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too much basal? How do I tell?

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the_anticarb

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How do I know if my basal dose is too high? I tend to go hypo if I am not eating on a very regular basis eg 3-4 hours after a meal I will go below 4mmol/l but due to pregnancy I need to make sure my post prandial readings are below 7.8. I am using novorapid and metformin for meals.

I have heard of people doing fasting tests how does this work?

I am on 12u lantus in the morning and 4 at night. If I go to bed with bg's of say 6 -8 I always wake up around 3.5 -4.5. This can be a concern because I drive to work and don't eat until later in the morning

Should I just drop by 1u for a couple of days to see the difference and then drop more until I am not going hypo all the time? Is there any other way to tell? Obviously I need to check that it does not make it harder to acheive my post prandials.

Any advice greatly appreciated thanks
 
Hi,

The way your basal is meant to work you should wake up pretty similar to what you went to bed with as its designed to keep your BG's stable inbetween meals, it deals with the glucose your liver and muscles release in your body throughout the day.

If you are using lantus you should only adjust once every three days and monitor to see how it's affecting you.

As you are pregnant and it would be silly for any of us to advise you incorrectly i would consult your specialist before you make any changes and if you do make changes to your basal insulin i would recommend you do a 2am/3am night test a day or two after the adjustment to make sure it's not straying from your strict targets in order to keep your little one nice and healthy :)

make sure if you are driving if you are around 3.5-4.5mmols you are having sufficient carb intake to make you nothing happens when you are driving.

good luck!
 
DO NOT follow Ebony's driving advice this is incorrect and totally dangerous the correct advise for driving is 5mmol/ml this is from the DVLA...

If you attempt to drive with a BG below 4mmol/ml this is classed legally as hypo in the eyes of the highway and driving licensing laws of the UK, you can have your licence revolked and/or you could also face being charged with either or both, Driving without due car and/or driving under the influcance of drugs or alcohol... And if you driving with a 3.5mmol/ml that would be if you didn't have/cause an accident that killed you!

As to your main question of basal rates..

The only way to check them is fasting tests, you fast for a period of time and you test every hour, your BG should change +/- 2mmol/ml if correct.. When doing a fasting test you should avoid excessive exercise, you need to be prepared to stop the testing if you become hypo or high, taking appropiate corrections.

Testing over night, you can do this several ways, either testing every hour on one night, testing several hourly periods over several nights, or even testing once in the night over many nights, so you build a picture of what happens over night.. If testing over different nights, pick the nights when your starting BG, day-time exercise regime and last meal are all similar...

But as you are pregnant, then you do need to discuss this with your diaebtic team before hand, as they may be reasons why this isn't suitable for you as a pregnant individual...

As when pregnant you insulin needs change very quickly during the pregnancy so it's very important to work very closely with your diabetic team
 
the_anticarb said:
How do I know if my basal dose is too high? I tend to go hypo if I am not eating on a very regular basis eg 3-4 hours after a meal I will go below 4mmol/l but due to pregnancy I need to make sure my post prandial readings are below 7.8. I am using novorapid and metformin for meals.

I have heard of people doing fasting tests how does this work?

I am on 12u lantus in the morning and 4 at night. If I go to bed with bg's of say 6 -8 I always wake up around 3.5 -4.5. This can be a concern because I drive to work and don't eat until later in the morning

Should I just drop by 1u for a couple of days to see the difference and then drop more until I am not going hypo all the time? Is there any other way to tell? Obviously I need to check that it does not make it harder to acheive my post prandials.

Any advice greatly appreciated thanks
Click to expand...

Hi

You could do with waking up with a slightly higher bg than 3.5-4.5. Its too low :!:

One of the best ways to get bg levels to behave is to get an insulin pen that delivers in 0.5u increments instead of 1u. Unfortunately, silly Aventis have not figured this out yet, so your best bet is to get GP or D consultant to prescribe you a Lilly Humapen Luxura HD which will accept the Aventis cartridges.

What you can then do is to reduce basal down to 3.5u at night and see what that does to your morning bg by carrying out Ebony's advice. Until then, I would eat a small bit of carb before going to bed (how much though can only be determined by testing middle of the night so that you can make adjustments to carb as necessary). If you drop Lantus by 1u it might be too much of a drop so half unit adjustments are better I think.

If you find yourself going hypo during the day at random times, before making adjustment to morning basal, try altering the insulin to carb bolus ratio (again get 0.5u Novopen Junior for this) and see if that corrects the situation.

Hope this sorts you out and you can drive to work safely with higher bg level. Your bg level really needs to be on a level of 8 before you put your keys in the ignition. A bg of 5 is not really safe to drive as it's very near to 4. It's far better to have slightly higher bg level and complete your car journey safely than for you to take the chance of maybe feeling hypo and not having sufficient warning until you drop down to 2 and find yourself hitting the kerb while you lose your concentration and start zig zagging as though you are drunk. Not good is it, especially if you find yourself involved in an accident.

Good tip (really worth remembering, is to always keep a pack of sweets open on your dashboard and if you feel as though you might feel low, pop a couple of sweets in your mouth and then look for somewhere safe to pull over so that you can sort yourself out with some glucose/hypostop etc.
 
Just to clarify jopar you totally misunderstood me, i was meant to say MAKE SURE you have sufficient carb intake so you ARE NOT hypo whilst driving. i would never imply that that is a safe level to drive at all.
 
Sorry Ebony, but you are implying that it's safe to be driving around 3.5mmol/ml and all you need to do is have some carbs! at 4.5mmol/ml I would actuall eat some carbs to ensure that I maintained my BG above the 4mmol/ml hypo threashold...
 
Just to clarify the DVLA rules regarding Bg levels and Driving, here is an extract from their latest guidelines.

Drivers with insulin treated diabetes are advised to take the following precautions:
• Do not drive if you feel hypoglycaemic or if your blood glucose is less than 4.0 mmol/l.
• If hypoglycaemia develops while driving stop the vehicle as soon as possible in a safe location, switch off the engine, remove the keys from the ignition and move from the drivers seat.
• Do not resume driving until 45 minutes after blood glucose has returned to normal. It takes up to 45 minutes for the brain to fully recover.
• Always keep an emergency supply of fast-acting carbohydrate such as glucose tablets or sweets within easy reach in the vehicle.
• Carry your glucose meter and blood glucose strips with you. Check blood glucose before driving (even on short journeys) and test regularly (every 2 hours) on long journeys. If blood glucose is 5.0mmol/l or less, take a snack before driving.• Carry personal identification indicating that you have diabetes in case of injury in a road traffic accident.
• Particular care should be taken during changes of insulin regimens, changes of lifestyle, exercise, travel and pregnancy.
• Take regular meals, snacks and rest periods on long journeys. Always avoid alcohol.
Click to expand...

I am sure Ebony is aware of the rules, just a genuine mistake which has now been corrected.
Therefore I don't think anything further needs to be said on this matter.

cugila
Forum Monitor
 
Thanks all.

Well I reduced my daytime basal to 10u today and yesterday and so far, much less hypo. Which ironically means less highs too as I am not then overtreating the hypo and swinging about like a pinball in a machine.

As for the car thing, I couldn't possibly wait til it was 8 before I drove we can't go above 6 in pregnancy unless this is after a meal. The reason I don't eat til later in the morning is to give the lantus time to kick in otherwise I will rise above 7.8 after my breakfast which is the post prandial limit in pregnancy. It would also be hard to always snack before driving (if less than 5) without affecting the very strict control pregnancy requires. I have however managed to get work to let me take the train rather than drive long distances (I live and work in manchester but also cover an office in london) so I am only doing short journeys now.

My dsn said to test before I drove and not drive if it was less than 4. I have been having a bit of lucozade or fruit juice in the morning if it is low but I often get a rise without taking anything anyway due to dawn phenomenon.

I know that in my type of diabetes (mody) this is caused by the message from whatever senses your blood sugar level to tell the pancreas to release insulin not getting through. So it seems that I am much more insulin deficient in the day, when food plays a greater role in insulin requirements, than at night. I often wonder if I need any insulin at all at night but, being pregnant, would not want to test this. before pregnancy I was only on the one dose of lantus per day anyway.

Thanks for the tips guys I think I was on too high a basal as I was going hypo several hours after meals but the way I see it, the two insulins work in tandem for most of the day so it's not as simple as saying is it one or the other but more, which one is making more of an impact.
 
Hi

Thanks for letting us know that things are now better. I didn't realise how tight bg levels needed to be while pregnant so good luck and keep well :)
 
Ha! Not when you're pregnant. NICE guidelines state anything less than 3.5 is too low, 3.5 and upwards is ok. And according to my dsn I can drive at 4 and upwards.

Doctor seemed to think waking up in the high 3's was 'good' - his words.

I'll test before I drive though and stop at the first signs of hypo
 
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