Basal Adjustment

[digihat]

Good Morning Everyone 🙂

Recently I have been taking about 38 Units Toujeo but I have been cranking this done now to 26 units a day reducing by 2 every 3 days or so. It was mainly cranked up to deal with overnight highs then suddenly these have settled done out of nowhere. Also have just switched to tresiba this was planned starting at 26 will start cranking this down if similar pattern continues after about a week to let it settle. Something I have posted about before is not long after I wake up my levels go off a cliff downwards which in my head means too much basal ive not eaten for about 11 hours at the time of writing. This is a repeat pattern I see every morning over months. Dont get hungry till mid morning. I end up propping it up a few times in a morning.

Relatedly I tend to have alot of post meal dips dropping to mid 4's which isn't hypo of course. Unless ive reacted too slow will go to high 3's I've been asked to keep it above 5 for trying to get hypo awareness back which i manage to do most days. Normally I would consider raising the insulin to carb ratio here here currently 1:12 which has worked well for months but if there is too much basal floating around I assume this would play a factor as well.?

Just for last bit of context i had cpeptide come back at 151 non fasting hadn't eaten had some coke zero at the time it wasn't planned consultant decided to do it after appointment. Need to check with them what the result means had brain blank moment forgetting to ask what it meant ha

Ultimately I guess what I'm asking is my logic potentially right about how im approaching this?

Graph example below I raised my level before bed hence the spike overnight

 

[helli]

Is there a reason why your basal has been changed to Tresiba?
Given the very long, very flat profile, any changes can take 3 or 4 days to take effect so you will not be able to reduce it by 1 unit per day.
It is unusual to see BG falling upon waking, due to Dawn Phenomenon/Foot on the Floor, it is very common to see a rise at this time of day. As you have no other insulin on board, you will have too much basal AT THAT TIME. However, if you reduce your basal, this will mean you have too little basal for the rest of the day. If this is repeatable, are you able to have a very small snack when you wake? Just something like a single biscuit without a bolus.

Yes, if you have too much (or too little) basal on board, this will appear to impact your insulin to carb ratio. This is why it is recommended to get your basal right before tweaking your bolus ratios.

 

[digihat]

Is there a reason why your basal has been changed to Tresiba?
Given the very long, very flat profile, any changes can take 3 or 4 days to take effect so you will not be able to reduce it by 1 unit per day.
It is unusual to see BG falling upon waking, due to Dawn Phenomenon/Foot on the Floor, it is very common to see a rise at this time of day. As you have no other insulin on board, you will have too much basal AT THAT TIME. However, if you reduce your basal, this will mean you have too little basal for the rest of the day. If this is repeatable, are you able to have a very small snack when you wake? Just something like a single biscuit without a bolus.

Yes, if you have too much (or too little) basal on board, this will appear to impact your insulin to carb ratio. This is why it is recommended to get your basal right before tweaking your bolus ratios.

Thanks for the reply 🙂

Its something I partly requested as I had been having some issues with Toujeo and it seemingly running out due to overnight highs constantly despite increasing it we agreed to try a different one tresiba u/100 in this case to see if it was any better although as mentioned my overnight levels started behaving out of the blue just as we were about to switch we've gone ahead with the switch anyway as I had everything in ready and nearly out of toujeo.

Yeah I do a change every 3/4 days to see how it filters through. Exactly I feel I have the opposite problem to what I hear alot of people talk about with morning rises, which is why I am gradually reducing seeing as my overnights have steadied lately. This was another reason we swapped to tresiba with the falling morning levels but high overnight.

Yeah Ive experimented with taking a banana, biscuit etc to try keep it steady often just keeps falling until ive had quite few nibbles without any bolus.

Yeah this is why I've not changed the carb ratio for now seeing how we go with basal reduction . I think im still honeymooning as well

 

[everydayupsanddowns]

Those graph are really unusual @digihat

And they seem to require completely opposite actions. When are you eating in the evening before?

Your levels rise steeply from bedtime (not enough basal?). Then level out from 2am-waking (enough basal, but too high at that point). Then drop off a cliff as soon as you wake (too much basal?)

It’s a nightmare.

The only thing that could match that, of it’s a pattern that repeats, would be an insulin pump?!

 

[digihat]

Those graph are really unusual @digihat

And they seem to require completely opposite actions. When are you eating in the evening before?

Your levels rise steeply from bedtime (not enough basal?). Then level out from 2am-waking (enough basal, but too high at that point). Then drop off a cliff as soon as you wake (too much basal?)

It’s a nightmare.

The only thing that could match that, of it’s a pattern that repeats, would be an insulin pump?!

In the past that has been a problem the rising before bed the one on this graph was me raising my levels as I've been asked to keep them above 5. But i have had the rising issue alot. It randomly settled a few weeks back with steady overnight but the morning falls continues. Which in my head says too much basal...

Yeah its been a bit of nightmare with raising generally for overnight but the morning crashing down with only basal active. I've reduce the basal alot recently now on Tresiba U/100 which im hoping will help alleviate the morning side of things to at least more of a gradual fall. Early signs are potentially positive but too soon to tell on the third day of it

All MDI could be the honeymoon side of things ive given up trying to figure it out ha hence the change of basal...