Basal suddenly too high?

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helli said:
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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Thank you. I’m really hoping this is the case for me!

Are you suggesting to think about not putting my Abasaglar down 3 units (but maybe 2) and then go to bed a little higher? Or do both (and go down 3 units tonight and go to bed a little higher)?
 
It sounds like you've got a plan for tonight, but have you considered if your monthly cycle is affecting your insulin needs?

I find I need more insulin when I'm on my period, but less when I'm ovulating, mid-cycle. The difference can be quite big: I could need +30% my usual insulin during my period, but -30% my usual insulin when I'm ovulating.

Obviously the honeymoon period throws a spanner in works, but it's worth looking at whether other hormones are playing a role.

Also, if you have a Libre and you're worried about going low tonight, I'd set the low alarm a bit higher than usual to catch any drops sooner rather than later.
 
Finn said:
It sounds like you've got a plan for tonight, but have you considered if your monthly cycle is affecting your insulin needs?

I find I need more insulin when I'm on my period, but less when I'm ovulating, mid-cycle. The difference can be quite big: I could need +30% my usual insulin during my period, but -30% my usual insulin when I'm ovulating.

Obviously the honeymoon period throws a spanner in works, but it's worth looking at whether other hormones are playing a role.

Also, if you have a Libre and you're worried about going low tonight, I'd set the low alarm a bit higher than usual to catch any drops sooner rather than later.
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Good point! I think I might be ovulating! It’s never been this big of a difference but then I suppose it might just be a combination of all these things.

Also good point about the Libre alarms. They are set to 4 now, I completely forgot I can put them up a bit. Thank you!
 
I deliberately looked to see whether you were male or female, but no clues, then forgot to mention that possibility in the finish. Tell you what, by my age, you'll be sick to the back teeth of medics telling you 'it's probably' either 'your hormones' or 'your diabetes' - aaarrgghh.
 
trophywench said:
I deliberately looked to see whether you were male or female, but no clues, then forgot to mention that possibility in the finish. Tell you what, by my age, you'll be sick to the back teeth of medics telling you 'it's probably' either 'your hormones' or 'your diabetes' - aaarrgghh.
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Haha yes I can imagine that gets a little tiring!
 
Evergreen said:
Good point! I think I might be ovulating! It’s never been this big of a difference but then I suppose it might just be a combination of all these things.

Also good point about the Libre alarms. They are set to 4 now, I completely forgot I can put them up a bit. Thank you!
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Once I noticed that I seemed to be going low when I was ovulating, I started keeping track and confirmed the pattern. I've got a calendar marked so I know when to start gradually reducing my insulin for ovulation, and when to increase it in the run up to my period. I find adjusting my bolus works out better than adjusting my basal, but that's just me. I only take 5u basal in the morning and 3u at night, so adjusting either dose of my basal by a unit is too big of a change for me and swings me too far in the opposite direction.

I have my Libre low alarm set to 4.2 at night so I can lightly treat lows before they're actual lows. I try to go to bed above 5.5, so if I'm at 4.2, I'm probably on my way to a low, so I beat it to the punch.

I've recently found that dried apricots are a very slow-release carb, so not a good low treatment, but something that can drip-feed me sugar over an hour or so. If I have a low at night, I'll have 1-2 glucose tabs (2.2g carb each) or a sip of juice to avoid the low in the short-term, and then have a dried apricot to avoid a low over the next hour. I estimate one small dried apricot is 2.5g carbs and a big one is 5g carbs and I'll take whichever one I feel like I'll need (a small one when I'm insulin resistant, a big one when I'm insulin sensitive).
 
How did things go overnight @Evergreen

Always a bit of a faff when your doses need tweaking and it can take a day or three for things to settle into the ‘new normal’.

Hope the night passed without hypos, and without bouncing the other way either - and that your sleep wasn’t too disrupted 🙂
 
Finn said:
I only take 5u basal in the morning and 3u at night, so adjusting either dose of my basal by a unit is too big of a change for me and swings me too far in the opposite direction.
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Have you looked into getting half unit pens for your basal?
I am not sure they are available for all slow acting insulins but I believe you can get them for NovoNordisk ones such as Levemir and Tresiba
 
helli said:
Have you looked into getting half unit pens for your basal?
I am not sure they are available for all slow acting insulins but I believe you can get them for NovoNordisk ones such as Levemir and Tresiba
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I'm on Abasaglar and I don't think half unit pens are available for Abasaglar, at least not here in Germany. I do have half unit pens for my bolus insulins (Humalog and Lyumjev) and they make a big difference.

I have an appointment in a few weeks and I'm going to ask about half unit reusable pens (HumaPen Luxura HD for Eli Lilly insulins, I think) and cartridges for Abasaglar so I can do half units.
 
Hi everyone! Apologies for the delay in responding, it’s been a busy day!

The night passed without hypos, but I couldn’t sleep really until about 3am and did have to eat some things throughout the night to stay ok. Same again all day, no real change yet although the drop seems to be slowing somewhat I think.

I’ve been feeling a little weird all day, but can’t pinpoint whether I’m getting ill, whether it’s the constant up and downs that are making me feel different or whether it’s just a bit of anxiety. I’m ringing my diabetes team first thing in the morning and hope they can shed some light on what’s happening!

Think I’ll be setting some alarms again tonight and I’m keeping fingers crossed for a better night!

Thanks everyone for checking in, this is such a lovely supportive forum!
 
Finn said:
Once I noticed that I seemed to be going low when I was ovulating, I started keeping track and confirmed the pattern. I've got a calendar marked so I know when to start gradually reducing my insulin for ovulation, and when to increase it in the run up to my period. I find adjusting my bolus works out better than adjusting my basal, but that's just me. I only take 5u basal in the morning and 3u at night, so adjusting either dose of my basal by a unit is too big of a change for me and swings me too far in the opposite direction.

I have my Libre low alarm set to 4.2 at night so I can lightly treat lows before they're actual lows. I try to go to bed above 5.5, so if I'm at 4.2, I'm probably on my way to a low, so I beat it to the punch.

I've recently found that dried apricots are a very slow-release carb, so not a good low treatment, but something that can drip-feed me sugar over an hour or so. If I have a low at night, I'll have 1-2 glucose tabs (2.2g carb each) or a sip of juice to avoid the low in the short-term, and then have a dried apricot to avoid a low over the next hour. I estimate one small dried apricot is 2.5g carbs and a big one is 5g carbs and I'll take whichever one I feel like I'll need (a small one when I'm insulin resistant, a big one when I'm insulin sensitive).
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You sound like you are so organised and have things under control! I noticed you were diagnosed a year before me and I really hope at this point next year that I have everything under control as much as you! Something to aspire to

I will also try the apricots!
 
You could knock another unit off if you’re anxious @Evergreen Swinging sugars can make you feel anxious, yes, not just because it worries you but as an actual physical response by your body. Lows and anxiety can also sometimes cause further lows because your body is all ‘hyped up’ and burning glucose quicker. It’s a horrible feeling.

@Finn I set my Libre low alarm at in the 5s. That way you get a proper warning at a good level. By the time your Libre is reading 4.2 you could easily actually be 3.1. Repeated lows like that will blunt your hypo awareness and that’s something to avoid.
 
Evergreen said:
You sound like you are so organised and have things under control! I noticed you were diagnosed a year before me and I really hope at this point next year that I have everything under control as much as you! Something to aspire to

I will also try the apricots!
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Thanks @Evergreen.

Some days are better than others, but I've found a lot of useful information on forums like this. Reading other peoples' experiences has helped me think of what might benefit me and what factors might be coming into play.

I'm able to pay a lot of attention on my numbers and what I'm eating since I work from home, work flexible hours and have quite a regular schedule outside of work. I think I'd be in a very different position if I had to go into an office.
 
Inka said:
I set my Libre low alarm at in the 5s. That way you get a proper warning at a good level. By the time your Libre is reading 4.2 you could easily actually be 3.1. Repeated lows like that will blunt your hypo awareness and that’s something to avoid.
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Thanks for the thought @Inka. I'll keep it in mind.

My Libres tend to read low when I'm sleeping - not compression lows, just a bit lower than finger pricks. If I get up to go to the toilet, the reading picks up a bit by .5 to .8 (matching finger pricks), then dips back down when I go back to bed.

I'm definitely still hypo-aware, but manage to avoid hypos at night by having the low alarm set to 4.2 and gently pre-treating lows (and testing fingers occasionally or if I feel low). I rarely actually go below 3.8 at night (confirmed with finger pricks) and when I do, I can definitely feel it.
 
Afternoon everyone!

Thought I’d give an update as luckily the worst of these hypos seems to have passed for now. I’ve spoken to the diabetes team and they’ve said to keep the basal where it is for now until my face to face appointment later in the month.

I still haven’t really had to use rapid-acting insulin for my blood sugars to return to normal so I’ll do some tweaking of my ratios there as well as I think my body is (temporarily) producing some more insulin at the moment.
 
I couldn't eat one dried apricot or one dried prune! - daren't have either in the house.
 
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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I waas told by my Nurse never to eat Carbs without injecting insulin due to the risk of Ketones.
 
Merryterry said:
I waas told by my Nurse never to eat Carbs without injecting insulin due to the risk of Ketones.
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Well, that’s not literally true because what do you do if you have a hypo? Yes, you eat fast-acting carbs without insulin! What do you do if you’re on a walk and feel your blood sugar dropping - eat carbs without insulin!

I guess what your nurse meant was more along the lines of making sure you don’t forget your mealtime insulin.
 
Merryterry said:
I waas told by my Nurse never to eat Carbs without injecting insulin due to the risk of Ketones.
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That is not a good general rule. If you are hypo, you need to eat carbs without injecting insulin.
Ketones are only a concern if your BG levels are high (usually mid teens or above) and then you need to inject insulin to reduce them. If your levels are dropping low, then of course you need to eat carbs without injecting insulin to stop the drop.
I do wonder if some of these "rules" were devised before the widespread availability of BG testing and more recently the advent of CGM but nurses seem to retain these guidelines instead of moving with the times and realising that they may no longer be applicable.
 
They couldn’t be @rebrascora because in the old days we had regular insulin and that usually causes a dip in blood sugar a few hours after injecting, so it was normal to have to eat a mid-morning and mid-afternoon snack without insulin in order to keep your blood sugar up.

I think the rule was either badly explained or misunderstood.
 
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