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Should I reduce my basal?

becky.ford93

becky.ford93

Well-Known Member
Messages
244
Location
Exeter
Type of diabetes
Type 1
Treatment type
Insulin
Currently I'm taking 8 units of lantus (glargine) at night as my basal insulin. However, unless I snack, I consistently go into hypo around 4 hours after eating. My meal rise at breakfast is fine, but I have to snack around 3 hours after finishing to keep my sugars up. I've just tested two hours after lunch and my meal rise went up to 11.9. Obviously tomorrow I will try increasing my lunch time bolus, but I know this will put me into hypo before I finish work at 5. I don't understand what I'm doing wrong, I would like to be able to keep my meal rise <8 without constantly going into hypo a few hours later. Every time I speak to my diabetes team they say not to decrease it as I'm waking up at a good level (5-6), but I'm sick of having to rely on snacking 3-4 times a day!! Help would be greatly appreciated! :)
 
Likely is your basal insulin, the only way of knowing for sure is to do a basal test, this means testing your bg levels 4 hours postprandial and missing your next meal (and bolus of course) and see if your bg levels go up or down, if your basal dose is spot-on your bg levels shouldn't fluctuate by more than 1.6mmol/l.
 
If you are rising and dropping after eating, it might be that you need to inject your bolus a bit earlier to coincide with the spike.
 
That's really useful to know, thank you! Not looking forward to trying that but hopefully it'll be worth it
 
Do you have any active NovoRapid on board when you go to bed? i.e. is the gap between your last NovoRaid injection and the time you go to sleep more than 3-4 hours? If so, and your levels on going to bed and waking up are remaining the same, then your basal is probably set at the right level and I'd recommend trying robert72's suggestion of injecting your rapid insulin 15-30 minutes before eating and leaving your Lantus as it is for now.

I find that NovoRapid takes at least 30 minutes to kick-in and I get the best control of my post-meal spikes by injecting at least half an hour before eating. I was also taking 8 units of Lantus but I recently dropped to 6 units because of the same problem as you - hypos occurring 3 hours after injecting. However, my night levels were also dropping and I was already injecting 30 mins before food.
 
I think I'll try injecting 10-15 minutes before eating to start with and see how that goes. Just rang my nurse and she didn't seem to see any issue with being that high after a meal, and even advised me to just not test afterwards!! Feel like I'm banging my head against a wall sometimes :banghead:
 
Sounds like a good plan.

I had exactly the same from my consultant ... he said there was no need to test after eating and that I should only test before each meal!
 
A while back I was only using 1 unit with breakfast because this meant I could get to lunch at 4-5mmol/L without needing to test, little did I realise that 2 hours after breakfast I was at 17.9!!! And she's advising not to test after? So glad I did!
 
Yes, it's shocking - I had much the same experience! I like porridge for breakfast on weekdays and the only way I can ensure I do not spike too high is to inject my NovoRapid as soon as I wake up, shower, get ready etc. and then have my porridge about 30 mins later. Thanks to my Libre I know that, doing this, I can keep my maximum spike to 7-7.5mmol. Anything less than about a 20 mins gap before eating and I invariably peak at more like 9.5mmol (and sometimes higher).

Leaving a decent gap between injecting and eating has made a HUGE difference to my post-meal levels and has drastically improved my overall control. You can really "strike the spike" when you work out how long it takes for the rapid insulin to kick in and how quickly certain foods begin to digest.

This article is well worth a read.
 
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I'm a porridge fan too, fortunately I think my 35 minute walk to work seems to control that spike, but I think lunch is obviously an issue. Thank you so much for your advice, I'll have a read :)
 
complete agreement with @pinewood on the dosing early -- I often take my bolus injection 30 minutes before a meal as it definitely stops the spike getting as high-- and I 've never used a libre -- that's just from doing a few extra tests to make sure my thinking head was on straight
 
becky.ford93 said:
A while back I was only using 1 unit with breakfast because this meant I could get to lunch at 4-5mmol/L without needing to test, little did I realise that 2 hours after breakfast I was at 17.9!!! And she's advising not to test after? So glad I did!
Click to expand...

That's exact,y what my BS did when I was first diagnosed, and, like you, I didn't realise at first as I'd been told to only test before meals. i was on tiny doses of insulin because my BS looking OK, but I was actually spiking. I could take NO insulin with my breakfast and be 3.8 before lunch, BUT I then realised after breakfast my BS went up to 13.9!

Like you, I increased my bolus and snacked. I actually quite enjoy snacks so I didn't mind too much and soon got into a routine. I also slightly reduced my breakfast so I was more ready for my mid-morning snack.

I just wanted to know that you're not necessarily doing anything wrong. My consultant told me that my body was still making some insulin but making it too slow, causing the high spike.
 
Thanks for your advice everyone, I'll try leaving a gap between my lunchtime bolus and lunch tomorrow and see how it goes. Thanks all! :)
 
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