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Basal test

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This thread is now closed. Please contact Anna DUK, Ieva DUK or everydayupsanddowns if you would like it re-opened.
H

heasandford

Well-Known Member
Relationship to Diabetes
Type 1
I have finally managed to do an evening basal check (no dinner!), but I'm really not sure whether it tells me clearly enough that the Lantus is running out. Can anyone help me?

time BG carb insulin
13:41 4 60 8
17:12 5.8
18:32 4.8
19:37 4.7
20:43 7
21:42 7.7
22:50 8.3
23:50 7.9
00:32 9.2

08:48 4.3
 
I'm a little confused - when do you inject your basal, the forum has messed with your table a bit!

To me, the rises after 8pm do look as though your basal is insufficient.
 
I was going to ask the same as Alan - what time do you inject your basal.

There does appear to be a lack of basal after 7:30pm.
 
By about 7pm your lunch bolus will have completely finished. Then you rise steadily 7.x-9.x which (if this is typical of what usually happens) that your basal is a tiny bit low at that time of day. You should really repeat the test to be sure. Some D books say +/-1.7 is the limit, others within 1-2mmol/L
 
But then you drop markedly overnight, ideal change + or - overnight is that 1.7 again. You dropped 5.

Is that usual for you? cos it's too much really.
 
Thanks for your comments, I agree with all you have said, I needed some support for my thoughts.
I inject Lantus at 'bedtime' which is usually between 12 and 1am. I do drop about 4 overnight these days, but if I reduce it won't that mean it will be even worse later in the day? My results are currently so inconsistant I am trying to find any pattern, so I will repeat the test (when I can bear not to eat dinner again!)

Sorry about the figures, it looked alright before I submitted, having tried loads of ways of trying to put them on - any suggestions for future would be appreciated
 
My first suggestion would be to switch Lantus to breakfast time. Your rise late eve could be Lantus running out/fading at 22hours-ish. Then there's an hour of onset before the next dose gets going. By injecting at breakfast you shift this troublesome period to waking hours and can tackle it with rapid. Alternatively a split pattern of Lantus early eve/breakfast time might spread the activity better.
 
I would definitely consider splitting your lantus. You have too little in the evening and too much overnight, which would suggest that an uneven split is required. I probably wouldn't wake up if I dropped 4 mmol overnight! Worth having a word with your DSN to see what split might be appropriate. 🙂
 
I think I had missed the implications of what was happening, the overnight drop has been fairly recent I think, as I say my results are fairly erratic and I hadn't seen that pattern until it was pointed out here.
I will try and contact my DSN to discuss, although that hasn't been easy up to now, let's test my new team!

Thanks again all of you, you seem to make so much sense of all the confusion!
 
I would agree with Mike and Alan.

The onset of lantus is hard to see when it's through the night and any fading would be masked by your evening bolus (normally).

If you switch to the morning, you can compensate for the initial rise and the fade in the last few hours would become apparent as a rise overnight showing high BGs first thing in the morning.

Deffo one for the DSN to guide you through but the switch to mornign showed up my shortfall and now I'm on split with a small boost in the evening to see me through the night.🙂

Rob
 
I would suggest discussing with your DSN, but don't be surprised if they are a little dismissive of basal changes.

Mine told me moving to morning wouldn't help, when in fact it solved a long-standing problem of overnight hypos at a stroke. I just then needed to tackle what happened after breakfast (with effectively a 'gap' in basal coverage during onset).

Keep testing to try to spot repeating patterns, and don't be afraid to trust your instincts as well as the guidance of your DSN - as long as you are careful of course! 🙂

M
 
Hee hee, that's one solution of course.

However I was going to suggest (if it was Lantus and it was bedtime) moving your jab of it back to nearer evening meal time.

Why? because we don't know whether it's running out, or whether in fact you for some strange reason just like me (I now know this for a fact, because of the pump!) your BG actually naturally rises late night/early hours - mine is approx 10pm to 2am. Unless you match the peak of Lantus to one of your own peaks, it will never be exactly right. If you do it after dinner, if it is running out under 24 hrs you will then see a BG rise sometime late afternoon.

Having then established it really doesn't last you 24hrs, you then try summat else ..... eg morning or split.

This is a marathon - not a sprint LOL
 
oh dear, now more confusion!

I assumed that my Lantus peaks during the night when I would otherwise get the 'Dawn Phenomenon' which I have never seemed to suffer from. I have breakfast of branflakes at about 8.30am (or later!) taking Novorapid just before eating - mostly this is OK (although occasionally it's not, variable results again)

I am also working at matching the peak of my bolus insulin, as with my evening meal it seems to take longer to peak, which is why I was starting to think the Lantus wasn't effective. My bolus profile seems late and has a long tail.
Too many variables.....
 
Last edited:
Remember that the rule is to only change one thing at a time until you are sure you have established it correctly, otherwise one change might mask the effects of another 🙂
 
Yes - and you always have to wait 3 days after, for any Lantus change to be 100% 'there'.

Unless you get your basal right though, as right as you can I mean! - it can throw all your insulin to carb ratios out ..... aaaaarghh.
 
PMFJI but have you considered switching to Levemir which is normally given in a split dose and doesn't have to be an even split. Also with Levemir you see instant results to any changes rather than having to wait the 3 days that Lantus takes to settle.
 
Yup LOL got it in one - because Patti's suggestion was completely different to what we'd had so far!
 
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