Afraid of sleep and food

[novorapidboi26]

I dont think the levemir would make much difference as the doses are so small, so the duration of the insulin also would not differ.......

But all avenues are explorable.............

 

[Northerner]

Hey Northerner, have you thought about swopping to Levemir like I have. I find a split dose really makes a difference and it seems a much more stable insulin. You'd also get a novopen!! Plus I think you can get novopens which are measured in half units which would give you a finer adjustment each time. As your annual review is coming up soon I'd definitely suggest it. I was all over the place with Lantus and didn't trust it at all. I'm still getting to grips with learning to trust the Levemir but am pleased with it generally. Just a thought.

Thanks Flutterby. I don't think I'm bad enough to merit a change of insulin and all that entails. I've been very happy (on the whole!) with lantus - it was pretty much perfect for months before this latest episode, and even now it's not truly terrible. I think in my current state of anxiety a switch to levemir would push me over the edge and I'd be a gibbering wreck. I'm trying to remember if the Clickstar pen allows half units? If it does, I can ask for one of them at my appointment.

 

[Flutterby]

I dont think the levemir would make much difference as the doses are so small, so the duration of the insulin also would not differ.......

But all avenues are explorable.............

You may be right but sometimes there's no explanation for what works or doesn't work, it's trial and error I find! My whole experience with diabetes over 33 years has been trial and error, mostly error!

 

[Northerner]

You may be right but sometimes there's no explanation for what works or doesn't work, it's trial and error I find! My whole experience with diabetes over 33 years has been trial and error, mostly error!

That's starting to sink in with me after only two years! 🙂

 

[katie]

Three cartridges in a year?? wow! I'm guessing that's just Lantus

I hope things get better for you now that you've changed the cartridge.

 

[Northerner]

Three cartridges in a year?? wow! I'm guessing that's just Lantus

I hope things get better for you now that you've changed the cartridge.

I changed it last night and had a much better waking level. Yes - just lantus, I use a novorapid cartridge in about 10 days. 🙂

 

[everydayupsanddowns]

Thanks Flutterby. I don't think I'm bad enough to merit a change of insulin and all that entails...

I wouldn't rule it out though... Levemir is a completely different concoction, often works well split, appears to react to changing requirements rapidly rather than taking Lantus's while to settle.

Another option might be to change the timing. I used to wake up hypo 2 or 3 times a week, sometimes not only low but dropping... with ensuing breakfast hilarity. Since I've switched Lantus to the morning that problem pretty much completely disappeared instantly.

The only subsequent tweak I've had to make is to combat slightly high figures after breakfast, but I'm pretty close to getting that licked with a combination of dose timing and using my slightly faster abdomen to give the Humalog a head start.

You could always switch for a week or two then put it back if you don't see any benefit.

Might be worth a try while you ponder the pump question?

M

 

[Flutterby]

I wouldn't rule it out though... Levemir is a completely different concoction, often works well split, appears to react to changing requirements rapidly rather than taking Lantus's while to settle.
M

I feel much safer on the Levemir, my own GP had been quite content to leave me on Lantus as my overall results didn't seem too bad, but I knew how much I was struggling and becoming afraid to go to bed for fear of hypos. I'd messed about with the dose so much that I didnt know what to do next. When the hospital team suggested a change I leapt at it. I too felt that it was worth a try. It does seem to work very differently to Lantus.

 

[MeanMom]

K is 11 and has 15 units of Levemir! (has 16 for a short while just after dx). As far as we know (touches wood) she has never had a hypo at night. Only 6 months since dx tho' (feels like 6 years)

Can I ask what people mean by basal testing? Assume this is to find out how much Levemir (etc) is needed but how do I go about it? Clinic sets the rate at the moment - also K has hers at bedtime but some have mentioned 'splitting' it - is this to make it last longer?

 

[novorapidboi26]

for me a basal test would be to have nothing to eat before bed , test, correct if needed and then test in the morning.......if dose is good ,the reading will be held steady..............unless you have dawn phenomonon...

Splitting is good if your dose doesnt last the full 24 hours, which for most it doesnt........

 

[everydayupsanddowns]

Splitting is good if your dose doesnt last the full 24 hours, which for most it doesnt........

That's interesting NRB, do you split yours for that reason?

I didn't find splitting helped lantus last any longer myself. I was trying to get round needing less basal at night than during the day and splitting the dose can help here as while the smaller doses typically last a shorter length of time you can, by experimentation, give yourself different amounts of active insulin during the night and during the daytime. (Splitting didn't work for me though, but taking Lantus in the morning has).

The principle of a basal test as far as I know, is to miss a meal and inject no bolus for it. Test every hour or two until the next mealtime. If your basal level is correct your bg should remain within a mmol/l or so of where you started. Best to do it on a day when you are not especially active. Since you are not eating carbs/calculating bolus doses the only insulin active is your basal. This ought to be just enough to hold your levels steady, but not so much that they drop.

For a thorough scheme you'd start by missing breakfast and look at the results. Two or three days of tests (not necessarily consecutive) help to iron out rogue results. Then move on to missing lunch, evening meal and finally (if you can face it) overnight. For pumpers, they can then match the rise and fall of their basal scheme to reflect their requirements. For us Lantus/levemir users it's more often a case of a unit up or down, or a tweak of the split doses.

The benefit of occasional basal tests/tweaks is that if my basal is right, my bolus doses/ratio seem to become much more reliable/predictable.

If I have a few dodgy days for no apparent reason I'll often to one or two basal tests and it's surprising how often I've needed to go up or down by a unit.

 

[MeanMom]

for me a basal test would be to have nothing to eat before bed , test, correct if needed and then test in the morning.......if dose is good ,the reading will be held steady..............unless you have dawn phenomonon...

... or been growing in the night like an 11 year old

 

[MeanMom]

The principle of a basal test as far as I know, is to miss a meal and inject no bolus for it.

Thank you but i have a very hungry 11 year old here so dont think thats going to happen! Probably explains why the clinic are setting it for us (but they must be just guessing?)

 

[novorapidboi26]

That's interesting NRB, do you split yours for that reason?

I didn't find splitting helped lantus last any longer myself.

I am not on Lantus or Levemir now, but when I needed to split my BI dose I changed to levemir......thats kinda what I meant by splitting, although I have seen people splitting lantus as they were allergic to levemir.........

 

[everydayupsanddowns]

(but they must be just guessing?)

Yup I reckon they are 🙂 mostly, as NovorapidBoi suggests, by looking at the early morning/pre-breakfast readings. I only came across the the idea of testing basal during the day earlier this year, but I'm converted! Like any kind of fasting though, I guess it's easier to do if you've decided to do it yourself, and know you are doing it to achieve something you want.

I suppose you could eat non-carb things to stave off hunger (a chunk of cheese, pile of bacon or whatever) as while a small proportion of these will be converted to bg they may not skew the results too badly...

 

[novorapidboi26]

Thank you but i have a very hungry 11 year old here so dont think thats going to happen! Probably explains why the clinic are setting it for us (but they must be just guessing?)

As I say a test can be done overnight, just no pre bed snacks or insulin.....then yout basal is the only thing working........

 

[sofaraway]

I was also going to suggest levemir for the half unit dosing and that it reacts quicker when you change the dose. I have like you always been on lantus and have real reservations about changing insulin type.

hope things start to look up for you

 

[margie]

Hope the replacement cartridge does the trick. I think that Lantus gets more unpredictable as it degrades, I think that is why I was having so much trouble when my fridge wasn't working properly.

Wouldn't say all is perfect now - but its a lot more predictable.

If you carry on getting erratic results it might be worth speaking to your GP to see if they can suggest anything. The other thing that could be affecting you is your anxiety over the variability.

Anyway I hope that with your new cartridge things get back on track.

 

[shiv]

Monday - how exciting! Why is it a trial though? Hannah says when she sees you in Brighton she will make you a carb counted meal (as a treat - I know you carb count anyway) and advise you on dual waves etc - if you want.Bev

It's a trial because they aren't 100% convinced I need one. From what I understand, as long as I 'prove' to them I need it, ie I show improvements, I should be okay to go ahead and apply for funding.

Oh bless Hannah! I think I have added her on facebook, if not can you get her to add me? Tom will be a mutual friend. I would love her advice, I know how good she is with Alex & the pump and to be honest I need as many people like that in my life as I can get when I first go on it! I will definitely take her up on that offer, and I'm sure if Tom catches wind of that he'll want in too!

 

[Barb]

Keep an open mind on Levemir

I gave Lantus a try but simply didn't get on with it - pain at injection site, etc. Trials with other night-time insulins which helpfully 'peaked' in the middle of the night led to some interesting near-death experiences. In short I only felt safe once I'd changed to slow-release Levemir which means I can go to bed reasonably sure that I'll wake up in the morning, providing I have my night-time snack. Your night time units seem incredibly low and must be having virtually no effect at all - please mention them when you see your doc and hopefully he can advise on this.

The biggest problems for me came with NovoRapid, which I'm still on. Despite following the GI bible I find this insulin can drop levels alarmingly even after short bursts of exercise. Carrying extra CHO at all times is a necessity, even on fairly low levels of insulin, and that of course, leads to weight gain. Oh the joys of diabetes. Hey ho.

Don't be afraid of scarily high readings during the day time and react by injecting extra units of NovoRapid - this insulin can dip faster than a rollercoaster and leave you low again in no time at all.

You're an inspiration to everyone. Hope you find the regime that works for you soon.

As you probably know, I am Mr Perfect Levels most of the time, but over the past month or so I have been having to readjust my insulin doses day in, day out. My levels aren't awful by any means, but not knowing how my basal needs might change from one day to the next is bothering me. I was on 8 lantus a few weeks ago, then that came down to 3 because of night hypos. Then I went on holiday and it began to creep up to 5 units. But during the day I've been getting hypos because my novorapid requirements don't seem to have changed in the same way.

So, I am in a state of confusion when I try and calculate my meal bolus - it's turning into pure guesswork. Sometimes I'll end up high, sometimes very low. Hence starting to fear food! Also, because I can't work out what my basal should be, and because of the hypos, I'm scared to increase the basal too much. However, I've been waking to levels around 7 when they used to be around 5. I've become worried when dropping off to sleep incase it's a hypo coming on - sometimes it is, sometimes it isn't - but because I'm anxious, I'm sleeping very badly.

Last night I realised that my lantus cartridge was way beyond its 30 days out of the fridge, since I need so little of it, so I changed the cartridge last night and woke to 5.5 this morning - so it seems like that was an issue. Funnily enough, when I got the new cartridge out I noticed that I have only got through three cartridges in a YEAR!

I'm hoping that this was the issue - the lantus had basically started to lose its potency, hence the unpredictability of the levels. Stupid diabetes! 😱