Adjusting insulin

[Deleted member 33898]

Here are two two great books about Type 1

Think Like a Pancreas’ by Gary Scheiner.

And Type 1 Diabetes in Children Adolescents and Young People by Ragnar Hanas (ignore the title - it’s great for adults too)

Browse, dip in - I find it’s helpful to have books on the shelf to refer to.

When I have a break from my pump, I use basal insulin in small doses and find it noticeably runs out at around 11 hours, so in my opinion one daily Levemir at such a small dose isn’t going to last you 24 hrs.

I see these books are well received. I'll definitely be purchasing at least one of them to start. Read from one source for a while might settle my head.

It is strange why they are happy enough with me to continue on a single small dose. Don't know if it would make much difference increasing again, probably just splitting it as you say. They mentioned some other ultra long basal but I forget the name.

 

[Deleted member 33898]

They didn't change me to split dose until the weekend before my DAFNE course and that was deliberately timed presumably so that they can help you find the correct doses and split on the course.

How long before you went on the DAFNE course ?

 

[rebrascora]

How long before you went on the DAFNE course ?

7 months from starting on insulin.

 

[Inka]

I see these books are well received. I'll definitely be purchasing at least one of them to start. Read from one source for a while might settle my head.

It is strange why they are happy enough with me to continue on a single small dose. Don't know if it would make much difference increasing again, probably just splitting it as you say. They mentioned some other ultra long basal but I forget the name.

Tresiba? I really don’t understand why some teams are obsessed with a single injection of basal. Unless there are special reasons connected to the individual, it makes little sense. The stress and work with Type 1 is not the number of injections we have to have! That’s a trivial detail.

A long-acting once a day basal like that gives very little flexibility and makes no allowance for varying basal needs through the day and night.

Use the Look Inside feature to see which book you prefer. You could even see if they’re available from your local library if you’re on a budget.

 

[helli]

A long-acting once a day basal like that gives very little flexibility and makes no allowance for varying basal needs through the day and night.

It seems that some people love the stability of Tresiba. I think most of them are men who do not have to deal with "monthly variations".
Personally, it seems like a nightmare to me. Before I was pumping, I was using Lantus and, much to my DSN's shock, I would be changing my dose almost daily depending what exercise I had done.

 

[rebrascora]

I agree with @Inka To me a very long acting basal like Tresiba is a backward step as it is so inflexible and people often seem to end up having to eat to their insulin to stop them from dropping too low at different times of the day/night in order for the dose to keep them in range at other times. I would fight tooth and nail to keep my Levemir over such an alternative but having the dose split and learning how and when to adjust your Levemir is important and to me that involves good education. Another injection is neither here nor there in the scheme of things in my opinion too and the pay back is being able to adjust it to fit your lifestyle. So if I get out for a long walk today I will be able to reduce my Levemir tonight by a couple of units and that will stop me hypoing or having to eat a load of carbs before bed and the impact of that reduction will take effect tonight. If you did that with Tresiba, you probably wouldn't see the benefit of that change for 2-3 days and by then it might need adjusting back up again.

 

[rebrascora]

@helli I am the same. My Levemir doses sometimes need tweaking on an almost daily basis, depending upon exercise and possibly hormones.... starting to suspect my HRT is having an impact but because there is no monthly cycle it is difficult to spot any particular pattern with it. For instance I can go months and be absolutely fine and then suddenly my boobs start to get bigger and really tender and I will be like that for several weeks or even months and then it settles down and I go back to normal again. I never had that problem before when I had monthly cycles and I can't see an obvious trigger for it but the breast screening people said that it will be the HRT. Hormones are such a complicated business!

 

[Inka]

When I had my pump training many years ago, part of the training was a diagram showing how basal needs varied in someone without diabetes. This was shown to explain how the pump tried to mimic that varying basal profile.

So the idea that a long-lasting flat profile insulin would be a benefit just doesn’t make sense to me. Of course, the cynic in me would think they’re just looking for new avenues to make money from insulin - always something ‘new and better’ to try - which turns out to be only true with regard to its newness.

 

[PattiEvans]

@Pattidevans I thought maybe the levermir was just taking a while to kick in. What I'm seeing is an initial rise an hour into sleeping and then it stays roughly that level through the night which makes me think the levermir is kicking in then to stop any further rise. Could be the initial rise is from my meal earlier ? Not sure. Thanks for the pdf!

Yes, it does take a while to kick in. As I think @Inka said, if it’s the case that it’s running out before you take your evening dose then it could be that it is being propped up by your evening bolus injection. I see you've done a morning basal test. i think if it were me I’d be doing an afternoon/evening one next to see if that is what’s happening.

I usually go alone to appointments, but hubby has been with me a couple of times when changes were being discussed and it’s great having him to ask later on what he heard in order to refresh my memory.

 

[Bruce Stephens]

How long before you went on the DAFNE course ?

NICE suggests some time after 6 months since diagnosis, but to consider offering it whenever seems appropriate for the patient. (In my case it was ~35 years after diagnosis, but this kind of structured education (and the superior insulins) isn't that old. It can be easy for people diagnosed a while ago to slip through if the team just has a good mechanism for newly diagnosed people and to find such courses annoying if they're on a course with lots of recently diagnosed people.)

 

[Deleted member 33898]

Yes, it does take a while to kick in. As I think @Inka said, if it’s the case that it’s running out before you take your evening dose then it could be that it is being propped up by your evening bolus injection. I see you've done a morning basal test. i think if it were me I’d be doing an afternoon/evening one next to see if that is what’s happening.

I usually go alone to appointments, but hubby has been with me a couple of times when changes were being discussed and it’s great having him to ask later on what he heard in order to refresh my memory.

Yes I've been thinking about doing the basal test for the rest of the day then double checking. My issue is I'll have to fix my bolus first to run levels higher. As explained earlier a few hours after breakfast i have to eat or hypo. So that would ruin the start of the lunch test cause I'll have had food within 4 hours leading up. Same with evening test because I run low or hypo 2 to 3 hours after lunch. I would try go the whole day but I don't know if there is an advantage to that other than getting answers quicker. Just plucking up the courage to start adjusting.

Well my partner is definitely going to the next appointment. As you say it helps if someone else has heard the same thing.

 

[Deleted member 33898]

I agree with @Inka To me a very long acting basal like Tresiba is a backward step as it is so inflexible and people often seem to end up having to eat to their insulin to stop them from dropping too low at different times of the day/night in order for the dose to keep them in range at other times. I would fight tooth and nail to keep my Levemir over such an alternative but having the dose split and learning how and when to adjust your Levemir is important and to me that involves good education. Another injection is neither here nor there in the scheme of things in my opinion too and the pay back is being able to adjust it to fit your lifestyle. So if I get out for a long walk today I will be able to reduce my Levemir tonight by a couple of units and that will stop me hypoing or having to eat a load of carbs before bed and the impact of that reduction will take effect tonight. If you did that with Tresiba, you probably wouldn't see the benefit of that change for 2-3 days and by then it might need adjusting back up again.

I think the eating to insulin is definitely what has been happening to me, with the bolus anyway from breakfast until evening. I'm just afraid of the highs that will come with adjusting. But it looks like I'll need to get my bolus sorted first before I test my basal. I know it's usually basal first to be sorted but as I described above it probably won't work. I haven't adjusted basal for exercise yet, I normally just eat a bit more

 

[Inka]

Do remember that as you’re recently diagnosed, some of your lows hours after eating could be from your own insulin ‘helping’ - too late but enough to push you low. There’s not much you can do about that. I used to snack to offset it. You could experiment with reducing your bolus too.

 

[everydayupsanddowns]

Hope the basal testing works out - and that you can find a way to dodge the hypos to enable that to take place.

I spent many years preferring to run on the low side, and accepting repeated mild hypos as a consequence - but in hindsight this was a mistake. It was actually far more damaging and had much more of a negative impact on me and my family than I acknowledged at the time. Particularly when my warning signs took a dent as a result of the repeated mild lows, and I started having occasional nastier hypos.

I also hadn’t realised how often hypos led to highs for me either. Partly because they can make my liver a bit twitchy, and it could randomly dump glucose after a mild low.

When I have wanted to reduce the number of highs I have been having, oddly one of the best and most surprising strategies for me has been to focus on avoiding some of those ‘regular’ run of the mill lows that can creep in. When I lose the lows, the highs go away on their own 🙂

 

[Deleted member 33898]

Do remember that as you’re recently diagnosed, some of your lows hours after eating could be from your own insulin ‘helping’ - too late but enough to push you low. There’s not much you can do about that. I used to snack to offset it. You could experiment with reducing your bolus too.

I remember you mentioning that, I actually said to a consultant would it not be easier if my pancreas was just not working at all. Most recent consultant said I need to keep my pancreas protected for as long as possible. Maybe I'm missing something here but surely if I have to put up with these issues due to my pancreas sporadically still working then why protect it ?

 

[Deleted member 33898]

Hope the basal testing works out - and that you can find a way to dodge the hypos to enable that to take place.

I spent many years preferring to run on the low side, and accepting repeated mild hypos as a consequence - but in hindsight this was a mistake. It was actually far more damaging and had much more of a negative impact on me and my family than I acknowledged at the time. Particularly when my warning signs took a dent as a result of the repeated mild lows, and I started having occasional nastier hypos.

I also hadn’t realised how often hypos led to highs for me either. Partly because they can make my liver a bit twitchy, and it could randomly dump glucose after a mild low.

When I have wanted to reduce the number of highs I have been having, oddly one of the best and most surprising strategies for me has been to focus on avoiding some of those ‘regular’ run of the mill lows that can creep in. When I lose the lows, the highs go away on their own 🙂

Sounds alot like what is happening to me . You say about hypos leading to highs , I have noticed mainly on weekends were a run bit lower I'll get a random spike out of nowhere. Guess the complications are always in the back of my mind and I'm a very anxious person so I keep wanting lower levels. Also keeping low most of the time so I can enjoy the odd takeaway and not feel soo bad if I run higher.

Glad to hear you were able to sort it out

 

[Inka]

I remember you mentioning that, I actually said to a consultant would it not be easier if my pancreas was just not working at all. Most recent consultant said I need to keep my pancreas protected for as long as possible. Maybe I'm missing something here but surely if I have to put up with these issues due to my pancreas sporadically still working then why protect it ?

Protecting it helps preserve your remaining beta cells longer. That might seem like a pain to have them working now, but over time you should see the benefit. I had a long honeymoon and having a few working beta cells did make control easier. They might seem a nuisance now but they really can help. My honeymoon lasted some years. I noticed the difference when it was over. Control was harder and keeping my blood sugar down was more of a fight.

 

[Deleted member 33898]

Regarding basal testing for anyone who has done this. If you drink coffee or sugar free drinks throughout the day did you continue to drink them ? I don't bolus for the 2 cups of coffee I have between breakfast and lunch. Also don't bolus for a can of Pepsi Max I have in the afternoon. They all have caffeine in them which is what I'm getting at.

 

[Inka]

Some people find that black coffee puts their blood sugar up. I’d avoid coffee and Pepsi Max, and stick to weakish tea, water, sparkling water, etc

 

[rebrascora]

If you drink these things every day then to me your basal should to cover them. I certainly couldn't imagine bolusing for a coffee or a diet coke, so you would want the basal to have enough surplus to cover that as it is only likely to be a unit or two increase..... a bit like not needing to bolus for a 5g snack.
I find I am fine with one cup of coffee but the caffeine from a second starts to increase my levels. I normally just have one cup, so I would still have that cup if I was basal testing, but not a second one. That would be my take on it.