Sorry I wasn't clear. To deal with the hypo I had a salad that was a prawn/rice/mango/salad and it had 50g of carbs. So I didn't use any insulin at all and only food to treat the hypo. From 11.15 onwards I have taken no bolus whatsoever and if you look from 16.00hrs onwards I'm stable - this makes me think the basal is doing that. However I could be totally wrong!
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Switched Bolus and Having Issues
- Thread starter Michele01
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Sorry I wasn't clear. To deal with the hypo I had a salad that was a prawn/rice/mango/salad and it had 50g of carbs. So I didn't use any insulin at all and only food to treat the hypo. From 11.15 onwards I have taken no bolus whatsoever and if you look from 16.00hrs onwards I'm stable - this makes me think the basal is doing that. However I could be totally wrong!
Lucyr
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You should really treat a hypo with fast acting carbs, as food takes time to be digested. The reason you didn’t take insulin with the salad at 2pm was that the correction dose from 11am was still working and sending your blood sugar too low, and that dose could have covered the 50g carb in the salad. So the second correction was way too much fiasp, not just a couple of units too much.
You must deal with a hypo with fast acting carbs such as jelly babies or dextrose or fruit juice.
A salad is not a good hypo treatment.
Have you attended any Type 1 training such as a DAFNE course which will explain how to adjust insulin doses, treat hypos, manage diabetes and exercise and more?
I normally do use glucose tablets to treat a hypo but today I've just had a horrible day and haven't known what to do.
No Type 1 training whatsoever.
I'm going to phone my Endo team tomorrow and ask for an urgent meeting because I'm not going to use the Fiasp and need to go back to the Novorapid, get my basal right and start again. I hate feeling like this.
Thank you for all your help x
rebrascora
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Hi.
So sorry to read that you are battling such horrid highs and lows. That must be making you feel pretty yuk!
Firstly are you aware that lying on the arm which has your Libre sensor on it can cause a compression low? It is therefore always important to double check a low Libre readings, particularly at night. Did you check your BG with a finger prick before taking carbs on board and how many carbs did you eat to treat the 3.8?
Secondly Libre takes about 30 mins to show a rise from the carbs you have eaten to treat a hypo (it lags behind your blood reading by about 15 mins), so always best to check with a finger prick 15 mins after your hypo treatment rather than rely on the Libre and perhaps be tempted to retreat if your levels haven't come up above 4. The fact that your Libre was up to 7.4 18 mins after your supposed hypo, suggests it may have been a compression low rather than a real low BG as it would be pretty unusual for it to respond to carbs so quickly. Usually the LIbre shows a lower reading 15 mins after you have eaten your carbs but a finger prick will show you have come up. This may be why your levels then went so high after treating that 3.8.... because you may not have actually been hypo in the first place and perhaps ate those carbs on top of a reading of 7 or 8 or maybe even higher.
Once your levels are high, ie over say 12, it often takes more insulin to correct them than your normal correction factor and I find this more of an issue with Fiasp.
It has taken me a good 6-8 months to get along with Fiasp and this is my second trial of it but I am on the same page with it now. I still need to bolus 45 mins in advance of breakfast with it most mornings and 15-20 mins in advance of other meals but it was 75 mins at breakfast with NR and 20-30 mins at lunch and evening meal, so whilst it is quicker than NR it still needs a considerable prebolus time for me.
I think your problems may be a combination of reacting to Libre readings which may not be giving you a true picture of your BG levels and not pre bolusing enough with the Fiasp and possibly not mentally allowing for the 15 min time lag with Libre readings.
So sorry to read that you are battling such horrid highs and lows. That must be making you feel pretty yuk!
Firstly are you aware that lying on the arm which has your Libre sensor on it can cause a compression low? It is therefore always important to double check a low Libre readings, particularly at night. Did you check your BG with a finger prick before taking carbs on board and how many carbs did you eat to treat the 3.8?
Secondly Libre takes about 30 mins to show a rise from the carbs you have eaten to treat a hypo (it lags behind your blood reading by about 15 mins), so always best to check with a finger prick 15 mins after your hypo treatment rather than rely on the Libre and perhaps be tempted to retreat if your levels haven't come up above 4. The fact that your Libre was up to 7.4 18 mins after your supposed hypo, suggests it may have been a compression low rather than a real low BG as it would be pretty unusual for it to respond to carbs so quickly. Usually the LIbre shows a lower reading 15 mins after you have eaten your carbs but a finger prick will show you have come up. This may be why your levels then went so high after treating that 3.8.... because you may not have actually been hypo in the first place and perhaps ate those carbs on top of a reading of 7 or 8 or maybe even higher.
Once your levels are high, ie over say 12, it often takes more insulin to correct them than your normal correction factor and I find this more of an issue with Fiasp.
It has taken me a good 6-8 months to get along with Fiasp and this is my second trial of it but I am on the same page with it now. I still need to bolus 45 mins in advance of breakfast with it most mornings and 15-20 mins in advance of other meals but it was 75 mins at breakfast with NR and 20-30 mins at lunch and evening meal, so whilst it is quicker than NR it still needs a considerable prebolus time for me.
I think your problems may be a combination of reacting to Libre readings which may not be giving you a true picture of your BG levels and not pre bolusing enough with the Fiasp and possibly not mentally allowing for the 15 min time lag with Libre readings.
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rebrascora
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Education is a huge part of balancing your insulin, getting your basal dose right and using the Libre system. Ask to be put on the list for a DAFNE course or whatever your local equivalent is. It is a 5 day course and will make a huge difference to your understanding and confidence in adjusting your insulins and understanding how they work. There is a Libre Academy on the Abbott website and I had to prove I had done the training before I could get Libre on prescription. It is really important to understand how it differs from finger pricks and how to use it effectively.
Thank you so much.
It's interesting you mention the compression issue and I hadn't thought about that. What I have noticed is that the Libre2 is consistently 2 behind or in front of finger prick readings. I've found quite often that when the Libre2 tells me I'm hypo, I have no symptoms and if I finger prick, my readings are actually ok. The problem is that the Libre2 keeps alarming when I'm going low - I suppose I could turn the alarm off but then I do run the risk of having a hypo and not being aware. My night time basal (identified by my Endo) was far too high and I was having too many nighttime hypos which is why we decided a month ago to try the Libre2. So before this I used to take 20-22 bolus units at night, I'm now on 13! So although maybe I could reduce it further I am wondering whether it's a combination of evening meal bolus and my basal! In terms of the readings, I do allow for a lag which is why if my levels were going up or down and my finger prick test was a bit higher or lower I haven't panicked. It does seem to be a consistent 2 units different at all times though irrespective of time lag.
One thing that you've said that really strikes home is that I have been taken all bolus insulin right before I eat - not allowing any time beforehand. In fact, my Endo was VERY clear with me that I should never take Fiasp unless it was immediately before food - this seems to not suit me because of the double spike I'm experiencing. Did you have that too?
It's interesting at how long you're injecting before eating. I'm going to switch back to NR for my evening meal tonight and will take it 30 minutes beforehand and see what happens.
As for my basal - I'm so confused right now I have no idea what to do - I think so I'm not changing too much, I will take 1u lower than I normally would! Hopefully that and the timing of the evening meal bolus may help. Thank you for your insights.
Pumper_Sue
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That looks a complete and utter mess
It's no wonder you are having problems.It's not the fault of the insulin it's the way you are using it. So you need ask your team to sort you out an education course so you understand how to use your insulins.
Why oh why are you taking one does of Levemir at about 10AM?
Levemir is a two injection basal as it does not cover 24 hours, so needs to be taken AM and PM.
Doing that will give you a lot better control. 🙂
Edited to add just seen in another post you take Levemir at night as well. Try moving your Levemir to when you get up in the morning.
Fiasp you inject between 4 and 15 mins before you eat. the 4 mins if in range a tad longer if a bit higher. If you inject to long before you eat you will end up hypo.
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I do take a split dose of Levemir. I got out of bed at 10am this morning - had a lie in because couldn't get back to sleep after the "hypo".That looks a complete and utter mess
It's not the fault of the insulin it's the way you are using it. So you need ask your team to sort you out an education course so you understand how to use your insulins.
Why oh why are you taking one does of Levemir at about 10AM?
Levemir is a two injection basal as it does not cover 24 hours, so needs to be taken AM and PM.
Doing that will give you a lot better control. 🙂
My morning Levemir is typically 19u (down from 24u a month ago as advised by Endo) and my nighttime Levemir is typically 13u (down from 20-22u - also advised by my Endo).
Although I look like a complete idiot, my HBA1C has always been around 50-55 although I appreciate this is because I've had high peaks and low troughs. The reason for the change in Bolus was to get rid of the peaks and troughs and get me more stable. So this past month has been a complete learning curve with lots of changes and clearly the change in bolus has been a step too far because my levels are totally out of control whereas before I could get a nice stable line between meals.
I have never particularly worried about my levels before but I have wanted to reduce the hypos. This is what started this process a month ago. Clearly I have a lot of work to do to correct it but I am generally a sane individual! I'm just having a tough time right now and can't see the wood for the trees.
I was told to always double check Libre highs and lows with a finger prick before doing any corrections?
Not only is there a risk of compression lows, Libre is inaccurate when levels are high and low.
For example, Libre may say 15 when a finger prick gives a reading of 12. Making a correction bolus seriously risks over correcting and hypoing. No wonder your levels look like a roller coaster ride if you are not checking before correcting.
Not only is there a risk of compression lows, Libre is inaccurate when levels are high and low.
For example, Libre may say 15 when a finger prick gives a reading of 12. Making a correction bolus seriously risks over correcting and hypoing. No wonder your levels look like a roller coaster ride if you are not checking before correcting.
I never had to correct my bolus with Novorapid. I have only done this with the Fiasp because I've never experienced such awful peaks.
Pumper_Sue
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No you are not an idiot and please don't think you are. 🙂
No one can manage their diabetes unless they are given the tools to do so (education) If you think of it logically you can not fly a plane with instruction and or the manual and from what you have said it appears you have had no help in understanding how insulin works and how to sort issues out.
Take things nice and slow one day at a time.
No1 rule is always sort out your basal first.
No2 is make sure if using Novo is to bolus 15/30 mins before you eat.
No3 is always treat hypos with quick acting carbs 15 carbs wait 15 mins and treat again if no improvement. This is known as the 15min rule 🙂
rebrascora
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It is important to carefully adjust the timing of your bolus insulin. We are all different and some people hardly need any time before or they will hypo mid meal whilst others, it takes a lot longer than the manufacturers/health care professionals will have us believe. I was initially on NR and used multiple finger pricks on a morning to find when the insulin started kicking in and it was the best timing to have my breakfast because going up to 15 and then coming rattling down to 5 every morning in the space of 2 hours was not a pleasant experience! Libre makes it so much easier because I can just keep scanning and look for when my levels start to drop. Do keep a close eye on it rather than just going straight for 30 mins, which might be too much for you. Or try 20 mins and see how that works and then try 25 mins the next night. Always important to keep yourself safe. Also, high fat or fibre meals like pizza or pasta with a creamy sauce or lentils will take longer to digest so for those meals you need to reduce the pre bolus time or even take it just before you eat and some of us find that splitting the dose with some before we eat and some an hour later works best for those sort of meals. There really is quite a lot of experimentation involved with diabetes to figure out how your individual body works/responds to particular foods and insulin and whilst it looks like the Libre is unfortunately not giving you very accurate results it is still a fantastic tool for showing you the general trend of what is happening.
For what it is worth my consultant was horrified that I was taking the Fiasp 45 mins before my breakfast or 1hr15mins with the NR, but he couldn't argue with the graphs/results. I am not the only member of the forum who needs that long for it to work but there are many who just need 20 or 30 mins and some who only need 5mins and it does vary at different times of the day. I usually inject my breakfast bolus Fiasp as soon as I wake up, plus 1.5-2 units to cover Dawn Phenomenon/Foot on the Floor syndrome (DP/FOTF), then I get up, go to the loo, make myself a coffee, dish out my breakfast and then keep scanning until I see levels start to drop and then I eat my breakfast. I don't time it to 45 mins every morning because there is a slight variation depending upon my waking reading. If my levels are high to start with it may well take longer if I am in the 4s or 5s on waking then it may just be 30 mins but I have the breakfast ready to go when Libre shows my levels start to drop.
As @Pumper_Sue says, the first thing to sort out is your basal. Trying to adjust all at the same time will make everything harder. Get the base right first and then build on it with sorting out your bolus.
Any bolus, tweaking such as dose timing, will make correcting your basal harder as you don’t know if, what is working is the basal or bolus.
No.1 - I'm going to have to work on but thought I had it right (so did my endo) but clearly not. So back to the drawing board.
No.2 - I definitely haven't been doing that and clearly that's wrong so I'm going to try 20 minutes tonight (wimped out and going back to NR). So I'll see if that helps.
No.3 - I promise you I always take glucose tablets - today was the exception because I had no idea what was going to happen and my head is absolutely mashed from being so stressed! I have always waited before treating again because I know you can easily overtreat.
Thank you - I'm going to speak to my Endo tomorrow to get a plan together for my basal because I'm slightly dyslexic and trying to read how to do a basal test has really been tough for me so think I need a convo so I can write down what to do! I'm good at following instructions lol
A hypo during a meal? OMG I've never had that!
Never split my bolus for a meal either but that's something to consider. Thank you.
I'm going back to NR for tonight's evening meal because I'm too scared to try the Fiasp again BUT I'm definitely going to inject 20 minutes before the meal. As for my basal, I'll reduce 1u from last night and see if that, together with my known friendly NR and injecting earlier, will do the trick!
Thank you again.
rebrascora
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Good luck and do be aware of compression lows with the LIbre through the night. I find it amazing that my brain has adapted to the Libre and even though I alternate arms with the Libre sensor, when I roll over in bed I seem to subconsciously take the sensor into consideration and no longer lie on the sensor side. Mostly I sleep on my back though which means the sensor is fine. It's a bit like the spacial awareness thing when you sleep in a different bed, that your mind subconsiously logs information to keep you from rolling out etc.
We are all different when it comes to insulin usage but just to be aware that Levemir doesn't need to be split anywhere near 50/50. I need very little during the night so my evening dose is only about a third of my morning dose and if I have been quite active during the day or it has been very hot etc, I dial back my evening basal a unit or two because otherwise I will hypo during the night. My basal insulin doses need tweaking on a very regular basis. Often 2 or 3 times a week but then other times I can go months without needing any change of dose.
Getting your basal dose right and learning what affects your basal needs and how to counteract the effects of those factors is a dark art, but it makes all the difference in the world to your diabetes management. Even just the timing of your basal doses can make a big difference. Health Care Professionals (HCPS) will say they have to be 12 hours apart but sometimes it can be beneficial to not have them evenly spaced. I take my morning one at 7am and my evening one at bedtime which is anywhere between 10pm and midnight.... sometimes a bit later. That worked well for me for nearly 2 years and then recently I started going high in the evening and had to bring my evening basal dose forward to tackle that.
So.... there are lots of things you can experiment with, but always it should be done with one eye firmly on keeping yourself safe.
We are all different when it comes to insulin usage but just to be aware that Levemir doesn't need to be split anywhere near 50/50. I need very little during the night so my evening dose is only about a third of my morning dose and if I have been quite active during the day or it has been very hot etc, I dial back my evening basal a unit or two because otherwise I will hypo during the night. My basal insulin doses need tweaking on a very regular basis. Often 2 or 3 times a week but then other times I can go months without needing any change of dose.
Getting your basal dose right and learning what affects your basal needs and how to counteract the effects of those factors is a dark art, but it makes all the difference in the world to your diabetes management. Even just the timing of your basal doses can make a big difference. Health Care Professionals (HCPS) will say they have to be 12 hours apart but sometimes it can be beneficial to not have them evenly spaced. I take my morning one at 7am and my evening one at bedtime which is anywhere between 10pm and midnight.... sometimes a bit later. That worked well for me for nearly 2 years and then recently I started going high in the evening and had to bring my evening basal dose forward to tackle that.
So.... there are lots of things you can experiment with, but always it should be done with one eye firmly on keeping yourself safe.
Pumper_Sue
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Basal test is done for the night as you can use your Libre (no sleepless night) 🙂
Morning test take basal as normal
Skip breakfast as long as you are in range (not hypo or need a correction dose as out of range)
Next day have Breakfast as normal.
Skip lunch and have evening meal as normal.
Following day skip evening meal and see how it goes.
This way you should get a reasonable idea as to what is going on.
There are loads of peeps on here who can help out and see things you can't. (those pesky trees are a pain) 🙂
It's a slow frustrating process but it can be done and at the end of the day less hypos and you will feel a lot happier and healthier. 🙂
Can I just thank you all for your input. I am finally happy today because I've gone back to NR for my dinner. As you suggested @rebrascora I've taken my NR 30 minutes before dinner (was aiming for 20 mins but hubby was cooking and he's hopeless with timings!) and this is the result! I may have taken a bit too much NR but I'm feeling so much happier AND NO SPIKE!
Time / Result
20.20 - 9.2 - 30 minutes before dinner - calculated dinner as 60g so using my 2 x 10g I injected 12u
of NR (plus an extra 2 to get me further towards 5 - that was probably a mistake).
20.50 - 7.7 immediately before eating
20.57 - 12u of Levemir (evening dose)
21.58 - 10.9 - 1 hour after eating (no spike) - perhaps too low at this point but will see
Lessons learned:
- Definitely inject bolus [30] minutes before eating [experiment with this to see what works].
- Hold off with correction doses
Time / Result
20.20 - 9.2 - 30 minutes before dinner - calculated dinner as 60g so using my 2 x 10g I injected 12u
of NR (plus an extra 2 to get me further towards 5 - that was probably a mistake).
20.50 - 7.7 immediately before eating
20.57 - 12u of Levemir (evening dose)
21.58 - 10.9 - 1 hour after eating (no spike) - perhaps too low at this point but will see
Lessons learned:
- Definitely inject bolus [30] minutes before eating [experiment with this to see what works].
- Hold off with correction doses
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