Ratio advice

If you can do the bolus at about 7pm and leave the basal until 10 or 11pm when you go to bed then the bolus action will be working independently from the basal. Of course, there will be the need to remember to always do the basal wherever you are or might be at this time but if you leave the basal until 10 or 11pm, then its action will be a tiny bit greater overnight resulting in slightly lower bg in the morning and will still be working in the morning till about 2pm and that should enable you to use less bolus at lunch. Seems as though youve got to use a lot less bolus at lunch at the moment but this should enable you to hopefully get better results. You may still need a snack mid afternoon though but maybe not quite so much...

Hiya!

This is all really interesting as I am on Levemir and having similar problems to Hale. I split mine 6.30 am and pm but high most mornings, low mid morning high again by tea time, so iHs's suggestion of moving the evening dose later at night is one I might just nick LOL.

Hale - I used to be on Insuman Basal and I can vouch for what Brett said about the peak of intermediate acting keeping fasting levels excellent - mine have gone to pot since the move to Levemir. I wonder if you can do an evening jab of Insuman and a morning one of Levemir? Think I'll ask my consultant that when I see him next week because I reckon that would work for me. Anyway, I'll butt out and stop hijacking this thread with my basal issues LOL.

BTW, I reckon Levemir lasts no more than 16 hours for me Hale.

Smidge

Tbh, I think if on a long acting insulin there will be a problematic period for most. Its just some lucky ones counteract the wearing off of the long acting by covering with extra quick, and opp to that counteract a period off too much long acting either by reducing qa for a particular meal or by having a snack.
for some though by covering with quick acting gives a good 2 hour reading but results in a hypo.

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Hate to say it, but, test and see lol. Knowing that you should have more basal working should mean a reduction with breakfast bolus. But not much

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Yeah lost me too. Bit confused myself by this one hale.


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Oh dear .......lol

Brett has explained the action of basal against bolus fairly well, whereas I didnt so much. We all need different amounts of insulin according to how our body needs it even without eating any food but unfortunately all the injectable insulins have a duration of action to them and some have a faster onset than others so that is why we all need to adjust these insulins like we do....

If you start from Weds night with the bedtime basal (not tonight if youve injected it with the bolus) then you will need to adjust the eve meal bolus to be slightly more and only by testing yr bg level will you be able to alter the doseage through trial and error. Try and get the eve meal bolus carb ratio to give you the sameish bg levels 4hrs later but remember that the bolus action will be nearly at its end but not quite so if going to bed 4hrs after bolus, then aim for bg to be about 8mmol for safety and then that will allow for the tail of the bolus.....

In the morning like Brett said.... you could leave yr morning bolus the same or increase it slightly (use yr previous bg reading to be your guide) and just test bg to see what happens. The first day, you might not see too much of a change, but will see it more on the start of the second day....

Just make sure that you have test strips to hand and some jellybabies or carb to deal with how the alterations affect your bg levels. Also, although a complete PITA, get up in the night about 3am just to see what the basal is doing.....

Hale, without stating the obvious but have you asked for your DSN's input on what is happening with your bg levels? Might just be that they could offer you some advice on adjusting your insulin doses.

Hale, not sure if this helps at all, but I'm on DAFNE this week (not ideal for a low carber but that's another story!) And they insist everyone splits their basal. Mine was already split, but everyone else has had to split there's even if they're on Lantus. I wonder why you were told not to - was it because you take such small doses? Just wondering if it would help you to increase the basal by a unit, but then split the increased dose morning and night to give longer coverage but avoiding having the whole dose active at the same time. In the early stages, I used to take 3 units in the morning and 1.5 at night - although that was an intermediate rather than Levemir. Just a thought.

Smidge

they were against us splitting on my DAFNE course - it was something i suggested for myself because DAFNE itself screwed my BGs up so much. (capping correction at 4...my BG is 27.7. Fook that.) but basically they said no changes to insulin type or injection routine. Dont really know why. Hang in there Hale and I understand the hoops you got to get through for a pump trust me. It'll be worth it in the end

This is fascinating reading and how good is it that you can get top quality advice from the forum when you are unable to get it from the 'professionals'. Well done everyone (sorry - was that condescending - not meant to be?!?)