UNSURE ON MY BACKGROUND INSULIN NEED ADVICE

[lucie]

Hi, I am a type 1 on 1.5 units of lantus before bed and 11 in the morning. i done a fasting morning to see how steady it made me and my levels were from 6.45-11.45.. 5.5,5.9,6.7,5.7,5.2,4.9 over the next few days i was having quite alot of hypos in the morning and also pre meals so last night i went to bed 6.9 and i put my evening lantus down to 0.5 and the morning down to 10.5 and my 3am check this morning was 5.4 then my fasting readings were 7.2,7.2,8.4,8.4,7.2,8.0.

im unsure weather i shouldve stayed on 11background and not put it down to 10.5. these readings today are just to high and i even corrected at lunch with 1 unit and 2.5 hours later i was still 8.2.

hope somone can help as my doctor i seen in my followup appointment was rubbish and told me it was to complex for her!! im thinking if i put maybe the background up to 1 and stay on 10.5 or keep background on 0.5 and go back to 11background in the morning? thanks

 

[Radders]

Hi Lucie
It’s quite unusual to split Lantus into two doses, is there a reason why you do that?

 

[lucie]

Hi. I went on a DAFNE course for type 1s and this is what they teach you to do.

 

[lucie]

Also the diabetes specialists tell me to do it aswell. Just feel really fed up at the moment

 

[malturn]

I also split my Lantus 20 units AM and 20 units PM as advised by my DSN. Hope you soon get it sorted.

 

[Lucy Honeychurch]

I may be wrong, but from what I have seen on here if you need to split the dose, then Levemir is generally the basal insulin to be on.

 

[Lucy Honeychurch]

I stand corrected! Just seen malturns post 🙄

 

[Radders]

Hi. I went on a DAFNE course for type 1s and this is what they teach you to do.

Really? They didn’t when I did It, but it was a while ago. I just wondered what the rationale behind it was?

 

[lucie]

Really? They didn’t when I did It, but it was a while ago. I just wondered what the rationale behind it was?

Yeah before I went on the course I was just on 1 dose of lantus a day then they made everyone in the course do a spilt. They said that lantus doesn’t last all day and night of one dose. Looking at the readings what do you think?

 

[everydayupsanddowns]

Hello @lucie

Welcome to the forum 🙂

Looking at the numbers you’ve posted (if I’m reading them right!!) they don’t look bad to me.

Before the switch you looked to be dropping overnight, and mention multiple hypos - in just wondering if the basal tweak has sorted those out?

It’s great that you are basal testing. That’s a cracking technique to try to separate wood from trees in your situation.

When I was on Lantus I ended up just taking it in the morning - and that looks more or less what you are doing. I’m not sure what that 0.5 or 1u are adding to the mix personally, but the 10.5-11u are probably lasting into the overnight period (Lantus tends to last 16-24 hours-ish) and giving you a little background overnight.

Like others, I think that I you want to separate day and night into separate (and more flexible) phases I wonder if you might find Levemir a good option. Tends to last a shorter time and adapt to dose changes more rapidly that Lantus I think.

I’m not quite sure on the timing of those fasting readings, but if during one morning it just looks like a bit of liver action getting you from 5ish to 7ish - then holding fairly steady after that. Not perfect, but pretty good I would suggest - and much better than lurching through the hypos you described earlier.

 

[trophywench]

What I think is not permitted to be typed on here because I'm not AT ALL happy with the lack of help your hospital diabetes clinic has displayed Lucie.

Why the HELL do the NHS pay a fortune for the DAFNE course and then refuse to assist the people they sent on it, to apply what they have learned? Utter stupidity.

Generally, Levemir does take more readily to being split since it was originally invented with that attribute in the first place - ie here's a new basal insulin but you need to take it twice a day - whereas Lantus was never formulated with that intention - but it does work OK, once or twice daily, for some people. We aren't all the same and our bodies don't react the same to whatever we stick in it !

Personally - if 1.5 caused hypos and 0.5 results in highs, then 1.0 seems to make sense to me.

But when you talk about pre meal hypos that won't be the evening dose - Lantus 'peaks' its activity 4-5 hours after jabbing it - so if the hypo was anytime in the morning or pre-lunch - and more especially if it's pre dinner - then it's the morning Lantus that's causing it (as long as meals don't follow each other within 4 hours)

It's always better to do a full 24 hrs testing (in the 4 x 6hr time blocks) and consider all the readings together really to give yourself the info of what happens when - and when changing anything - only make ONE change at a time otherwise you won't know which change worked or didn't!

It ain't a quick job - but none of it is - this is a marathon, not a sprint!

 

[lucie]

Hello @lucie

Welcome to the forum 🙂

Looking at the numbers you’ve posted (if I’m reading them right!!) they don’t look bad to me.

Before the switch you looked to be dropping overnight, and mention multiple hypos - in just wondering if the basal tweak has sorted those out?

It’s great that you are basal testing. That’s a cracking technique to try to separate wood from trees in your situation.

When I was on Lantus I ended up just taking it in the morning - and that looks more or less what you are doing. I’m not sure what that 0.5 or 1u are adding to the mix personally, but the 10.5-11u are probably lasting into the overnight period (Lantus tends to last 16-24 hours-ish) and giving you a little background overnight.

Like others, I think that I you want to separate day and night into separate (and more flexible) phases I wonder if you might find Levemir a good option. Tends to last a shorter time and adapt to dose changes more rapidly that Lantus I think.

I’m not quite sure on the timing of those fasting readings, but if during one morning it just looks like a bit of liver action getting you from 5ish to 7ish - then holding fairly steady after that. Not perfect, but pretty good I would suggest - and much better than lurching through the hypos you described earlier.

So yeah when I was on 1.5 before bed I was waking up around 6am-7am like in the 2s or 3s. Also when I was on 11 background In the day I was going low pre meals but looking at the fasting levels for 11 and then fasting levels for 10.5 I’m unsure which one I should stick with. So I fasted on 10.5 today and my levels just stayed in the 7s and 8s and that’s just to high for me I just can’t win. I had 4 hypos yestedsy was so tiring. Just had one tonight aswell after tea. I exercised around 4.30 took correction as I went up to 10 then had a hypo not long ago. I really need to get away from these hypos but also stay say in the 6s in the days

 

[everydayupsanddowns]

Ugh this sounds grim Lucie. I think you are right - it’s the hypos you need to get rid of and then I think you will find the rest begins to settle.

Personally I wouldn’t panic so much about the 7s and 8s. A third of your readings could be higher than that and you could still have an A1c in the 40s (or 6s if you prefer old school!). Research suggests readings after meals are better below 9, and it looks like your BGs are settling lower down in between meals as you are still regularly dipping below 4. IMO you have to give yourself a bit more license to sit in the 7s-9s every so often - even if you sit there for a while.

 

[lucie]

Ugh this sounds grim Lucie. I think you are right - it’s the hypos you need to get rid of and then I think you will find the rest begins to settle.

Personally I wouldn’t panic so much about the 7s and 8s. A third of your readings could be higher than that and you could still have an A1c in the 40s (or 6s if you prefer old school!). Research suggests readings after meals are better below 9, and it looks like your BGs are settling lower down in between meals as you are still regularly dipping below 4. IMO you have to give yourself a bit more license to sit in the 7s-9s every so often - even if you sit there for a while.

I’m just never like stable it’s either loads of hypos or in the highs. I only had a salad for lunch and took 1.5 units with it and a correction dose and I didn’t budge, so annoying. Got nobody to ask or speak to to help because the doctors are rubbish, it’s really hard. Looking at my fasting levels would u say stick to 10.5 or 11 for the day?

 

[SB2015]

Hi Lucie and welcome to the forum.

Are you in care of your GP Practiec or the hospital specialist team? If it is the hospital team I am surprised that the support and advice has been so poor. If you aer with the GP I would ask to be seen at the hospital.

Like others have said, I was asked to switch to Levemir in order to split my background insuiln. As it has a shorter action time it is more flexible. I was told that there was no point in splitting Lantus because it lasts close to 24 hours. The Levemir split made things a lot more flexible. I wonder whether you could ask to be switched to this? It certainly seems to be worth a try based on the problems that you are having with hypos and highs.

 

[everydayupsanddowns]

I’m just never like stable it’s either loads of hypos or in the highs. I only had a salad for lunch and took 1.5 units with it and a correction dose and I didn’t budge, so annoying. Got nobody to ask or speak to to help because the doctors are rubbish, it’s really hard. Looking at my fasting levels would u say stick to 10.5 or 11 for the day?

It is very difficult and frustrating. Part of the problem is that everything is so interlinked and dependent on each other (doses and ratios etc) and part of it is that no two days are the same and there are multiple factors that affect BG that we can’t directly control.

One thing to bear in mind is that (particularly during the daytime, less so a night) having hypos can make your liver a bit twitchy and you might get a dump of glucose. Conversely, sometimes the body needs to replenish muscle and liver stores which have been released earlier so following a hypo you are much more likely to have another hypo...

As a result I would stick with the smaller doses for a few days to see if you can avoid some of your ‘regular’ hypos and try to concentrate on avoiding any which follow activity etc by looking at your hypo-dodging strategies generally.

Obviously you don’t want to sit in the teens all day every day as that will make you feel grim and can negatively affect your mood, but there should be no problem looking to be in the 7s, 8s and 9s rather than 5s and 6s - and it will give you a little more wiggle room to avoid the low BGs which seem to be causing the chaos.

 

[everydayupsanddowns]

Out of interest it might be helpful for people to know:

- what ratios you use for meals
- what your correction factor(s) are
- what your duration of insulin action is (ie when do you expect a dose to have finished working)

So that they can see if anything looks very different to their experiences - which I might give you some clues.

 

[lucie]

Hi Lucie and welcome to the forum.

Are you in care of your GP Practiec or the hospital specialist team? If it is the hospital team I am surprised that the support and advice has been so poor. If you aer with the GP I would ask to be seen at the hospital.

Like others have said, I was asked to switch to Levemir in order to split my background insuiln. As it has a shorter action time it is more flexible. I was told that there was no point in splitting Lantus because it lasts close to 24 hours. The Levemir split made things a lot more flexible. I wonder whether you could ask to be switched to this? It certainly seems to be worth a try based on the problems that you are having with hypos and highs.

Hi, I am under the hospital yes but every appointment i have i see someone different and they just don't have a clue, the last doctor said it was to complex for her.
did you find a difference in your levels once you changed?

 

[lucie]

Out of interest it might be helpful for people to know:

- what ratios you use for meals
- what your correction factor(s) are
- what your duration of insulin action is (ie when do you expect a dose to have finished working)

So that they can see if anything looks very different to their experiences - which I might give you some clues.

So my ratios are 1:10 and correction is 1 unit to bring me down by 3 but i mean some days my corrections don't even made me budge.
some meals i literally just guess how much to take especially when it comes to meat and veg that's always a guess. for breakfast ill have like 4-6g of greek yogurt, maybe 4 raspberries and a few seeds which probably doesn't even come to 10g and i will rocket after that if i only take half or 1 unit but yet i can have 2 pieces of soya and linseed bread take exact amount for it and be fine 2 hours later but then go low. then when i have salads in work thats always a guess and ill go high after it. yesterday i had lettace, 1 cherry tomatoe, cucumber, boiled egg, half a avocado few slices of chicken and i took 1.5 units plus 1 for correction as i was 8 and i didnt budge i actually went up. im just really struggling at the moment

 

[everydayupsanddowns]

No idea if this will help, but here's what I would be thinking in your shoes. This isn't advice, it's just based on what happens to me - everyone is so different that (annoyingly) a lot of stuff you have to work out for yourself - and like you I have lots of things which seem to go in opposite ways on different days.

So my ratios are 1:10 and correction is 1 unit to bring me down by 3 but i mean some days my corrections don't even made me budge.

OK these seem fairly standard so that's good. Of course, you may need slightly different ratios at different times of day (eg each main meal might need a different insulin:carb ratio, or you might a lower correction factor at some times of day).

Your Lantus that you take at breakfast is likely to take about an hour to get up to full strength and then have a slight peak at around 4-5 hours. It will probably last roughly 18-24 hours and may be tailing off slightly overnight, but you have the extra small dose in the evening which *might* be helping. One of the difficulties you might be facing is that your basal is likely to be providing fairly flat coverage, but your body may need 'a bit more here' and 'a bit less there'. This might explain some of the non-effective corrections and/or hypos - if your Lantus is a bit too active or not active enough it could cause your doses/corrections to misbehave. If this is fairly predictable for you you could work around it by changing meal ratios/correction factors based on the time of day. A bolus calculator meter (eg Expert ot Insulinx) can help with this as you don't have to keep track. Alrternatively there are smartphone apps like mySugr where you can programme it all in and it will help with the maths.

some meals i literally just guess how much to take especially when it comes to meat and veg that's always a guess.

Meat shouldn't need to be dosed for unless your carb intake is extremely low as far as I know. For veg, I would ignore leaves, and only really worry about root veg if having quite large quantities. Spoonful of carrots I'd ignore... a whole stew made of swede, parsnips and carrots etc I'd count for.

for breakfast ill have like 4-6g of greek yogurt, maybe 4 raspberries and a few seeds which probably doesn't even come to 10g and i will rocket after that if i only take half or 1 unit but yet i can have 2 pieces of soya and linseed bread take exact amount for it and be fine 2 hours later but then go low.

This sounds very annoying, and also quite familiar! 🙄 I think there might be two different things going on. My Dawn Phenomenon generally only kicks-in after I get out of bed. So my BGs begin to rise when I get up whether I eat or not. In addition, your body might be waiting for the breakfast Lantus dose to get going. Can't be sure this is happening for you, but especially at breakfast, when people tend to be a bit more insulin resistant, you may be dealing with more than just food.

If the hypos *always* happen after Soya and Linseed it might suggest that your ratio needs tweaking, but to double-check that it might be worth eating 25g of some other carbs (assuming you are having 2 slices of regular Burgen).

then when i have salads in work thats always a guess and ill go high after it. yesterday i had lettace, 1 cherry tomatoe, cucumber, boiled egg, half a avocado few slices of chicken and i took 1.5 units plus 1 for correction as i was 8 and i didnt budge i actually went up. im just really struggling at the moment

That is perplexing! Have you fasting-checked that time of day to see what happens if you are running on basal only? Maybe that's something to do with your basal need at that time of day?

I do know there are others who have a strange relationship with eggs and have to bolus for them even though they are carb-free... maybe one of them will chip in with what works for them?

The great thing is that you are working hard at this and trying to analyse what is going on.

You will get there!