Basal insulin Q

[Lisa65]

I've been using abasaglar for just over a month now, usually holding fairly steady overnight on 14 units. I'm in range (4-9) on the libre almost 90% of the time. However I'm still running between 6 and 9 most of the time despite eating very low carb, no more than 50g a day.
Ideally I would like to run a bit lower than this so that I could eat a bit more carbs, would more basal help or is that just likely to send me low overnight given that 14 units is holding BG steady? I take my basal at about 5pm.

 

[Inka]

What would make it easier would be a twice daily basal or an additional bolus (meal) insulin @Lisa65 It would depend what they’re willing to give you and how many injections you want to do.

 

[Lisa65]

What would make it easier would be a twice daily basal or an additional bolus (meal) insulin @Lisa65 It would depend what they’re willing to give you and how many injections you want to do.

I intend to ask about meal time insulin when I have my next appointment, but if they say no, I might try splitting the basal 🙂

 

[Inka]

I intend to ask about meal time insulin when I have my next appointment, but if they say no, I might try splitting the basal 🙂

You could split the Abasaglar, but it would probably be easier and more effective if you asked for a proper twice daily basal like Humulin i or Levemir @Lisa65

 

[mashedupmatt]

I split my Levemir as @Inka has suggested and it has been a great help for me (even despite relatively low dosages) - worth asking the question I reckon

 

[rebrascora]

I intend to ask about meal time insulin when I have my next appointment, but if they say no, I might try splitting the basal 🙂

If your very low carb way of eating is unsustainable, eat more carbs and let your levels rise and then the nurse will see a need for a bolus insulin to be added. If you try to keep managing your levels with your diet and/or more basal than you actually need, the nurse will be reluctant to change anything, so in some respects you need to ease some of your dietary restrictions in order to get what you need to manage your levels long term. It is just a shame that you didn't manage to get this sorted before Christmas as your nurse might think you were just being a bit indulgent over the festive season, when in reality you are probably still going to be quite reserved, but do allow yourself some treats and don't worry if your levels start hitting mid teens. Short term it will not do you any appreciable harm and will hopefully prompt them to give you the tools you need to manage things well in the long term.

 

[Lisa65]

I was thinking that Barbara, if they see me being 90% in range, they will probably just think I'm doing really well and be reluctant to change anything. I'm happy to eat a lowish carb diet long term, but I'd like to have a sandwich now and then and a couple of spuds with dinner!
The nurse at the surgery is very approachable though and she said I can ask to speak to her anytime and she'll get back to me. So once Christmas day is out of the way I think I'll add in a few extra carbs and see what happens.

 

[mashedupmatt]

I'd keep a detailed food diary with the carbs and the effect that it has on your BG (2hrs, and 4 hrs after, as well as before) - then you can present this to your DSN and they can make an informed decision on whether to add Bolus insulin to your regime - good luck with it (and I love a sandwich FYI!)

 

[rebrascora]

I would have a few roasties and a mince pie or whatever on Christmas day too. No reason to restrict yourself on the special day itself or at least not to try to prove a point. I wasn't suggesting that when I posted that it might look like you had had a splurge if your levels started spiking above range on Christmas day, for the first time, but just unfortunate timing, but yes do give yourself more leeway as your diet sounds a bit too strict at the moment to be sustainable .

 

[Lucyr]

I was thinking that Barbara, if they see me being 90% in range, they will probably just think I'm doing really well and be reluctant to change anything. I'm happy to eat a lowish carb diet long term, but I'd like to have a sandwich now and then and a couple of spuds with dinner!
The nurse at the surgery is very approachable though and she said I can ask to speak to her anytime and she'll get back to me. So once Christmas day is out of the way I think I'll add in a few extra carbs and see what happens.

I'd eat normally on christmas day then show her the results if you want a bolus insulin adding

 

[Lisa65]

I'd eat normally on christmas day then show her the results if you want a bolus insulin adding

Good thinking!

 

[everydayupsanddowns]

Good thinking!

Yes a compare-and-contrast might be pretty compelling @Lisa65

I wonder if your nurse may not really have appreciated how low carb you are keeping things in order to maintain your TIR?

 

[Lisa65]

Yes a compare-and-contrast might be pretty compelling @Lisa65

I wonder if your nurse may not really have appreciated how low carb you are keeping things in order to maintain your TIR?

I haven't really discussed my diet with her so far. I said I didn't eat loads of carbs but didn't specify how few.

 

[everydayupsanddowns]

I haven't really discussed my diet with her so far. I said I didn't eat loads of carbs but didn't specify how few.

Ah OK! Might be good for her to know that you are finding your menu a little too restrictive (though very effective in managing your BG levels!)

 

[Lisa65]

I have just had 6 oatcakes with cheese 36g
2 snack size sausage rolls 25ish?
1 mince pie 45g
Total of 106g
Trepidatiously waiting to see what happens

 

[rebrascora]

So pleased to read you have treated yourself. Keep us posted! Hope your rocket fuel only takes you into a moderately low orbit level.

I have just had a lovely big salad with chicken and avocado and balsamic vinegar and lots of baby leaves and tomato, cuc and peppers and really enjoyed it but then totally tarnished my halo by following it with a mince pie, supposedly 33g carbs (Ha!) Don't believe that! It's got to be at least 45g. I have now injected 11units for all of it including a small correction. The salad should be about 20g carbs but levels still going up nearly 2 hours later. Worst of it is that I am now craving and want another mince pie, but I am already in double figures and rising, so I am fighting the urge to indulge further.

 

[Lisa65]

So pleased to read you have treated yourself. Keep us posted! Hope your rocket fuel only takes you into a moderately low orbit level.

I have just had a lovely big salad with chicken and avocado and balsamic vinegar and lots of baby leaves and tomato, cuc and peppers and really enjoyed it but then totally tarnished my halo by following it with a mince pie, supposedly 33g carbs (Ha!) Don't believe that! It's got to be at least 45g. I have now injected 11units for all of it including a small correction. The salad should be about 20g carbs but levels still going up nearly 2 hours later. Worst of it is that I am now craving and want another mince pie, but I am already in double figures and rising, so I am fighting the urge to indulge further.

Fingers crossed you start coming down soon! I feel pretty full, we normally have a picky tea on Christmas Eve so it's the first carby meal I've had for a couple of months.

Already at 12.4 and got the vertical arrow 😱

 

[rebrascora]

Eek! I am on 12.3 but thankfully horizontal so hopefully my Fiasp is starting to turn the tide! Really, really want another one though! In fact I want the box empty and out of sight! I really should not have bought them because I know I cannot be trusted!

 

[Lisa65]

Mince pies are like that! This is the first one I've had though.
Now at 14.8 and still vertical 😱

 

[mashedupmatt]

Went up to 12.5 with my 1st mince pie of the season but got the dosage right as coming down slowly at 9.1 a couple of hours after (good job Fiasp!) - will definitely have another tomorrow now! Merry Christmas 🙂