Anyone else winding down their basal at the moment?

[everydayupsanddowns]

I’ve been taking mine down a notch or two over this recent warm weather.

Still slightly surprises me that something like ambient temperature, and shifts of season can have such an effect.

Plus of course the weirdness of the huge difference a fraction of a unit of insulin an hour can make (either from knocking a unit off a long acting dose, or by minutely adjusting a pump basal pattern).

Only with Diabetes Maths(TM) would that sort of ‘excess’ insulin require eating quite so many Haribo to dodge hypos! 😱

For those on oral meds - do you get seasonal variations like this?

 

[Inka]

Yes, I had to decrease my basal this morning after two nights of unexpected low sugars right at the beginning of the night. I could see it was basal as it was a sudden drop which needed a fair bit of glucose, but then recovered later in the night so much so that I woke high 🙄

I totally agree that the effect of tiny adjustments is incredible. I find a change of 0.02 or 0.03 can have a big effect. So strange when you think of corrections on pens. It just shows how crucial the right basal rate is - it’s a delicate balance, with minuscule nudges needed.

 

[rebrascora]

I was torn between a 1 unit or 1.5 unit decrease in Levemir last night. I went for the 1 unit reduction and ended up hypo 3 times needing 4 JBs. None of them major but trashed my TIR stats and clearly I made the wrong decision! 🙄 That half a unit would have made all the difference. Daytime levels are still stable on 22 units but that night time dose is always tricky and the difference between 2.5 and 3 units is so significant. If I can get it down to 0 with some more exercise, I will be happier! One less injection a day and one less dose decision..... Decision making is one of my main character flaws ( I am a terrible procrastinator), so it is surprising I manage as well as I do with my diabetes really. Needs must I guess!

 

[SimonP]

I'm down 2 units on my winter standard (18 total vs 20 total) so not a vast reduction. I do wonder if the reduction is simply because I do more (and/or more consistently) when the days and longer and warmer.

Plus of course the weirdness of the huge difference a fraction of a unit of insulin an hour can make (either from knocking a unit off a long acting dose, or by minutely adjusting a pump basal pattern).

I also think this sometimes, but it's 10% in my case so it is a reasonable fraction, it does pale into insignificance when compared with the active insulin provided by bolus doses though.

 

[Tdm]

As my basal is only 2 units per 24 hrs and i have a pen thst delivers on whole units, not a lot of adjustment possible chez tdm

 

[nonethewiser]

Decreased mine weeks ago, always same as weather warms up.

 

[rebrascora]

As my basal is only 2 units per 24 hrs and i have a pen thst delivers on whole units, not a lot of adjustment possible chez tdm

You really need to get a half unit pen!

 

[eggyg]

I’ve been taking mine down a notch or two over this recent warm weather.

Still slightly surprises me that something like ambient temperature, and shifts of season can have such an effect.

Plus of course the weirdness of the huge difference a fraction of a unit of insulin an hour can make (either from knocking a unit off a long acting dose, or by minutely adjusting a pump basal pattern).

Only with Diabetes Maths(TM) would that sort of ‘excess’ insulin require eating quite so many Haribo to dodge hypos! 😱

For those on oral meds - do you get seasonal variations like this?

I have today after battling hypos all week, which is unlike me. Just by one unit though, even changing my basal ratios hasn’t helped. I’m sick of eating sweet stuff, I hate the cloying feeling it leaves in your mouth.

 

[JSC]

Being very new to the Type 1 diagnosis for my son at just two months in, I had no idea about the warm weather possibly needing a reduction in basal insulin - my son is on 10 Lantus and tracks around 6-8 overnight. How are you supposed to know these things? If we make any adjustments to my sons insulin doses ourselves, the diabetic nursing team seem to get rather 'upset' but then do not seem to want to help us work through the issue we are having to want to make the change - Please tell me this frustrating and stressful time of feeling out of your depth ends at some point I just feel like I don't know what I need to know but I am not sure how I can know what I need to know?

 

[rebrascora]

Being very new to the Type 1 diagnosis for my son at just two months in, I had no idea about the warm weather possibly needing a reduction in basal insulin - my son is on 10 Lantus and tracks around 6-8 overnight. How are you supposed to know these things? If we make any adjustments to my sons insulin doses ourselves, the diabetic nursing team seem to get rather 'upset' but then do not seem to want to help us work through the issue we are having to want to make the change - Please tell me this frustrating and stressful time of feeling out of your depth ends at some point I just feel like I don't know what I need to know but I am not sure how I can know what I need to know?

Try not to worry too much. It doesn't sound like his basal insulin doses need changing just yet if he is pretty stable through the night..... and yes, it absolutely does get easier with time and experience. In the early days you are really just learning the absolute basics and trying to keep your head above water most of the time, so don't worry about this seasonal change.
I do however think that nurses should be more encouraging of people experimenting (as long as they err on the side of caution) because we learn best through trial and error and it is no good being totally reliant on the nurses long term because they are not there 24/7 and are not able to offer as much support as they do in the early days, so I really think they should encourage people to try a little tweak here and there provided there is a good reason for tweaking things, to see what happens.
The key thing is to learn as much as you can WITHOUT overwhelming yourself. If you feel overwhelmed, take a step back and let things just muddle along until you feel able to take on a bit more. Diabetes is complicated and frustrating. Sometimes it all goes wrong even when we haven't changed anything, so don't take any errors or bad results to heart. Tomorrow is a new day and maybe you will be luckier. Keep good records particularly if you are making adjustments yourself and don't draw any conclusions from just one incident. Always look for patterns. Learn what you can from the less good results and then let them go but make sure to blow your own trumpet and celebrate any little successes and victories. Diabetes is tough and you cannot get it right all the time.... just like I didn't get it right last night. 🙄 I take comfort in the fact that if I hadn't reduced my Levemir at all I would have hypoed a lot worse, so whilst I didn't get it completely right I still made a good decision, it just could have been better still if I had erred more on the side of caution, which really should be the first consideration.

Hang in there! I would not want to go back to those early days because it was scary not being in control and not knowing enough to take control, but little by little it just becomes second nature.

 

[Pumper_Sue]

My basal has dropped by 37% since the hot weather paid a visit.

 

[JSC]

Try not to worry too much. It doesn't sound like his basal insulin doses need changing just yet if he is pretty stable through the night..... and yes, it absolutely does get easier with time and experience. In the early days you are really just learning the absolute basics and trying to keep your head above water most of the time, so don't worry about this seasonal change.
I do however think that nurses should be more encouraging of people experimenting (as long as they err on the side of caution) because we learn best through trial and error and it is no good being totally reliant on the nurses long term because they are not there 24/7 and are not able to offer as much support as they do in the early days, so I really think they should encourage people to try a little tweak here and there provided there is a good reason for tweaking things, to see what happens.
The key thing is to learn as much as you can WITHOUT overwhelming yourself. If you feel overwhelmed, take a step back and let things just muddle along until you feel able to take on a bit more. Diabetes is complicated and frustrating. Sometimes it all goes wrong even when we haven't changed anything, so don't take any errors or bad results to heart. Tomorrow is a new day and maybe you will be luckier. Keep good records particularly if you are making adjustments yourself and don't draw any conclusions from just one incident. Always look for patterns. Learn what you can from the less good results and then let them go but make sure to blow your own trumpet and celebrate any little successes and victories. Diabetes is tough and you cannot get it right all the time.... just like I didn't get it right last night. 🙄 I take comfort in the fact that if I hadn't reduced my Levemir at all I would have hypoed a lot worse, so whilst I didn't get it completely right I still made a good decision, it just could have been better still if I had erred more on the side of caution, which really should be the first consideration.

Hang in there! I would not want to go back to those early days because it was scary not being in control and not knowing enough to take control, but little by little it just becomes second nature.

Thank you so much for taking the time to pass on so much detail it is very much appreciated. As a Mum I just want to fix my boy and I know that I cannot do that and must learn to let that go (it's a tough one!). I think I am trying to arrive at a point and say to myself well that's sorted now, life can get back to normal. It is strangely reminiscent of grief, having been on the receiving end of that, I am finding it hard to let go of what life was and embrace the new. I can therefore see how it will just evolve to be the new way of things as time goes by. I know you should be careful what you wish for but if I could trade places with him I would in a heartbeat, sometimes it feels that would be easier as I would then be in the driving seat and able to know what was happening in each moment, which would be far less stressful. On the other hand my son seems to be, on the whole, very accepting of his diagnosis and just more able to take it as it comes, he seems quite relaxed about just trying and seeing, which is great. I think it is just the once a Mum always a Mum thing that I am trying to put down and let myself trust his approach. Thank you for sharing your knowledge and passing on your advice.

 

[Pumper_Sue]

Thank you so much for taking the time to pass on so much detail it is very much appreciated. As a Mum I just want to fix my boy and I know that I cannot do that and must learn to let that go (it's a tough one!). I think I am trying to arrive at a point and say to myself well that's sorted now, life can get back to normal. It is strangely reminiscent of grief, having been on the receiving end of that, I am finding it hard to let go of what life was and embrace the new. I can therefore see how it will just evolve to be the new way of things as time goes by. I know you should be careful what you wish for but if I could trade places with him I would in a heartbeat, sometimes it feels that would be easier as I would then be in the driving seat and able to know what was happening in each moment, which would be far less stressful. On the other hand my son seems to be, on the whole, very accepting of his diagnosis and just more able to take it as it comes, he seems quite relaxed about just trying and seeing, which is great. I think it is just the once a Mum always a Mum thing that I am trying to put down and let myself trust his approach. Thank you for sharing your knowledge and passing on your advice.

Hello @JSC
as you say always a Mum 🙂 My lovely Mum is 87 this month and she still worries about me even now even though I have had type1 for 58 years and haven't lived at home since the age of 18 🙂

If it helps with dealing with things (diabetic's point of view) I tend to just look at my sensor or meter and treat the result as just a number.
There's no post mortem it's a case of need a JB or two or extra insulin then move on.

 

[JSC]

Hello @JSC
as you say always a Mum 🙂 My lovely Mum is 87 this month and she still worries about me even now even though I have had type1 for 58 years and haven't lived at home since the age of 18 🙂

If it helps with dealing with things (diabetic's point of view) I tend to just look at my sensor or meter and treat the result as just a number.
There's no post mortem it's a case of need a JB or two or extra insulin then move on.

My goodness you really are a seasoned diabetic then! You also seem to have lots of other health complications to deal with and yet still have the time to offer your words to others, so thank you it is very much appreciated.

 

[Pumper_Sue]

My goodness you really are a seasoned diabetic then! You also seem to have lots of other health complications to deal with and yet still have the time to offer your words to others, so thank you it is very much appreciated.

Thank you for your kind words 🙂 In all honesty though the only condition that really bother/affects me is the MS. Which bugs me no end with the fatigue but then again there are a lot of people worse of than me so am thankful it is no worse than it is.

 

[Lucyr]

I just didn’t take any basal last night. A combination of the warm weather making me more insulin sensitive, natural fluctuations in my body’s insulin production and grumpiness about the way an appointment went and wanting a break from diabetes. Woke at 7.8, better than usual morning bgs. Diabetes makes no sense most of the time.

 

[eggyg]

I am winding mine down another half unit tonight. Was down to 4.4 at 6.10 (after a small portion of fish, chips and mushy peas at 1pm, split dose of 3 units just before eating and 3 units an hour later when I was 9.8 arrow up) I had half a Tesco quiche. 35 grms carbs, no insulin taken or onboard at 6.45 as soon as I got home. Then down to 3.9, 3.6, 3.3! Two hours later 5.3! It’s been incredibly hot today and I had two glass of wine at the Glasgow meet. I also had a KitKat on the train in the way home when I hit 4.6. I’ve drank lots of water too. This week has been a real struggle, and it’s not going to let up anytime soon.

 

[Robin]

I've gone from 6 units of Levemir in the morning and 3 at night, to 4 and 2. Part of it is probably because I’ve been up and down North Devon cliffs for the last week, but some of it is definitely due to the accompanying heat! The trouble is, whenever I have to make drastic adjustments, I acclimatise after a few days, then I gradually have to increase back to where I was again.

 

[rebrascora]

Not taking any Levemir tonight as had a couple of nasty hypos this evening after a very long and hot day, and quite a bit of unbolussed carbs. I am however going to bed with IOB after a very late/early supper of a chicken salad, so we will see how that pans out. Another long hot day on the cards tomorrow but I tend to find that my evening dose reduction will impact my daytime levels so it is best not to adjust both in the same direction at the same time, so I am sticking with 22 in the morning I think.... but reserve the right to change my mind when I see my morning levels!

 

[Proud to be erratic]

3+ years in to the D malarkey, my annual trends are still pretty mixed. 2020 doesn't count (too new); '21 and '22 I dropped my Tresiba in the spring and I smugly patted myself on the back as my Libre graphs confirmed a restoration of fairly consistent nightime level flat lines.

Throughout this year I've not had much consistency - certainly not enough (until this week) to let me conclude a drop in basal might be appropriate. But my TIR is decreased and my last HbA1c in March was increased.

This week my activity level has been much greater (our house move should be in c.4 weeks time and too much to be done in too few days!) - but my stress level is definitely greater (house sold allegedly; but no confirmed date or contract exchanges, pointless puerile paperwork asking questions already answered in writing, relentless cold calls from removal companies ... and inevitable anxiety about it all [are we doing the right thing, etc etc]). But the last 3 nights have shown recognisable steady falls and could be a cue for Tresiba downward adjustment; but is it this because of exceptional weather or the extra activity? Prevarication moment.....?

I had presumed that the current warm weather would generally reduce my insulin resistance and both my basal and bolus ratios would alter with a net total reduction of insulin. My main meals are seemingly relatively unchanged, if anything actually less carbs as winter hotpots have been replaced by more summery meals; but I suspect I am snacking more between meals.

All goes to show what a complex weave of things going on that we play with - part instinctively and part with due consideration. No surprise that Gary Scheiner describes D as Complicated, Confusing and Contradictory. The 42 Factors that affect BG seem too few!