[robert72]

DD - it was @tim2000s who figured out the Levemir curves

 

[donnellysdogs]

Oh... Omg!! 4.7 now and still my brain is addled!!

A huge big, big thank you @tim2000s. You have helped me beyond belief!! Thank you for interpreting the graph for me and taking the time to sdvise me. You are wonderful.
Thankyou soooooo much!!

 

[ann34+]

I'm finding this with the Insight pump it's so slow on using the handset, and boy oh boy I mean slow I am really starting to dislike the blooming thing, I've tried using the functions but I've got better things to do with my time, "it's not your iPhone"
the wife keeps telling me.

The bad thing is I've started bolusing with my pen as the pump process takes too long apart from the "standard bolus" but even that's a nuisances, the only thing that I'm pleased with is donnelly dogs getting me onto Rapids "nice one dd" their a godsend.

I feel that I could do with more training on this gadget I'm so pleased for DD and Spiker going bake to mdi I'd love to but have horrific memories of how unbalanced my control was, but I do now have a better understanding of the basal, bolus, carbs etc than I did 15 years ago when I stated a pump.

Oh yes the only two things I'm really enjoying about my insight pump is you can see exactly what's left in the cartridge and the coloured Pie charts

Hi, masonbason63, Re a bolus with a pen - why do you think this is a bad thing? in my view, as long as someone is not using pump apps or checking pump TDD, or averages, i do not see a problem ...and if more convenient for any reason, i occasionally use a syringe for a bolus. Ann

 

[masonbason63]

I suppose not but when your meant to be using a fan dangled piece of kit it's a bit against the rule book but ooooh those lovely 4mm needle no pain no gain

 

[donnellysdogs]

Bad reaults all night...
Didn't go to bed till almost 2am.

01.38 7.2
05.00. 3.1. 15g
06.00. 3.9. 15g
07.00. 5.3
09.00. 3.1

Have corrected hypos with 15g.

This morn lowered to 8.5 for Lev.
Lowered to 1.0 for NR.

This is because of working so hard during the day I think....
Same today.

Would advise be to lower to 12 tonight? Gone from 10 to 15, 14 last night.. Perhaps 12 is middle? Did Lev at 21.30 last night...

@tim2000s, @robert72 what do you think??