Request: Advise on basal dose

Hello lovely people, I hope you are all very well today!
The last couple of days I detected 2 cases of hypoglycemia during the afternoon hours which I thought were due to activity/exercise.

Today, I decided to run a basal test following the instructions at “think like a pancreas.”
My morning Levemir is of 12 units at 07:00 am.

For the basal test, my starting level was within range, I skipped lunch, had only water (no beverages whatsoever) and the previous meal and bolus was at 07:00am. I took the day off from work so not activity/exercise was involved.

Here is the breakdown:
13:00: 6.4
14:00: 4.6
15:00: 4.3
16:00: 3.6
At 16:00 I abandoned the basal test and treated.
According to my calculation, I had a reduction of 2.8 mmols within 3 hours (meaning 0.9 per hour).

I do not want to jump into hasty conclusions so, I wanted to ask for your advise and opinions first.
Please, what do you think?
Regards
Josephine

Hello, good day!
Thank you all for your advise!
Regards
Josephine

AndyS said:

Just to elaborate a little since I posted the last one as I was running out the door.

If you are not happy making larger changes or trying to work it out then you can simply titrate down. Make a small change (I think my DSN once told me 10% of total once though don't take that as ground truth) then repeat the tests until you see the profile you are after. But I work out changes because I know that 1U of insulin drops me by 2mmol, so based on your original numbers if it were me I would likely had backed off by 1.5U if I had a pen that could dose that. If I wasn't happy about hypos then -2U but the way I do my calculations is seen as a bit odd by some people.

I still have good hypo awareness and have always had fairly graceful hypos so I tend to be more aggressive in upping my doses than bringing them down.
If you are not happy with the hypos then you could always back it off a little bit more then gradually bring it back up until level.

It really all comes down to your personal preference and your own experience with hypos / hypers to how you deal with it. I think the key is just to make the changes then repeat your testing then go back through the whole cycle until you are happy.

Best of luck.

A

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Thank you so much Andy!
Unfortunately, I do not have a half pen for Levemir but, I do understand how handy it can be.

I reduced my morning Levemir by 1 unit and so far it has done okay… my 1:1 bolus ratio seems to be working accurately this morning…

During the DAFNE course we were also told to adjust by 10% each time but, since I cannot adjust by 1.2 units (on the basis of 12 units of Levemir), I thought I would start by 1 unit and gradually work my way from there.

I know that I have not had a pattern in order to make a change but, 2 cases of hypos during the last 2 days (around the same hour of the day) alarmed me somewhat.

I do not know why my insulin sensitivity changed but, I suspect why….

I have made some nutritional changes, I am still at 90 grams carbs per day but, these come mainly from fruits and 100 grams 0% fat yogurt, I have reduced meat/fish to 70-80 grams per day and have added lots of fresh salads. This approach helped me to lose about 2 kg in 2 weeks. (It wasn't necessary for me to lose weight as my BMI is 21.2 but... I always feel better when I go shopping and I can ask the lady "do you have this in size 8 instead of 10, please?")

Since I started feeling a little bit more confident with this basal/bolus scheme, I also started being more active! More brisk walks, yoga and stretching in the afternoons, more walks and play with my dog, Charlie, at the park. These things make me happy! And, I am happy to be happy, again... I was so afraid of this basal/bolus scheme that I became... redundant...

I suspect that all the above might have added up in becoming somewhat insulin sensitive.

I thank you so much for all the time that you devote in giving me answers and suggestions!
I wish you a beautiful day and a lovely and relaxing weekend ahead!!
Josephine

donnellysdogs said:

I meant to write 1 unit!! Lol!!

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Thank you so much for your suggestion. Unfortunately, I do not have a half pen.
I reduced my morning basal dosage by 1 unit and, so far, it looks alright as my 1:1 bolus ratio seems to be working accurately.

Thank you for your suggestions.
Have a good weekend!
Jospehine

robert72 said:

Actually, I would drop 1u from morning basal and retest. The point is to avoid hypos first.

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Thank you Robert.
My initial thought was to follow the DAFNE rule and continue with 12 units Levemir in order to see if there is a pattern however, I saw the logic in your suggestion as there is no point to "achieve" another hypo just for me to make a point to myself.
I followed your suggestion and I reduced my morning Levemir by 1 unit this morning.
If this doesn't work... well... I will raise it again!! This is easier for me than treating a hypo!

Thank you for your answers!
Have a good weekend!
Josephine

himtoo said:

Hi @Bluemarine Josephine
glad you have made the change and hope the 1u change does the job !!
I am so pleased at the progress you continue to make in your self management.

all the best !

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Hello Himtoo!! I am always happy to receive your messages! How are you?
Thanks ever so much, yes, it has been quite a journey lately with my diabetes.
But, you know how I feel about it, I love my diabetes and I treat it like every other relationship in life knowing that everyone is going to hurt us…we just have to find the ones worth suffering for….

I read that so many pump users are deliriously happy with their pumps.
You know, I am thinking to apply for a pump too. My diabetes nurse told me it can take up to a year to get approval.
When the time comes, I will have so many things to ask you regarding your Omnipod.
Have a beautiful weekend!!

Dillinger said:

Hi, next time you see your GP or nurse ask them to change your prescription to this one:

http://www.novonordisk.com/patients/diabetes-care/insulin-pens-and-needles/novopen-echo.html

Best

Dillinger

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Hello Dillinger and thank you for your reply.
I do have a half pen for Novorapid but, I do not have a half pen for Levemir. I know there is one because my diabetes nurse has prescribed it to a friend of mine who is diabetic. I do think it would be convenient to have half dosages for basal insulins as well..

Thank you for your message.
Have a nice weekend
Josephine.