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Basal insulin

Woodywoodpecker

Woodywoodpecker

Well-Known Member
Relationship to Diabetes
Type 1
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Hi just looking for some advice with basal dose. Last few days been sitting higher about 2-3 hours after I’ve eaten, not like me as usually need a snack between breakfast and lunch and lunch and tea. Don’t know much about basal dose as been on 5 units twice a day for about a year, just wondering if I should put it up
 
It may be that your needs have changed (I've doubled mine over the last 18m) but best to try a basal test 1st and of course, if you do need to increase it, do it slowly

How to test can be found here:

www.mysugr.com

How To Successfully Test Your Basal Rate

Are you looking for basal rate information and testing instructions? Perfect! You're in the right place!
www.mysugr.com www.mysugr.com
 
Thank you think going to try a unit more tonight. I’m at hospital next Monday for yearly check, will see how things go before then
 
Inka said:
What bolus are you on @Woodywoodpecker ? If I’m higher than usual 2 or so hours after my meal, it’s often my bolus that’s wrong.
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Levimer I always spike in morning but comes down as quick as it goes up. Lunch today 1.20 42 carbs took 4.5 units and I’m at 11.6 now
 
Woodywoodpecker said:
Levimer I always spike in morning but comes down as quick as it goes up. Lunch today 1.20 42 carbs took 4.5 units and I’m at 11.6 now
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What was your pre lunch reading?
 
@Woodywoodpecker you mentioned you have seen a rise in the last "few days".
Is this a gradual rise or a sudden change?
I would check that nothing else has changed before permanently changing insulin.
For example, have you exercised less than usual? Are you unwell? Are you stressed? Has the hot weather caused any issues? Are you sleeping well? Are you taking any additional medication? Have you started a new insulin pen/cartridge?
All of these things can affect our BG.
 
It’s a sudden change, bit stressed at work did notice change them days. But over weekend been the same, bit lazier weekend but done loads jobs round house. Changed cartridge on the 7th, not sleeping that well and think through night heat makes me bit higher
 
Woodywoodpecker said:
7.5
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And how long did you prebolus? If I personally ate 42g carbs when my levels were on 7.5 I would probably be in double figures for the rest of the afternoon, so when I can, I wait for my levels to come down to mid 5s after injecting but before I eat. I also have strategies for if I can't wait, like keeping an eye on my levels an hour or so before lunch and injecting a correction if I think they are going to be a bit higher than I would like at lunchtime or eating the fibre, protein and fat first and then the carby part of the meal and eat slowly or sometimes I inject an extra couple of units because I know that my levels will go higher than I want if I have to eat straight away, making a mental note to keep an eye on levels later or raise my low alarm so I get notification when they start to come down and be prepared to eat a small snack later if I need to nudge them back up. I appreciate you may not be comfortable with these strategies, but just saying that they are valid options.

Are your overnight levels going high? I would be reluctant to increase the evening dose unless you are seeing high levels regularly overnight. From what you are saying it seems to be mostly after meals??
 
Woodywoodpecker said:
Sorry nova rapid
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Then it could be that you either have something causing the temporarily raised sugars, as @helli suggests, or maybe you need more bolus or an earlier bolus injection, as @rebrascora suggests. I would be looking at my bolus not my basal first but I’d also be careful that this wasn’t just a temporary blip due to some reason. Type 1 is like that. Some days things just go awry.
 
@rebrascora whilst these may be your usual experiences, I understand the concern from @Woodywoodpecker is that things have changed for her and she is looking for reasons why that may be and what to do about it.
Why would she suddenly need to prebolus 45 minutes ahead (for example) when she hasn't needed to until recently?
 
rebrascora said:
And how long did you prebolus? If I personally ate 42g carbs when my levels were on 7.5 I would probably be in double figures for the rest of the afternoon, so when I can, I wait for my levels to come down to mid 5s after injecting but before I eat. I also have strategies for if I can't wait, like keeping an eye on my levels an hour or so before lunch and injecting a correction if I think they are going to be a bit higher than I would like at lunchtime or eating the fibre, protein and fat first and then the carby part of the meal and eat slowly or sometimes I inject an extra couple of units because I know that my levels will go higher than I want if I have to eat straight away, making a mental note to keep an eye on levels later or raise my low alarm so I get notification when they start to come down and be prepared to eat a small snack later if I need to nudge them back up. I appreciate you may not be comfortable with these strategies, but just saying that they are valid options.

Are your overnight levels going high? I would be reluctant to increase the evening dose unless you are seeing high levels regularly overnight. From what you are saying it seems to be mostly after
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15 minutes have tried correction before and went low, over night not bad. This my graph for today
 

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That is a fairly significant drop overnight from midnight until about 2am from what looks like about 10 to 6mmols and then a steady rise from 3am. If that drop during the night is a fairly common trend then I would be reluctant to increase your evening basal dose at this stage. I am not sure there is any clear suggestion from that graph that basal is an issue.
Out of curiosity, do you get up about 6am where that hesitation in the upward slope is?

I found that when my honeymoon period started coming to an end and it happened in 3 clear stages for me, I found that I was having to do lots of corrections to keep my levels in range, until I increased my basal and then I could manage on the same insulin to carb ratio as before and get good results, so it seemed to be that it was mostly my basal needs which changed and I continued with my 1:10 mealtime ratio, whereas I think some people find they need to increase their meal time ratios when their honeymoon period tails off. As with all things diabetes you have to find what works for you. I think there is reasonable certainty that the honeymoon period will come to an end sooner or later, so it may well be that this is part of that process but only time will tell.
 
rebrascora said:
That is a fairly significant drop overnight from midnight until about 2am from what looks like about 10 to 6mmols and then a steady rise from 3am. If that drop during the night is a fairly common trend then I would be reluctant to increase your evening basal dose at this stage. I am not sure there is any clear suggestion from that graph that basal is an issue.
Out of curiosity, do you get up about 6am where that hesitation in the upward slope is?

I found that when my honeymoon period started coming to an end and it happened in 3 clear stages for me, I found that I was having to do lots of corrections to keep my levels in range, until I increased my basal and then I could manage on the same insulin to carb ratio as before and get good results, so it seemed to be that it was mostly my basal needs which changed and I continued with my 1:10 mealtime ratio, whereas I think some people find they need to increase their meal time ratios when their honeymoon period tails off. As with all things diabetes you have to find what works for you. I think there is reasonable certainty that the honeymoon period will come to an end sooner or later, so it may well be that this is part of that process but only time will tell.
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Yes get up at 6, forgot about the honeymoon ending. I have always taken 5-6 units in morning for 26 carbs but usually by 8.30 starting to drop usually have a piece of fruit, if I’m working or doing housework might need another snack before lunch, lunch usually 4.5 to 5 units and by 3-3.30 need a snack, tea varies to what I’m eating but usually find I need less insulin. Just had tea at 5 took bit more insulin 5.8 at the moment hopefully stay that way. Never thought I would be saying I wish it was lower
 
Thanks everyone for help, done better tonight not been out off range. Sometimes wonder if I know what I’m doing, and get in my head to much. Don’t know what I would do without you all. Well having early night as was still awake at 1 this morning
 
I’d back @mashedupmatt ’s suggesting of running some sort of fasting basal check to see what happens to your BGs in the absence of food/bolus active. Even if it’s just checking a couple of ‘sections’ of the day, eg skipping breakfast and watching until lunch for a couple of days… or having breakfast/dose and then skipping lunch and checking through until evening meal time. That way you can see what happens without your meal doses getting in the way.

Woodywoodpecker said:
not like me as usually need a snack between breakfast and lunch and lunch and tea.
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It may have been what you are used to, but there shouldn’t be any need to regularly snack between meals in order to prevent your levels dropping. That sort of ‘feeding’ of insulin isn’t a great habit to be in really.

Hope your tweaks work out OK whatever you decide to do.
 
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