Basal suddenly too high?

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Evergreen

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Relationship to Diabetes
Type 1.5 LADA
Afternoon everyone! And happy new year!

Just wondering if anyone has ever experienced this. I was diagnosed with LADA in July and was started on basal insulin. I’ve been steady at taking 11 units, with a slight increase to 12 over the past week. After a bout of illness a couple of weeks ago my blood glucose did not come down on its own anymore the majority of the time, so I started taking novorapid just before Christmas. All was well and I generally had my blood glucose levels under control.

Last night I suddenly had two hypos and this morning again. Today I have been fighting off hypos by eating many more carbs than I usually would (no rapid insulin at all). I’m assuming my basal insulin is suddenly too high and I will reduce it tonight.

Has anyone ever had this? Is it likely that my levels will stabilise with less basal? I’ve been walking a little more (but not hugely) than usual, so I’m wondering if that’s possibly increased my insulin sensitivity?

I’ll ring my diabetes team on Monday to discuss, but in the meantime any words of wisdom would be appreciated, I’m pretty terrified about tonight to be honest!
 
Definitely reduce your basal @Evergreen Do you have a Libre? Basal needs change frequently, especially soon after diagnosis. Sometimes your beta cells recover a bit temporarily and start making some insulin again. This happened to me. It can cause persistent lows. Reduce your basal and test lots.
 
Thank you Inka, that’s what I thought so that’s very reassuring. I think I’ll go down 2 units down tonight, do you think that sounds about right (going from 12 to 10 units)?

I do use a Libre which was what woke me up in the night luckily. It’s been terrifying to see my blood sugar plummet as much as it has been. I’ve eaten so many carbs today without any rapid acting insulin and I’m still 75% in target zone!

Just worried about having another night like last night but hoping that taking 2 units less will do the trick
 
Most def reduce your basal, and yes 2 units sounds like a very good start 🙂
 
Evergreen said:
Thank you Inka, that’s what I thought so that’s very reassuring. I think I’ll go down 2 units down tonight, do you think that sounds about right (going from 12 to 10 units)?

I do use a Libre which was what woke me up in the night luckily. It’s been terrifying to see my blood sugar plummet as much as it has been. I’ve eaten so many carbs today without any rapid acting insulin and I’m still 75% in target zone!

Just worried about having another night like last night but hoping that taking 2 units less will do the trick
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We’re not allowed to advise on doses but if you’re going so low that you don’t need your bolus insulin, I’d reduce it by more than 2 units. Better a little high than scary hypos.
 
Inka said:
We’re not allowed to advise on doses but if you’re going so low that you don’t need your bolus insulin, I’d reduce it by more than 2 units. Better a little high than scary hypos.
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Yes of course, I know these probably are questions for my diabetes team. Really hope they will start opening soon over the weekend!

It makes sense to reduce it a little more in that case. I really appreciate everyone’s advice and help!

I’ve just been baffled that one day 12 units kept me so steady and the next day I’m having these scary hypos. But I suppose that’s life with diabetes…
 
Another possibility is impending illness. I often find my blood sugar goes unexpectedly low for a couple of days before I get a cold. But not normally as low as yours sounds - however I’ve had Type 1 decades.
 
Inka said:
Another possibility is impending illness. I often find my blood sugar goes unexpectedly low for a couple of days before I get a cold. But not normally as low as yours sounds - however I’ve had Type 1 decades.
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Oh gosh, that might make sense. I’ve been feeling a little nauseous although I thought that probably had to do with eating more carbs/sugar than normally.

I was ill before Christmas and my sugars went up instead of down but I suppose this might be different for different type illnesses. I hope I’m not getting ill but it would be an explanation!

Thanks again for your help everyone! Knowing I can post here with any questions really is such a help 🙂
 
Abasaglar unfortunately is unlikely to show the full effect of a dose change immediately - it's not unlike Lantus for that (being a biosimilar insulin glargine) Hence although you might see some change next day it's very often the next day - or even the day after that - when you'll see the full effect and be able to make a proper assessment.
 
trophywench said:
Abasaglar unfortunately is unlikely to show the full effect of a dose change immediately - it's not unlike Lantus for that (being a biosimilar insulin glargine) Hence although you might see some change next day it's very often the next day - or even the day after that - when you'll see the full effect and be able to make a proper assessment.
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Oh gosh, does that mean another night of hypos? Anyone any ideas of how to deal with the night? Besides obviously having stuff ready next to the bed?
 
What time do you take your Abasaglar? You could have a larger bedtime snack and set an alarm for before the time you had the hypo so that you can test and top up with carbs if necessary. It’s worth doing that for the peace of mind.
 
Inka said:
What time do you take your Abasaglar? You could have a larger bedtime snack and set an alarm for before the time you had the hypo so that you can test and top up with carbs if necessary. It’s worth doing that for the peace of mind.
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I take it at 9.30pm. So pretty late..

That sounds like a good idea though. Might have a pizza for dinner then
 
If Abasaglar is like Lantus, it will peak at roughly 5hrs after injecting, so that will inform your alarm-setting too. You won’t sleep if you’re worrying, so setting an alarm or two and eating if necessary will probably mean you sleep better anyway. I’d also aim for a higher nighttime blood sugar than usual so you have a bit of a cushion.
 
I think it might not have a peak from what I read, but works equally throughout the 24 hours. I always thought that was a positive but heading into the night I’m actually changing my mind!
 
Anyway, setting alarms when you went low before or tend to go low normally is a good idea. It’s reassurance and might ward off any lows.
 
Yes definitely! I will be setting alarms and hope I’ll get some sleep. Will take 9 units and then hope that’ll change something sooner rather than later.

Thanks again for everyone’s help and input
 
trophywench said:
Abasaglar unfortunately is unlikely to show the full effect of a dose change immediately - it's not unlike Lantus for that (being a biosimilar insulin glargine)
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When I took Lantus, I found I could adjust my basal daily and it would have an affect immediately as it only last about 22 hours.
I would do this often as I always reduce my basal after exercising.

For this reason, if I was in the shoes of @Evergreen , I would certainly not assume hypos through the night. I would follow the approach suggested by @Inka to go to bed slightly higher than usual with a stash of carbs (fast and slower acting) next to the bed.

We are, of course, all different. So, as we are not biosimilar to Evergreen, I would make little assumptions and be prepared for either eventualit’s.
 
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