UNSURE ON MY BACKGROUND INSULIN NEED ADVICE

[lucie]

aw thank you thats alot of help. well i went back up to 1BG last night just to see and i dropped from 6.1 last night to 4.9 this morning so i think maybe ill go back down to 0.5 at night but hoping it doesnt keep me high. today ive done fasting and its 6.30 4.9, 7.30 5.7, 8.30 5.2, 9.30 5.8, 10.30 4.9, 12pm 6.1. now this has confused me again, do i need a extra half and go to 11 background because ive jumped up to 6.1 by lunch?yeah it is literally going to be all trial and error but so hard aswell because im so fed up of the hypos. they want to put me on a pump aswell but i know theres a long wait. or lunch today i have tin of tuna with lettace cucmber mayo and egg and ill take 2 units and see what happens.

 

[everydayupsanddowns]

today ive done fasting and its 6.30 4.9, 7.30 5.7, 8.30 5.2, 9.30 5.8, 10.30 4.9, 12pm 6.1. now this has confused me again, do i need a extra half and go to 11 background because ive jumped up to 6.1 by lunch?

That looks pretty perfect to me. You've stayed within 1mmol/L of your waking level all morning! The variation you are seeing could simply be meter variation.

The suggestion I picked up about fasting tests was only to consider making a change if you moved by more than 1.7mmol/L up or down and you are well within that.

I think a pump might really help you, as you will be able to tailor your basal more precisely. All the learning and research you are doing now will really pay off if you get one.

 

[trophywench]

The other tedious thing about Lantus is - you should only make any change to any dose, with a 3-day gap between them - since it takes it a full 3 days to completely get out of your body.

This is the reason Levemir is so much easier to adjust - I still wouldn't change it again within 24 hrs if the adjustment hasn't done what I wanted mind you - but you pretty much knew whether it was going to work within 12 hours of injecting it rather than needing to give it half a ruddy week to make its mind up.

I hated having to fiddle with Lantus doses cos it took so damn long - some of us have lives! LOL

The word I have always used to describe the greater flexibility I got with Levemir, was that it was more 'biddable' - ie I could seem to make it do what I wanted it to do fairly easily without all that much effort - just a bit of logic.

Let's see what other people say.

 

[lucie]

That looks pretty perfect to me. You've stayed within 1mmol/L of your waking level all morning! The variation you are seeing could simply be meter variation.

The suggestion I picked up about fasting tests was only to consider making a change if you moved by more than 1.7mmol/L up or down and you are well within that.

I think a pump might really help you, as you will be able to tailor your basal more precisely. All the learning and research you are doing now will really pay off if you get one.

do you think me going up to 6.1 by lunch is still ok and no reason to go up to 11.
yeah ive always been on pens so its really scary to have a change.
are you on pens or pump?

 

[lucie]

The other tedious thing about Lantus is - you should only make any change to any dose, with a 3-day gap between them - since it takes it a full 3 days to completely get out of your body.

This is the reason Levemir is so much easier to adjust - I still wouldn't change it again within 24 hrs if the adjustment hasn't done what I wanted mind you - but you pretty much knew whether it was going to work within 12 hours of injecting it rather than needing to give it half a ruddy week to make its mind up.

I hated having to fiddle with Lantus doses cos it took so damn long - some of us have lives! LOL

The word I have always used to describe the greater flexibility I got with Levemir, was that it was more 'biddable' - ie I could seem to make it do what I wanted it to do fairly easily without all that much effort - just a bit of logic.

Let's see what other people say.

I will defo ask about this then and see if i can have a change. ive been on lantus since being diagnosed 5 years ago so never really got told about other ones. have many people switched from lantus to levemir?

 

[Robin]

I will defo ask about this then and see if i can have a change. ive been on lantus since being diagnosed 5 years ago so never really got told about other ones. have many people switched from lantus to levemir?

I asked to switch to Levemir. I had been advised to split my Lantus dose by the DSN at the hospital, when I was first diagnosed, but it wasn't really working for me, so I went back to a single dose, shifting the times around to get the best result, and ending up taking it at lunchtime.
I decided I could do better, though. So, having discovered that a) my Lantus had a big peak after 5 hours then tailed off and b) the lower the dose of Lantus, the more pronounced is the peak and the tail off, ( I only need around 7 units of basal a day) I asked to try Levemir. I now take 4.5 units in a morning, and 2.5 at bedtime. It's not perfect, I still get a sharp dawn rise, which I tend to cope with by giving myself more Bolus at breakfast, but I do find it is more 'biddable' and tweaks in the dose are instant.

On the question of eggs, I find if I have scrambled eggs for breakfast (around 9am) and nothing else, I start to rise around 11 and have to do a correction dose. If I have them on toast, and bolus correctly for the toast, then I don't have to correct. Strange or what! We are all different.

 

[everydayupsanddowns]

do you think me going up to 6.1 by lunch is still ok and no reason to go up to 11.
yeah ive always been on pens so its really scary to have a change.
are you on pens or pump?

Yes I would leave the dose for now and look again in a while as the weather gets warmer (when it will probably change again!).

I've been using a pump since 2011 🙂

 

[lucie]

I asked to switch to Levemir. I had been advised to split my Lantus dose by the DSN at the hospital, when I was first diagnosed, but it wasn't really working for me, so I went back to a single dose, shifting the times around to get the best result, and ending up taking it at lunchtime.
I decided I could do better, though. So, having discovered that a) my Lantus had a big peak after 5 hours then tailed off and b) the lower the dose of Lantus, the more pronounced is the peak and the tail off, ( I only need around 7 units of basal a day) I asked to try Levemir. I now take 4.5 units in a morning, and 2.5 at bedtime. It's not perfect, I still get a sharp dawn rise, which I tend to cope with by giving myself more Bolus at breakfast, but I do find it is more 'biddable' and tweaks in the dose are instant.

On the question of eggs, I find if I have scrambled eggs for breakfast (around 9am) and nothing else, I start to rise around 11 and have to do a correction dose. If I have them on toast, and bolus correctly for the toast, then I don't have to correct. Strange or what! We are all different.

aw wow thats really interesting. so how did you find out about all those peaks and what time of day you it was best to inject basal?

 

[lucie]

aw

Yes I would leave the dose for now and look again in a while as the weather gets warmer (when it will probably change again!).

I've been using a pump since 2011 🙂

aw i know so hard to keep up with the changes ha

 

[Robin]

aw wow thats really interesting. so how did you find out about all those peaks and what time of day you it was best to inject basal?

Trial and error, mainly! My surgery nurse, who is the only health professional I see about my diabetes, is more used to Type 2s on diet or tablets, and freely admits I know more than her about Type 1!
I found about the lumps and bumps on Lantus from reading on here, then observing my results, and realising that yes, that was happening. I don't think I'd have achieved it, though, without using the Freestyle Libre. Because it gave me a continuous readout of my glucose patterns, it was so much easier to get a clear picture in a matter of days, rather than doing loads of fingerprick tests and hoping I hadn't missed something happening in between times. ( It was also brilliant for telling me what was going on overnight!). Expensive, though, I had to self fund it.

 

[lucie]

Trial and error, mainly! My surgery nurse, who is the only health professional I see about my diabetes, is more used to Type 2s on diet or tablets, and freely admits I know more than her about Type 1!
I found about the lumps and bumps on Lautus from reading on here, then observing my results, and realising that yes, that was happening. I don't think I'd have achieved it, though, without using the Freestyle Libre. Because it gave me a continuous readout of my glucose patterns, it was so much easier to get a clear picture in a matter of days, rather than doing loads of fingerprick tests and hoping I hadn't missed something happening in between times. ( It was also brilliant for telling me what was going on overnight!). Expensive, though, I had to self fund it.

i have heard about the libre and i have asked to trial it. yeah my fingers are in bits!

 

[TheClockworkDodo]

It seems really odd to me that they are advising you to split Lantus - we've had various threads about splitting Lantus on here in the past, and most people who've tried it have found that it just doesn't work split, especially in small doses (splitting 40 units like Malturn is one thing, but splitting so that either of the doses are under 10 units seems to make it unstable).

For some of us Lantus doesn't work at all, just causes loads of peaks and hypos, and it sounds like it may be doing this for you too. That four hypos in a day thing sounds really familiar to me, I used to be like that all the time on Lantus. Quite a few people on here have changed from Lantus to Levemir or to Tresiba, and found that their levels have improved and become more stable. So if I were you, I'd do what you can to limit the hypos for now, but in the longer term I'd be asking about switching to a different basal.

I'd love to have a fasting test result like yours though, it looks pretty much perfect to me. So it sounds as though the spiking isn't a morning thing for you, you just need to work out which foods cause you to spike. Some foods do unexpectedly do that, even ones which don't contain any carbs. Eggs are the one thing I really can't eat - I have a very slight intolerance to them, and I need so much insulin for them it's not worth trying to eat them at all.

 

[lucie]

It seems really odd to me that they are advising you to split Lantus - we've had various threads about splitting Lantus on here in the past, and most people who've tried it have found that it just doesn't work split, especially in small doses (splitting 40 units like Malturn is one thing, but splitting so that either of the doses are under 10 units seems to make it unstable).

For some of us Lantus doesn't work at all, just causes loads of peaks and hypos, and it sounds like it may be doing this for you too. That four hypos in a day thing sounds really familiar to me, I used to be like that all the time on Lantus. Quite a few people on here have changed from Lantus to Levemir or to Tresiba, and found that their levels have improved and become more stable. So if I were you, I'd do what you can to limit the hypos for now, but in the longer term I'd be asking about switching to a different basal.

I'd love to have a fasting test result like yours though, it looks pretty much perfect to me. So it sounds as though the spiking isn't a morning thing for you, you just need to work out which foods cause you to spike. Some foods do unexpectedly do that, even ones which don't contain any carbs. Eggs are the one thing I really can't eat - I have a very slight intolerance to them, and I need so much insulin for them it's not worth trying to eat them at all.

Hi, thanks for your reply. Ah really, I didn’t realise a lot of people don’t get on with lantus. It’s all I’ve known really but I will Defo ask for a change to see. Do you know which one is the better one or are they both the same? Yeah it’s mad isn’t it. When I went on the DAFNE course they don’t teach you about bolusing for protein but some people including me Defo have too. Again every day is so diff one day I can go high off certain food next day low such hard work but I am going to try and keep hypos down. Hopefully going down to 10.5 background will help in the days and just have to try to keep them away at night after exercise etc.
Are you on a pump or injections?

 

[Matt Cycle]

Yes, Tresiba is another possibility as a basal. I thought it was great - really steady with a flat profile and long action. It just didn't really suit my lifestyle. If you're doing similar things every day (within reason of course as we all do different things on different days) - work, exercise etc then it might be worth investigating.

 

[Robin]

Agree with Matt, I chose Levemir because I never know if I'm going to do three hours gardening, or go for a really long walk, or sit around all day. Tresiba takes longer to settle if you want to alter the dose, so it's not really any use if you need to lower your basal straight way overnight, for example, after exercise.

 

[trophywench]

Well anything with a very flat profile would never work for my body. One may assume that one needs the same amount every hour of every day and night (in the absence of extra activity or any food) but getting a pump and the intense basal testing you need to do in the first couple of months, proved to me that my body's requirements and FAR from even! it's gobsmacking where a rate adjustment of 100th of a unit of insulin during one or other particular hour, can make such a big difference to your control.

Obviously I'm not permanently adjusting rates by such a teeny amount - but you could if you wanted to be that ruddy OCD !

 

[SB2015]

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?

I found that things were a lot more flexible with a split Levemir dose. I did a 50/50 split initially but then reduced the day time basal on busy days, and so avoided the frequent hypos I was having. This reduction did not effect my overnight control as I had a separate basal for nighttime. Mush better. Once I had the basal doses sorted, I found I was able to get more accurate ratios for carbs during each period of the day, and also adjusted my sensitivity.

If the person you saw at the hospital found that your questions were too complex, make a note of their name and then ask for another appointment with another DSN. Be persistent, and if you keep a record of the changes you make and the readings that you gather, it will help them to help you at your next appointment.

I hope that this is of some help.

 

[TheClockworkDodo]

I haven't tried Levemir so I can only say that I like Tresiba a lot better than Lantus (not that that would be difficult!). I hadn't realised until I joined this forum that there were other basals either, I'd been putting up with Lantus on the assumption that there weren't any alternatives. I think what Matt and Robin said is right - if you have the sort of lifestyle where you get about the same amount of exercise every day Tresiba is good, but if you want to adjust your basal on a day-by-day basis Levemir might be better.
I'm on the waiting list for a pump - not holding my breath though as I've been on the waiting list to borrow a CGM for about 2 years.

 

[lucie]

I found that things were a lot more flexible with a split Levemir dose. I did a 50/50 split initially but then reduced the day time basal on busy days, and so avoided the frequent hypos I was having. This reduction did not effect my overnight control as I had a separate basal for nighttime. Mush better. Once I had the basal doses sorted, I found I was able to get more accurate ratios for carbs during each period of the day, and also adjusted my sensitivity.

If the person you saw at the hospital found that your questions were too complex, make a note of their name and then ask for another appointment with another DSN. Be persistent, and if you keep a record of the changes you make and the readings that you gather, it will help them to help you at your next appointment.

I hope that this is of some help.

Thank you I will look into this 🙂

 

[lucie]

I haven't tried Levemir so I can only say that I like Tresiba a lot better than Lantus (not that that would be difficult!). I hadn't realised until I joined this forum that there were other basals either, I'd been putting up with Lantus on the assumption that there weren't any alternatives. I think what Matt and Robin said is right - if you have the sort of lifestyle where you get about the same amount of exercise every day Tresiba is good, but if you want to adjust your basal on a day-by-day basis Levemir might be better.
I'm on the waiting list for a pump - not holding my breath though as I've been on the waiting list to borrow a CGM for about 2 years.

What’s a CGM?