Missed insulin and confused

[shirley]

My son moved from Lantus to Tresiba about 2 week's ago with great success. We were trying to avoid overnight lows and with a bit of tweeking found a dose that seemed to avoid that and were getting brilliant results.

He was having 7 units at breakfast. On Saturday I forgot to give him his Tresiba and only remembered at 5pm when he started getting high. I gave him the 7 units then and decided that I would have more success in remembering his background if I left it at teatime instead. So he had 7 more units last night after going higher in the afternoon. Overnight he went quite low so I thought we may be getting back on track.

He has come back from college measuring 11 which is unusually high. I can see from his Libre that as with yesterday, his short acting appears to have supported him until lunchtime and then slowly starts to rise.

Am I overreacting, is it going to take a few days to settle back down please?

 

[KookyCat]

It might take a few days to settle, but I've found Tresiba is more stable so doesn't need the three days for me. Could be that he has a pattern closer to my pattern and benefits from the morning injection. My background needs are much higher from lunch to 3pm so having the peak action of the insulin at that point works very well for me (because I tend to go low overnight). If you're taking it at tea time it's starting to wane by lunchtime I'd guess. You might need a touch more, but then of course you increase potential for an overnight low. I've concluded for me that any background in the evening is a no, it just doesn't work. Maybe give it another day and see if it settles? I'd be more willing to increase the dose by one with Tresiba but it depends how low he goes overnight as to whether that's an option to consider 🙂

 

[shirley]

Thanks KookCat yet again for your reply.

I think that you are absolutely right and Jamie's background needs are similar to yours. He certainly needs more in the afternooon and less overnight. Until I messed up our results were amazing and now we seem to be a bit haywire although he has dropped now without insulin to about 8.

I think that I will need to revert to mornings (and have alarms going off everywhere). I had thought that I would do this over the weekend when he is around. At the moment I inject the Tresiba at 5pm. I thought that I could put it back by 2 1/2 hours on Friday, Saturday and Sunday (when I can keep a close eye on things) and by Monday morning he will be back to his 9am dose.

Do you thing this is the right way to go about it?

 

[HOBIE]

I set alarms on my phone for things like that, pump changes etc. Good luck 🙂

 

[KookyCat]

Ooh not sure how you should move the time. If it were me knowing what I do about my almost zero basal requirement over night I'd probably wing it and miss the 5pm dose on Friday then inject the full dose on Saturday and do a correction with brekkie if needed or before bed if it started to go up rapidly. But I'm inordinately cavalier with these things so that might not be the best plan! Your plan sounds sensible to me, and you've got the libre for monitoring so that sounds sensible too, I guess you just do what feels right. I'm told by my medical team I'm too "comfortable" risking hypos, but I've had to be because I'm so sensitive to insulin and I'd be a basket case if I hadn't hardened to it 🙄

If you're worried maybe a quick phone call to your DSN?