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Adjusting my background insulin - Type 1

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PatsyCabbie

New Member
Relationship to Diabetes
Type 1
Hello,
I currently take 9 units of Lantus in the morning as my background insulin. My BG, has over the past couple of months, crept up even when I have not eaten anything more after breakfast.
I checked today by having no carbs for breakfast ( I didn't eat anything actually ) my BG was 7.7 when I first checked at 9am.
At 11am it was 9.2
1pm it was 8.4
I think from these results my background Lantus needs tweaking, should I raise it to 10 units rather than the current 9 units?
Pat
 
We are not really supposed to give dosing advice. The fact that you are asking here suggests that you are not confident about changing your basal and therefore it might be best to discuss it with your DSN.
That said, if it was me, I would increase it by one unit or maybe half a unit since I have a half unit pen and keep a closer eye on things than usual and probably go to bed on a slightly higher than normal reading, just to be safe overnight. Doing this at a time when I am not too busy for a day or two after the increase and can therefore monitor my levels more easily is important.

Learning to adjust your basal insulin is important as it can fluctuate quite a bit as a result of changes in activity levels, illness, the weather and the seasons. You should wait at least 3 days before making further adjustments, as it can take that long for the full effects of a change to become stable and obviously be very cautious about how much you increase or decrease it.
 
A lot of people find their blood sugars rise as soon as they get up, or sometimes before they get up, as a result of the 'Dawn Phenomenon' which is when the liver releases extra glucose from around 4am to gear the body up for the day ahead. So before you adjust your Lantus, perhaps you should check to see whether the current dose is holding you steady at other times of the day. Increasing Lantus to knock the morning rise on the head won’t work if it then means you’ve got too much in the system for the rest of the day, and overnight. Do you know about basal testing? If not, there’s a good guide to it here.

Basal insulins « Diabetes Support Information Exchange

www.diabetes-support.org.uk www.diabetes-support.org.uk
 
Hi Patsy
It would be well worth talking to your DSN. It is great if you are able to do a basal rate test to check your dose of basal insulin and also to learn how and when to change it. It is difficult to base it on just one days values and we are not able to advise on changes to doses. As @Robin says the rise in the morning could be due to dawn phenomenon. Worth checking at other times during the day.

Another thought is to talk to your DSN about switching to Levemir, which you would be able to split to two Injections morning and night time. The advantages of this is that you can increase one without impacting on the other.

A half unit pen can also be useful, especially when you are in lower doses, as you are. It enables you to make finer adjustments to both Bolus and basal doses. Another things o quiz your DSN about.

I hope that you can get things sorted.
 
Thank you so much for the information. I've found it really helpful. I think that I will adjust my lantus by 1 tomorrow morning and do another basel check on Tuesday.
Thank you all again.
 
I'm firmly of the belief that you need to test again to get a greater spread than only 6 hours - after all that Lantus has got to last your body until tomorrow, and you shouldn't therefore take little chunks of a day in isolation, because it will effect all of the day and all of the night! And it doesn't peter out after 24 hours either and just stop. Having been one of the authors of the link which Robin pointed you to - which both DAFNE and BERTIE recommend - I urge you to act on that advice instead, so you can then consider the whole day.

No point in getting just the morning sorted if what you did, wrecks the afternoon evening or night.

1u increase is in excess of 10% of the total dose - and I especially don't like that - it's the insulin related equivalent of taking a sledgehammer to crack a nut. I'd never want to increase or reduce doses of it by more than 5% at any one time - you aren't on a large amount of it in the first place, so you need to tread carefully until you are The Expert on your own diabetes.

You really ought to check with your DSN as has been said - and not only since it's an an ideal opportunity to request a half-unit pen!
 
Glad you will be discussing things with your DSN @PatsyCabbie

As with most things diabetes-related, you need to find your own approaches and strategies that work safely and effectively for you - and your HCPs are a great help in developing those.

I would find a 10% change pretty much right in order to see an effect on my background dose - but as is often said Your Diabetes May Vary, and caution as suggested by @trophywench is often a wise move until you find out what works for you.
 
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