Hello
@digihat,
Well done for getting on with your "trial and learning" process. In his book "Think Like a Pancreas" Gary Scheiner remarks (quite early on) that Diabetes is Complicated, Confusing and Contradictory. I think that most neatly sums D up! Nothing to do with insulin dependency is straightforward, in my limited experience.
Your team started you on 24 units of a long acting basal, Toujeo, and tweaked you to 26 a few days later - now 32 units and you are seeing better outcomes. That is great in all respects; they started you with some caution to minimise your vulnerability to hypos and now you are getting there. It might end up that you will want or need to change to a shorter lived basal that can be split into 2 differing parts for day and night (as surmised by a couple of remarks in replies to one of your earlier posts), but that would be, in my opinion, premature just now. There is merit in getting the existing Toujeo basal tried and confirmed first, then look at alternatives if that is what is needed. We all have differing needs and respond differently (hence D is Complicated).
I am on Tresiba basal, which is even longer in its profile at c.40 hrs. That means for me no possible sense in splitting it, today's dose is topping up yesterday's dose. Our basal needs are simply not equal or constant across a 24 hr period (hence D is Complicated and Confusing) and not necessary similar on 2 successive working days (hence D is Contradictory) for a multitude of reasons. An analysis relatively recently suggested 40+ factors that are known to affect blood glucose; that raises more permutations than my mental maths will cope with (did I mention that D is Complicated?).
The point I'm coming to is that given basal needs vary (in general) from night to day and back to night and you are on a single daily basal dose, you can only aspire to finding an average basal dose that holds you steady for part of the 24 hrs. If the basal is perfect by night it is most unlikely to also be perfect by day. I quite blatantly have optimised my Tresiba basal to hold me steady through the night which is my longest fasting period of my 24 hr day and the period when I'm mainly sleeping or resting. But I'm over 70 and I no longer party into the small hours (but can remember that happening before we started our family and sometimes running around after teenagers later on!).
So MY basal testing needs no extra effort: I scrutinise my CGM graph, confirm that in general my BG remains pretty flat through the night for successive nights and know I've got my basal about right. Then
ALL other of my BG needs are covered by my bolus insulin (NovoRapid) in conjunction with activity (exercise) which improves my insulin sensitivity and makes whatever insulin that I have on board "go further"; plus along with main meals and snacks when necessary. Whatever my Tresiba basal is bringing to my daytime party is what it is; I don't try to allow for it, or even consider it - its just there in the background. And that does have an advantage of keeping things simpler, no need to think about basal by day and whether it is appropriate for this particular day.
This is, of course, all so much easier to monitor and respond to thanks to CGM and the alerts. [I prefer to use my alarms as alerts and use them to tell me when my BG is changing (trend arrows when I had Libre 2, actual alerts as well as arrows now with Dexcom G7). Also I use alert settings at the top end of 5.6 (or higher with G7) for my low alert; I don't want to know when I've reached hypo territory - that's too late for me.
If you find the long profile Toujeo is broadly right for you,
you might (or might not) find that Tresiba could work even better for you -Tresiba doesn't need me to take it at a precise time each day; and people who fly frequently find it helpful for straddling time zone changes. The even longer profile of c.40 hrs provides a flexibility, that isn't apparent at 1st glance; eg dose first thing in the morning, irrespective of whether that's a work day, weekend or holiday.
But that's a distraction right now, the goal is to get your Toujeo supporting you as well as possible by understanding a bit more about what is going on, then by juggling with bolus timings to smooth out BG spikes - within reason - and so to let you live a great life, regardless of the D juggling in the background. This isn't easy and does need some grappling with - but I detect from your posts you have already pragmatically accepted this. With D I think knowledge is power. Good luck.
