Background Insulin Dose

[Tom1982]

Hello again.
After the usual school stomach bugs and colds we found we needed to adjust our daughters ratios. This coincided with changing her insulin type from Novorapid and Levemir to Friasp and Tresiba. How do you know if it’s the background dose that’s not right or the fast acting? We find she spikes after eating every time and is high at night. How do you know when you’ve got it right!?

 

[Sally71]

Do basal tests, they are a right faff but if the basal holds you steady with no food or fast acting insulin on board then you’ve got the basal dose right. If you drop you need to reduce the basal and vice versa.
But also, if she goes up after eating and doesn’t come down again then you probably need to adjust the meal dose; if that's right she should come back down to the starting point within about 4 hours.

 

[helli]

It s always recommended to get the basal/background insulin right and treat this as your foundation upon which to build the bolus.
If our basal is correct, our blood sugars remain stable(ish) in the absence of food and exercise. When you are on a long acting basal like Tresiba, the best time to see this is at night. You say your daughter's levels are high at night. Do they rise or do they stay at a constant (high) level? If they rise, the basal dose is likely to be too low. If you feel confident adjusting it, do so in very small increments and remember that Tresiba can take 3 days to show an affect.
Once you have the foundation right (ish), you will be able to see if the bolus needs adjusting. You say your daughter spikes after eating. Is this a "spike" going up and back down again or a plateau, going up and staying there? If it is a spike that returns to her pre meal levels after 4 hours, the bolus dose is correct but the timing may need adjusting: you need to match the peak of the insulin profile with the peak of the carb digestion by taking the insulin earlier. But, bear in mind, everyone's blood sugar spikes when they eat not just people with diabetes. If her levels plateau and are still high after 4 hours, then the dose was not enough and you may need to change the insulin to carb ratio.

 

[helli]

@Tom1982 I have just noticed your daughter has been changed to Fiasp.
I have been using this for the last coulple of years and found I really like it but ... I find it requires more nuance with timing that NovoRapid. The speed at which is works for me is very dependent upon my starting levels. If my blood sugar is around 4 or 5, it can work instantly so I have to dose after eating. If my blood sugar is between 6 and 9, I can dose about 5 to 15 minutes before eating (depends upon convenience). If my levels are in double figures, it can take over an hour to start working. If your daughters levels are high, this can be challenging as, for me, it feels as if I am injecting water and then suddenly my levels plummet.

We are all different and my reaction may be extreme (although I have read of others finding Fiasp very slow when high) but something to be aware of with your daughter.

 

[rebrascora]

Like @helli I find Fiasp quirky. I agree with what she has described but I think the main difference for me is that when my levels are higher (8+) I need much more Fiasp as well as much longer for it to work and if I eat before my levels come down below 8 it just won't work at all, so I have to inject and then wait for my levels to come down below 8 and then sometimes inject again if it doesn't come down, like tonight, when it really does seem to have turned to water and I haven't come down below 8 at all, so I haven't eaten this evening. I certainly don't find it as predictable as NR but if I can keep my levels mostly in the 4-6 range, it works well for me. I have to be much more proactive with corrections to keep my levels in that range though for it to be effective.
It took me 2 x 3 month trials of Fiasp, when I changed from NR to get the hang of making it work for me and both trials were very frustrating, so if you have recently changed, hang in there. It takes time to figure it out.

Tresiba needs to be adjusted to hold her levels steady overnight the majority of the time and then her bolus ratios adjusted during the day to manage her daytime levels. Personally I much prefer Levemir as a basal as it is more adjustable for day and night differential in needs, but it depends on the individual.