Bolus not basal!!

[Mumpie_olgran]

Really quick help please!
I've immediately spotted injecting my bolus not my basal
21 units
At least I spotted it immediately and so will stay home today not go to work so I can monitor and manage more easily
Should I now inject my basal too?

Feel like such an idiot

 

[Finn]

Don't inject your basal.

Can you calculate how many carbs 21 units of bolus would cover?

Start planning what fast carbs you have so you don't have to panic later. I find juice to be the fastest.

Is someone there with you?

Keep a close eye on your levels and don't wait to treat lows, or dips in your blood sugar levels.

We all make mistakes and this is one many of us have made. It's great that you spotted it right away.

 

[Mumpie_olgran]

Thank you yes have other half here
I reckon I've got about 250g of carbs to get through for the dose. Assume it'll hut me quicker than smaller doses so I've started on the orange juice now
Reckon better to stay just with the faster acting carbs in case fatty breakfasts like I normally have slow down glucose release when I want it?

 

[Finn]

Thank you yes have other half here
I reckon I've got about 250g of carbs to get through for the dose. Assume it'll hut me quicker than smaller doses so I've started on the orange juice now
Reckon better to stay just with the faster acting carbs in case fatty breakfasts like I normally have slow down glucose release when I want it?

That's what I would do. 250g of carbs is a lot to get through, so better to start now.

Do you have a Libre or Dexcom to keep an eye on your levels and a glucometer and test strips to confirm if the CGM isn't accurately reporting quick rises or falls?

Do you have a glucagon kit in case it gets bad (and does your other half know how to use it)? It sounds like you're well-prepared and won't need an emergency solution, but it's always comforting to have on standby.

What fast acting insulin do you use?

 

[Mumpie_olgran]

Yes Dexcomm G7 and yes test strips available

No glucagon so I'll be reliant on staying ahead of that need

Novorapid

Thanks v much for the quick responses

 

[helli]

Don't inject your basal.

Why not?

 

[Finn]

That's helpful that you have a CGM. Be sure to test your fingers if the CGM reading doesn't seem right.

No glucagon is no problem. You sound well prepared.

Novorapid will last a bit longer in your system than a faster acting insulin, like Lyumjev.

 

[Finn]

Why not?

I personally would wait until the extra fast acting is out of my system, then take a slight reduced basal. Why pile more insulin on right now? They will obviously need it once the Novorapid is out of their system, but it could make the situation worse now. 250g of carbs is already a lot.

 

[Mumpie_olgran]

I am going to wait. Last week I managed to forget my basal completely and it was fine. Im going to get through this mistake and then worry about basal later. Tbh I'm worried enough about the amount of insulin in me overall already and will def tolerate being a bit high in places form here

 

[Finn]

I am going to wait. Last week I managed to forget my basal completely and it was fine. Im going to get through this mistake and then worry about basal later. Tbh I'm worried enough about the amount of insulin in me overall already and will def tolerate being a bit high in places form here

That's exactly what I would do. You're already needing to eat 250g of carbs, why make it more?

I'd take a reduced basal later if I were in your situation. When I was on MDI, I was on a basal that I split, so in this situation, I would probably just take my evening basal a bit earlier and maybe increase a bit. But if you were fine last week without basal, you might be fine without now. Your call.

 

[Mumpie_olgran]

I'm taking single dose basal daily normally at 6am or so. This Novorapid should have washed through by 11am. So if I'm stable BS then I'll take my normal basal then. And then next couple of days phase it back to my normal 6am

Starting to think a bit more clearly. That was quite a head spin moment when I first did it. And clearly plenty more close monitoring from here before I'm out the woods

 

[Finn]

I'm taking single dose basal daily normally at 6am or so. This Novorapid should have washed through by 11am. So if I'm stable BS then I'll take my normal basal then. And then next couple of days phase it back to my normal 6am

Starting to think a bit more clearly. That was quite a head spin moment when I first did it. And clearly plenty more close monitoring from here before I'm out the woods

Good plan.

You can always delay insulin and adjust as necessary, but once it's in you system, you can't take it out!

If I were in your situation, I'd have done exactly as you did - not taken it and decided later what to do after I had a plan for dealing with the extra basal and woke up a bit more.

Good luck this morning and enjoy those carbs!

 

[Mumpie_olgran]

Lol there is that. I haven't had white toast for breakfast for ages. Nor cereal. Nor orange juice. About half way through my estimated carb need now...

 

[helli]

I personally would wait until the extra fast acting is out of my system, then take a slight reduced basal. Why pile more insulin on right now? They will obviously need it once the Novorapid is out of their system, but it could make the situation worse now. 250g of carbs is already a lot.

I think it depends on basal dose, type and frequency.
In this case, I agree with you but I would be nervous about delaying my basal and messing up future days when I try to get it back to the usual time. When I was on MDI, I only took my basal once a day and would be very nervous about going to bed with no basal at all.
So, I agree to miss basal if the dose is low and the frequency is twice a day. And delaying is ok for a very long acting insulin like Tresiba.
If it was once a day basal, the impact of the extra insulin whilst dealing with the extra bolus for a few hours would not be particularly significant in the grand scheme of things - e.g. 21 units over 24 hours is less than 1 unit an hour.

It is one of those things that we have to weigh up for ourselves. The important thing to me is not to be without basal whilst asleep when I am not able to top up with bolus if I go high (which I would once I dealt with the extra bolus).

 

[Proud to be erratic]

I am going to wait. Last week I managed to forget my basal completely and it was fine. Im going to get through this mistake and then worry about basal later. Tbh I'm worried enough about the amount of insulin in me overall already and will def tolerate being a bit high in places form here

As already said, this is easily done. Not that I'm an expert. I would also just forget the basal for at least the next 5 hrs - then take a view on that later - depending on how the morning went and what I might want to do this afternoon.

Meanwhile take measures to keep your insulin resistance high, so the excess insukin on board (IOB) has to work hard. So think about staying out of the sun and warmth, because warm or hot weather usually reduces most people's insulin resistance; [very few certainties with D management - some people don't experience this]! But today I will reduce my bolus for breakfast and have larger carb snacks close to hand because of today's warmth; I will most likely go low very easily on my normal doses. No housework or indeed anything mildly energetic, again activity lowers one's natural insulin resistance - sounds like a great excuse for a good book in a comfy cool place for the rest of this morning.

I have G7 and find it very stable, so I would trust my CGM and certainly not do any finger pricking if I can keep myself anywhere between 5.0 and 14. Outside of this temporary range then I might check my actual BG, just for my reassurance. Being higher for a few hours is totally fine; damage gets done after lots of time continuously high, not from "brief excursions" (sounds like a holiday!). I'd set my high alert at 14, so no yellow on the screen to "bother me" and my low alert at 6.0 to give me plenty of time to respond before getting anywhere near a low.

About your missing basal: as I understand it lantus is glargine and has a nominal 24 hr profile. Do you split your lantus normally? I'm not clear from your remark at thread #3 "Thank you yes have other half here". Some of our guidelines for keeping ourselves safe originate from pre CGM days and personally I have a lot of trust in my G7 alerts. So I'd reset my alerts back to more reasonable boundaries this afternoon and if tonight I was worried about not hearing my alert I'd put my phone or receiver in a tin beside my bed tonight - that will definitely wake me and my wife! Edit: old school methods are still 100%" reliable; none of this digital theory that 80% correct is good enough!

Good luck, enjoy your morning of pure leisure!

 

[Inka]

Scary @Mumpie_olgran ! It’s good you spotted it straight away. That’s a big dose to have to eat for. The concern is it can hit you before you get the food in. At least you’re not alone.

 

[helli]

Meanwhile take measures to keep your insulin resistance high, so the excess insukin on board (IOB) has to work hard. So think about staying out of the sun and warmth, because warm or hot weather usually reduces most people's insulin resistance; [very few certainties with D management - some people don't experience this]!

I am not sure if the impact of hot weather will make significant difference in the time it takes to eat 250g carbs.
But I agree not to do anything to reduce insulin resistance - today is not a good day to run a marathon, better to use the excuse to slob in front of the telly.

 

[Proud to be erratic]

I am not sure if the impact of hot weather will make significant difference in the time it takes to eat 250g carbs.

Yep, maybe not - although it's already sweltering here in Berks. But it's not a bad thing for someone pretty new to insulin to just gain an awareness of yet another factor in managing BG (insulin sensitivity and the effect of natural resistance) and without wanting to sound patronising @Mumpie_olgran has already made great decisions after spotting her mistake first thing this morning. Today is a particularly good day to stay calm after the adversity!

But I agree not to do anything to reduce insulin resistance - today is not a good day to run a marathon, better to use the excuse to slob in front of the telly.

I've stopped running marathons or even 5km! Done that enough up to my 50s +. I'll think twice before running for a bus these days; but I still get my 10k steps in most days without conciously planning that, so not too much 'slobbing'.

 

[Mumpie_olgran]

Do you split your lantus normally? I'm not clear from your remark at thread #3 "Thank you yes have other half here".

Ah sorry to be clear, that other half reference was to my wife being around to mop me up if I go too low. Apart from a brief and unsuccessful two day experiment on split doses (which I know is too short to really draw conclusions from) I have been on single morning shot of basal

Zero chance of me doing any runs or anything energetic today. But also sadly zero chance of slobbery as I have a full load on the remote work to get through!

Appreciate everyone's kindness as always

 

[Proud to be erratic]

Ah sorry to be clear, that other half reference was to my wife being around to mop me up if I go too low. Apart from a brief and unsuccessful two day experiment on split doses (which I know is too short to really draw conclusions from) I have been on single morning shot of basal

Zero chance of me doing any runs or anything energetic today. But also sadly zero chance of slobbery as I have a full load on the remote work to get through!

Appreciate everyone's kindness as always

Of course, silly me. Obvious in hindsight. Anyway, stay cool if you can.

I'm just not sure what I'd do about basal later today, if I was on Lantus; a bit of me says the weather is in my favour to manage all day on bolus only - I certainly wouldn't need lunch and probably only a light supper. Yet I have a sense that the daily basal doses build up a routine and accumulation of insulin that my body will be used to, would I want to manage the rest of my day from bolus alone (probably yes, for me on Tresiba). Either way I'd anticipate a possible quirky day tomorrow after today's hiatus. Don't understimate the carry over effects that diabetes seems to make us vulnerable to.

In his book, Gary Scheiner (Think Like a Pancreas) points out that to our body insulin is just insulin, unaware of whether its quick acting or slow release and often unaware that it isn't home-made. Its just there and will be used to our potential detriment if in excess. I have no panc'y so have to be aware that I simply don't have the other pancreatic hormones that do a lot of the balancing and regulating between excess insulin or excess glucose. One's panc'y is deceptively clever.

Your 'full load on the remote' could work either way for me: brain activity is akin to exercise and can lessen one's insulin resistance (so need more carbs); the work could be stressful and possibly increase internal glucose release thanks to our cortisol hormones. I wouldn't know how to 2nd guess all of that, but lean on my G7 to alert me about where my risk might be, hour by hour.

I had a ftf consult yesterday and was most pleasantly "ticked off" for not keeping a current Glucagon kit. It's on my prescription list, I've let it lapse because I thought no point: I'm always with others who know me, I've not needed this in 3+ yrs, when out or away on my own I wouldn't want this entrusting to a stranger and best to hope/expect that someone will call for an ambulance. But your incident this morning has further endorsed the Consultant's point yesterday that I was unnecessarily being a bit reckless - the kit is offered ..... So I've surrendered and put in my renewal request for another Glucagon pen.