Splitting Basal Dosage

[Timostags]

I have been struggling to keep my bg below 12 for the past few days. Today for example...
I wake and test 14.1, so I take a correction of 10units of Novo.
About an hour later I have a cup of tea with 2 sugars and do a test 8.4
Another hour another test 4.8 (yay)
Another hour 6.1 (I haven't had any carbs since my sugary tea)
Another hour 12.2 (still no carbs consumed).For lunch I have some chicken breast and no carbs.
Another hour 13.6, I take another correction of 10 Novo.
Another hour 10.5
Another hour 4.9
Another hour 4.2.

The fact that I have almost fasted all day and my bg has been increasing makes me think it is my Basal that has been causing this.
I have had alot of issues getting the basal (lantus) correct in the past but for the past few years I have been taking 38units before bed, and it's been perfect I can test as I go to bed and wake up with exactly the same bg.
About a month ago my diabetic specialist suggested splitting the dose from 1x38u to 2x19u as I was having to take a large dose of Novo with evening meals.

Could this small change really be causing my bg to go from 4.8 to 12.2 in 2 hours without ANY carbohydrate?

Has anyone else had issues after splitting their bolus?

As the high bg has been going on for a few days I am checking for ketones. This morning it looked like there were some but they were low. Is reducing my carbs risking making this worse? Or is the fact that I am still taking a decent amount of insulin and clearly have glucose in my blood enough?

 

[evilclive]

Lantus = basal innit?

 

[Timostags]

Lantus = basal innit?

Ooops (I've edited the post now)

 

[EllieM]

Lantus = basal innit?

I think that @Timostags has confused basal/bolus (I do it all the time)

basal = base insulin = long term background insulin
bolus = short acting insulin

About a month ago my diabetic specialist suggested splitting the dose from 1x38u to 2x19u as I was having to take a large dose of Novo with evening meals.

Logically, if you can reduce your evening bolus because you've got more basal in your system then I'd expect you to need to increase your basal overall to keep it at the previous level for the rest of the day?

Has your evening novo gone down?

 

[Colin of Kent]

I reckon the protein in the chicken may have raised your BG due to gluconeogenesis. But that wouldn't explain why you're having a rise before eating. I wonder whether the action profile of Lantus may be off in your case. It's not quite flat. you could try switching to Levemir, which has a flatter action profile over 24 hours? Others may have better ideas...

 

[Timostags]

I think that @Timostags has confused basal/bolus (I do it all the time)

basal = base insulin = long term background insulin
bolus = short acting insulin



Logically, if you can reduce your evening bolus because you've got more basal in your system then I'd expect you to need to increase your basal overall to keep it at the previous level for the rest of the day?

Has your evening novo gone down?

No up to a week ago I would say there had been no difference

 

[kitedoc]

Hi @Timostags, I really think you need to discuss your results with the doctor who suggested you split your Lantus dose.
We can suggest how each of us might approach the BSL results and manage them but I think that armed with some ideas you might now best discuss them with your doctor.

 

[Timostags]

I reckon the protein in the chicken may have raised your BG due to gluconeogenesis.

I had never heard of gluconeogenesis before, I'm guessing this is what happens with a "rebound" during a hypo? I did always wonder how the body just seems to be able to create glucose

 

[Timostags]

Hi @Timostags, I really think you need to discuss your results with the doctor who suggested you split your Lantus dose.
We can suggest how each of us might approach the BSL results and manage them but I think that armed with some ideas you might now best discuss them with your doctor.

Yes if its still happening by the weekend I will go back to a single dose and speak with the doctor. I have always been scared to change the lantus as it has caused me alot of issues with hypos in the past.

I was just trying to find out if others had had a similar experience

 

[SamJB]

Like @Colin of Kent said, in the absence of carbs your body will convert protein in a meal to glucose; typically 10-20%. Even the act of eating, will cause your body to produce glucose, although this is quite a small affect, around 1 mmol/l.

In my opinion, your basal looks incorrect. The standard way to test this, is to not eat or inject Novorapid at least 3 (ideally 5) hours before bed. Then take the difference between your before bed and before breakfast readings and adjust your basal by 10% for each 1.6 mmol/l change. I change my Lantus dose every single day and so long as you follow this rule (from Gary Sheiner's Think Like a Pancreas book) there's nothing to be scared of

I would question why the basal has been split. Some people post on here saying they split their dose, but I don't understand the advantage of this as Lantus lasts for 24 hours. If things were ok before, then as they say "if it aint broke, don't fix it".

 

[Timostags]

I would question why the basal has been split. Some people post on here saying they split their dose, but I don't understand the advantage of this as Lantus lasts for 24 hours. If things were ok before, then as they say "if it aint broke, don't fix it".

I'm told it doesn't actually last the full 24 hours and tends to drop off before 24 hours.
I generally take around 30units of Novo rapid with my evening meal. I don't normally carb count so I can't say how many carbs. I just take 30 for an average meal, down to 20 for something only light and upto 40 if I want that full cake after.
I find that at lunchtime I seem to be alot more sensitive to the Novo rapid and take 10-12 units often still having hypos in the afternoon. So it was decided that the Lantus was probably wearing off in the evening and the high Novo dose was covering for that.

It wasn't until EllieM asked that I realised that I hadn't had to reduce the Novo at all since splitting the Lantus.

 

[SamJB]

I'm told it doesn't actually last the full 24 hours and tends to drop off before 24 hours.
I generally take around 30units of Novo rapid with my evening meal. I don't normally carb count so I can't say how many carbs. I just take 30 for an average meal, down to 20 for something only light and upto 40 if I want that full cake after.
I find that at lunchtime I seem to be alot more sensitive to the Novo rapid and take 10-12 units often still having hypos in the afternoon. So it was decided that the Lantus was probably wearing off in the evening and the high Novo dose was covering for that.

It wasn't until EllieM asked that I realised that I hadn't had to reduce the Novo at all since splitting the Lantus.

Yes, that sounds right, it could be wearing off and the Novorapid covering for it. I personally find Lantus lasts the 24 hours, guess everyone is different

 

[Colin of Kent]

Yes, that sounds right, it could be wearing off and the Novorapid covering for it. I personally find Lantus lasts the 24 hours, guess everyone is different

I've been pumping for 11 years now, but was MDI prior to that, and I do remember having to split my Levemir dose, because it wore off well before the 24 hours was up. Like you said, we're all different.

 

[Timostags]

So in a welcome but strange change....
I woke up on Friday to a 4.3 reading and apart from a couple of over treated hypos it hasn't gone above 5's since.

I made no change to the Lantus injections still doing the 2 injections a day.

So I don't know I'm going to say it was some sort of bug etc. That I didn't realise I had.