Basal Insulin - some questions

[pawprint91]

So having been diagnosed as Type 1 (confirmation blood test pending, but every medical professional I've seen has said Type 1 so far) and sent home with basal insulin (already had units increased from 8 to 9), I've got a few questions (to be honest I've got about 100 questions about every aspect of being diabetic, but I felt here was a good a place to start as any ).

Do you have to keep your injection timings to a routine? I am now off work for the week (at least) so have been going to bed perhaps an hour or so later than I would normally, and injecting maybe 45 mins - 1 hour before I actually sleep (but I'll be in bed reading/relaxing following my injection). Can I just bring this forward an hour when my bed time changes, or is it something that would need to be done gradually? Equally for the morning - at the weekend I may wake up slightly later to no alarm (OH is still at work this week, so waking up to his alarm currently). Does it matter that I'll have had my basal insulin at 7-7.30am every weekday but on the weekend may end up having it 8-8.30am? Does it matter if you wake later/go to bed earlier or later than you would normally or do you need a set in stone routine?

Also, is basal insulin affected by exercise/food? I often walk the dog before breakfast. So far this week, I have been waking, finger pricking (bg is still high, 11-15 if the past 2 mornings are anything to go by), walking the dog, then coming back and having basal insulin followed by breakfast. Could I have my basal insulin when I finger prick before walking? Equally on the days when I have breakfast then go for a walk (often weekends), would this affect when I should inject the basal insulin?

Thank you for all the help, trying to find my way in this new world!

 

[Bruce Stephens]

Basal insulin (specifically Levemir) is long acting (12-16 hours in the case of Levemir, I think), so when you inject it doesn't need to be exactly the same each day. Sure, make it a routine: anything to make life simpler. But don't worry if you're an hour or two different one day for some reason. (And don't worry about clock changes twice a year: just do whatever's convenient to you.)

Could I have my basal insulin when I finger prick before walking?

Sure, if that's convenient.

Equally on the days when I have breakfast then go for a walk (often weekends), would this affect when I should inject the basal insulin?

No. Do it when you want to, pretty much.

An exception is if you want to lie in one morning: it makes sense to try and wake up sufficiently to inject your basal insulin before going back to bed to keep it twice a day at roughly the same times.

Also, is basal insulin affected by exercise/food?

Not that much. It's to cover the glucose that the liver produces pretty constantly. If you do a lot of exercise it can be useful to reduce the basal dose a little before that (and maybe afterwards), but walking the dog probably isn't enough to make that helpful.

 

[Lucyr]

I can move basal by an hour or so and not have any impact. If I move it by closer to two hours or more then it does affect my blood sugars. I take it at about 8am so that I can do it at the same time give or take an hour, every day.

 

[pawprint91]

Basal insulin (specifically Levemir) is long acting (12-16 hours in the case of Levemir, I think), so when you inject it doesn't need to be exactly the same each day. Sure, make it a routine: anything to make life simpler. But don't worry if you're an hour or two different one day for some reason. (And don't worry about clock changes twice a year: just do whatever's convenient to you.)

Sure, if that's convenient.

No. Do it when you want to, pretty much.

An exception is if you want to lie in one morning: it makes sense to try and wake up sufficiently to inject your basal insulin before going back to bed to keep it twice a day at roughly the same times.

Not that much. It's to cover the glucose that the liver produces pretty constantly. If you do a lot of exercise it can be useful to reduce the basal dose a little before that (and maybe afterwards), but walking the dog probably isn't enough to make that helpful.

Thank you so much for the help and advice. 🙂

 

[pawprint91]

Okay, I think I am going to sound really silly with this - if I was going out in the evening and wouldn't be back till late e.g. after midnight or later, would it still be best to do basal insulin within the 2 hours of normally doing it? (Say for example it's usually done between 9 and 11pm, but I wouldn't be back till 1/2am). Do they say just do it 'before bed' as a marker to mean, in the late evening within a semi regular window? I'm guessing it's the timing between doses being looked at, not what it does when you are asleep or anything like that?

 

[helli]

Okay, I think I am going to sound really silly with this - if I was going out in the evening and wouldn't be back till late e.g. after midnight or later, would it still be best to do basal insulin within the 2 hours of normally doing it? (Say for example it's usually done between 9 and 11pm, but I wouldn't be back till 1/2am). Do they say just do it 'before bed' as a marker to mean, in the late evening within a semi regular window? I'm guessing it's the timing between doses being looked at, not what it does when you are asleep or anything like that?

Basal insulin lasts a set length.
It should not make any difference what you are (or about to) do or eat when you take it.
Taking it just before bed is a good way to get into the habit of taking it at around about the same time.

 

[rebrascora]

If I am not going to be at home I just take it with me when I go out and inject it at the appropriate time... within that 2 hour window. If you forget to take it with you or to inject it at the appropriate time then take it when you get back but you will possibly see a bit of instability in the morning as a result of overlap. If you don't realize until 4+ hours later then I wouldn't take it at all but maybe give yourself a small correction with your fast acting insulin if your levels are high.

 

[pawprint91]

If I am not going to be at home I just take it with me when I go out and inject it at the appropriate time... within that 2 hour window. If you forget to take it with you or to inject it at the appropriate time then take it when you get back but you will possibly see a bit of instability in the morning as a result of overlap. If you don't realize until 4+ hours later then I wouldn't take it at all but maybe give yourself a small correction with your fast acting insulin if your levels are high.

I'm not on fast acting insulin yet/not at a place to correct with it, but also haven't any plans to be out late at the moment - so this is good to know for the future. I've so many questions at the moment!! Thank you 🙂

 

[rebrascora]

I'm not on fast acting insulin yet/not at a place to correct with it, but also haven't any plans to be out late at the moment - so this is good to know for the future. I've so many questions at the moment!! Thank you 🙂

I did think that was the case, but you will eventually have bolus insulin too so I thought I would mention it. At the moment your body will still be producing a bit of insulin which may take up the slack if you forgot. The important thing would be not to end up taking too doses too close together so that their activity overlaps enough to cause you a hypo. Better to be a little too high as too low.

 

[helli]

If I am not going to be at home I just take it with me when I go out and inject it at the appropriate time... within that 2 hour window. If you forget to take it with you or to inject it at the appropriate time then take it when you get back but you will possibly see a bit of instability in the morning as a result of overlap. If you don't realize until 4+ hours later then I wouldn't take it at all but maybe give yourself a small correction with your fast acting insulin if your levels are high.

This depends which basal you take.
The longer acting basals such as Tresiba are more resilient to late doses than the shorter acting ones like Levemir.
If I was on Tresiba, I would be happy to take my dose 4 hours late.

 

[Bruce Stephens]

The longer acting basals such as Tresiba are more resilient to late doses than the shorter acting ones like Levemir.
If I was on Tresiba, I would be happy to take my dose 4 hours late.

I take Levemir but I'd be OK with taking it 4 hours late, though I'd drop the dose a bit and be anticipating going a bit low an hour or two after taking the next dose (since 4 hours late does mean there'll be more of an overlap).

 

[helli]

I take Levemir but I'd be OK with taking it 4 hours late, though I'd drop the dose a bit and be anticipating going a bit low an hour or two after taking the next dose (since 4 hours late does mean there'll be more of an overlap).

Good point. I would be reluctant to go to sleep with no basal on board as I would not be awake to give myself a "small correction with my fast acting if levels are high."

 

[Bruce Stephens]

I would be reluctant to go to sleep with no basal on board as I would not be awake to give myself a "small correction with my fast acting if levels are high."

Yes, that would be my reasoning. And being a bit low during the day isn't so bad since I can just eat something. (Or, if I see it coming before a meal, lower the bolus.) Having alarms for too low/too high helps a lot, I think (though I don't rely on those working).

(As always, we're all just doing the best we can, and a large amount of suboptimal fudging happens. Taking your Levemir pen and doing the basal dose while you're out is also a reasonable thing to consider.)

 

[pawprint91]

I take Levemir but I'd be OK with taking it 4 hours late, though I'd drop the dose a bit and be anticipating going a bit low an hour or two after taking the next dose (since 4 hours late does mean there'll be more of an overlap).

I am on Levemir too. So in theory, if I usually took it at 10pm, 1am would be okay, but then you'd anticipate a drop after the next dose say at 8am - so maybe mid morning the following day? I know we're all different though. I try and be quite organised so I'd probaby remember to take my Levemir with me. But good to know other people's patterns, too!

 

[Bruce Stephens]

but then you'd anticipate a drop after the next dose say at 8am - so maybe mid morning the following day?

That's my best guess, yes. I wouldn't expect the drop earlier (because activity is pretty low for a couple of hours, if I remember correctly). Might be a bit later, though. I'd be watching the graph a bit more carefully for that day (as I do after anything that's out of the usual routine).