Appointment today, and some basal options

[Lucyr]

I had an appointment with the DSN today, which was a follow up after speaking to the consultant a month or so ago. My blood sugars have been hard work since I had covid (also about a month or so ago) and I’m still having to test and correct before and after every meal, injecting at least 6 times a day. Apparently covid can damage pancreatic function, and so some people are seeing this effect on blood sugars post covid.

We talked about a few options, firstly my diet - I’ve reduced carbs/calories/fat each by a bit to try and lose weight and improve insulin resistance, so I agreed on a referral to the dietician to check things are balanced okay there.

I asked about libre, the local health board is in the process of agreeing the criteria, so agreed on another DSN appointment in a few months to talk that through.

Talked about apidra doses, agreed to try slightly larger corrections if I’m high post meal, but to try this on a weekend when I’ve got nothing else on in case the bolus stacking works too well.

Then we talked about lantus / basal, which is where I have some questions. She said that smaller volumes of insulin absorb better than larger ones, and that’s why often peoples insulin dose reduces when they switch to a pump. Thinking along the same lines for lantus, it may be that I would get better absorption (I.e. the insulin would work better and bgs improve) if the volume I took at once was smaller. Options for doing this would be to split the existing lantus dose into two injections, or to switch to a u-200 insulin like toujeo for my basal as double strength means half the volume.

Did anyone have any experience of this theory that smaller doses at once absorb better and can give lower bgs?

 

[Lily123]

I can’t really give advice from experience but I hope this helps anyway.

Lantus - especially in bigger doses - tends to crystallise at the injection sight for lots of people which leads to bad absorption

 

[rebrascora]

I can't say if it improves anything or not but I actually split my Levemir dose into 3 just because I felt that 20+ units in one site wasn't a good idea, so my morning dose which is currently 20 units is split into 2 injections of 10units, one into each buttock and my evening dose, if I need any at all, and usually no more than 6 units, goes into a thigh which I alternate and then keep my stomach for bolus insulin and corrections. There is no harm in you trying splitting your Lantus dose in the same way as I split my morning Levemir. I just use the same needle without problem as I am doing one injection straight after the other. Yeah, it is an extra injection but not a big deal in the scheme of things for me.

 

[Inka]

It’s true insulin use is usually less on a pump - I was told a reduction of 20-25%. Mine reduced by approx 25%. However, the reason I was told for this was the accurate targeting of the basal not the tiny amounts. I was told a once daily basal was like trying to thread a needle wearing boxing gloves whereas the pump was threading it using a precision microscope and perfect hand control. A big dollop of basal can’t magically spread itself over the day exactly where you need it, so you need to have more whereas on a pump with fast-acting insulin which is more predictable and can be precisely targeted, that extra isn’t needed.

I’d go for a twice-daily basal in your position, I think. I’d also change from Lantus rather than just split that.

 

[Lucyr]

I have tried splitting the lantus for now, but done both injections at the same time. The other basals I’ve tried in the past are levemir and tresiba, but the vast majority of the time I’ve used lantus.

 

[DaveB]

I think you will find that Levemir comes out marginally better than Lantus in the Top of the Pops from comments I've seen over the years but both are very popular. BTW carbs are the biggest contributor to weight gain as well as BS so don't worry so much about fats and don't bother with calories.

 

[Lucyr]

I think you will find that Levemir comes out marginally better than Lantus in the Top of the Pops from comments I've seen over the years but both are very popular. BTW carbs are the biggest contributor to weight gain as well as BS so don't worry so much about fats and don't bother with calories.

The reason I stopped levemir was that you have to take it twice a day and I struggled to be consistent enough with remembering the morning dose on time, so if I do switch I like the idea of a more concentrated but once a day insulin instead of a twice a day insulin like levemir

Dietwise I am using nutracheck and counting calories primarily, though it does also track fruit&veg, carbs, fat, protein etc. I need to stick to a low fat diet for other medical reasons, and am not able to cut carbs below 130g. Nutracheck higher protein plan reccomends staying below 170g of carbs per day, so I’m aiming at 130-170g of carbs, and 1300-1700 calories, both of which are lower than I have been doing previously.

 

[trophywench]

Levemir is pretty forgiving all in all, I found, Lucy. I don't recognise a timing problem in the mornings whatever - just used to take it fairly soon after I got out of bed whether that was 06.00 or 11am. Times we went on holiday and drove through the night were a bit random esp pillion on a motorbike since insulin pens would be in my handbag in a pen Frio not about my person and in any case, I'd have to wait till we stopped! But that would be only a few specific days a few times a year - neither regular nor frequent. Evening was more time critical for me personally, too near bedtime and I'd be hypo in the early hours.

 

[rebrascora]

I need to get my Levemir into me before I get out of bed on a morning and ideally an hour before, so I often set an alarm to wake up and jab myself and then go back to sleep. That way it has got going enough to start tackling FOTF by the time I get out of bed. I am lucky that I mostly don't get DP, just FOTF.

 

[Proud to be erratic]

I find Tresiba very forgiving; I just take it 1x daily when I wake up. Because its profile is to last up to 40 hrs, the daily overlap gives that stability and my overall total no of units was reduced by my DSN from c.20 units Levermir split am & pm, to Tresiba, originally 16units; but it was quickly obvious those 16 were too many, so steadily reduced to 10 units Tresiba (& now reduced to 9 with the warmer weather). The longevity of its profile makes it less flexible and dose changes can need 2 or even 3 days to take effect - but I've not found that to be a problem.

So my smaller Tresiba doses do seem to be absorbing better. Until I changed, I hadn't realised how much my 2x daily Levermir was less helpful than my 1x daily Tresiba. My night pattern now is usually very flat and steady; when it's not, I invariably know what I did to upset that balance.

 

[trophywench]

No way Pedro has my BG ever been 'flat' - I think you are probably very strange, in that, frankly. 😱

 

[Proud to be erratic]

No way Pedro has my BG ever been 'flat' - I think you are probably very strange, in that, frankly. 😱

My night BG is generally flat; by day I get closer to my name here - erratic. When I had my Diabox CGM working I could see the 5 minute snapshots listed in that logbook and they confirmed the general evenness. Whether having no pancreas brings this about, I can only surmise. But no potential odd insulin surges or glucagon messages during the night; and generally whatever I had for dinner is digested and gone by midnight, when I usually turn in. Even if I need a small precautionary snack at bedtime, say a 6gm biscuit, the response from that is pretty gentle - steady - just not level. If I need a correction at bedtime, say from 10 to my target of 6, the fall is usually pretty even; takes up to an hour to kick in then steady fall to level off.

Not always flat, but I usually know what triggered a change and usually came from a misjudgement from earlier. This was never the case when I was on Levermir.

 

[Lucyr]

Tresiba being so flat is why I hated it and was so keen to come off it after I’d been out on it! Lantus has always been my preference because it doesn’t quite last 24 hrs and I can time it running out to when my bg drops most.

My bgs have improved the last two days, so either splitting the lantus into multiple jabs at the same time does help, or something else like the calorie counting has helped.

Had terrible headaches Monday and Tuesday but ate more carbs during the day today and it was much better.

 

[trophywench]

Yeah but, @Lucyr - Lantus can last up to 36 hours - just depends on your body, same as all insulins.

Plus theory seems to be (cos we asked everyone over on DSF years ago) that all/any insulin doses over 10u most likely needs the dose split for proper absorption.

 

[Lucyr]

Well I don’t know why splitting lantus wasn’t suggested sooner as it seems to make the insulin more effective, below are screenshots from the last two nights, I had to snack before bed on quite a few carbs both nights and reduced my lantus last night.

Going to try reducing my dinner insulin tonight to go to bed a bit higher as I’m absolutely nackered.

For anyone on higher doses or struggling with high bgs, splitting insulin into multiple injections seems a good thing to try but be aware you may need to reduce the dose if it does make it absorb better for you!

 

[Paul Goldie]

Well I don’t know why splitting lantus wasn’t suggested sooner as it seems to make the insulin more effective, below are screenshots from the last two nights, I had to snack before bed on quite a few carbs both nights and reduced my lantus last night.

Going to try reducing my dinner insulin tonight to go to bed a bit higher as I’m absolutely nackered.

For anyone on higher doses or struggling with high bgs, splitting insulin into multiple injections seems a good thing to try but be aware you may need to reduce the dose if it does make it absorb better for you!

Hi Lucy, put of interest, what was your evening Lantus dose. I currently have 13 units every night but levels always increase overnight. I am seeing my DNS next week so may well mention it to her. thanks

 

[Lucyr]

I don’t think you’d need to split a dose of 13u as that’s not a particularly high dose, think it’s more when you get beyond 20u that it’s considered

 

[everydayupsanddowns]

Really pleased to see how this is working out for you @Lucyr

Hopefully with a few tweaks you can get things just cruising along nicely 🙂

 

[trophywench]

Brill @Lucyr ! Really am very very pleased for you. 🙂

 

[SB2015]

Glad that things are settling for you @Lucyr and that you seem to have a DSN who listens and provides the support you need whilst listening to your ideas. Clone that one.