Bothersome basal

[Vix]

Argh!!! As you probably know i've changed my basal from morning to evening (about 6 weeks ago) on the request of my consultant... and I've gone from having about 2 hypos a week to about 2 hypos a day when I changed! I have persisted though to prove my point (I know I'm too stubborn) and was told to lower my basal... so I came down to 16 from 18 and I was going to bed with BGs of 11-13 (was previously 18-20 before increasing bolus ratio) and waking up hypo still so lowered basal to 15 about a week ago and I'm now waking up at 11-13 It seems to go from one extreme to another with just 1 unit of insulin different so I don't quite know what to do... I test in the night and I'm not hypo when I test so can't work it out!!!

So tempted to go back to morning basal, but can it really make that much difference? My hospital are still not giving me the support I need so am at a loose end... got an appointment next week so will see what happens, and what my hba1c is! Although it does seem a bit silly that to have the green light to start a family it has to be below 7.0 but that seems detrimental to my quality of life and how many hypos I'm having! Having said that who knows what my hba1c will be, just hope it's better than 7.6 not worse...

Ok, rant over!

xx

 

[Lauras87]

Have you thought about splitting it?

I used to go hypo in the night like you know but the split seems to have evened it out

 

[rossi_mac]

half unit pen? I have heard some splitting the dose morning & night no idea how this would help but might be worth asking the powers that be, i.e. dsn...

 

[Redkite]

This was exactly the problem my son had with Lantus, ie. he had to go to bed at 16+ to avoid being hypo by morning. All his (old) team could suggest was waking him at midnight for an extra snack!!!! We would have tried splitting the dose if we hadn't got his pump. It's all very well for consultants to sit behind a desk and pontificate - it's not them who are living with the d!

 

[Pumper_Sue]

Hi Vix, perhaps it might be a good plan to reread all the suggestions and advice given to you in previous threads you started on this subject. Hopefully by doing so it will give you the pointers you need. 🙂

 

[Cleo]

sorry to hear you're still having basal problems vix. Think I mentioned previously, I've been on a split Lantus dose (8u morning + 10u before bed) since christmas and its worked for me. When I used to take it at night I used to get hypos, and when I took it in the morning I'd be high before bed, because the stuff had run out. It worked really well for me, its 5 injections a day but in the grand scheme of things the benefits far outweigh the drawbacks.
I really hope you get it sorted soon.....🙂
xx

 

[newbs]

I have the same problem as you, 10 units I wake up high, 11 units I wake up hypo. I haven't tried splitting it myself, maybe the way to go.

How is it split though - 50/50 or thereabouts?

 

[Vix]

Thanks everyone -

Pumper-Sue I looked back, and the general concesus was pump (not an option at the moment) or splitting it... but then I have the same problem as what do I split it to eg. 50/50 as newbs says. All well and good if I can get hold of my DSN, who seems to have disappeared off the planet!

Xx

 

[Vix]

How do you lose a vile of blood???

I have a massive fear of having my blood taken, so to muster up the courage to go and have my hba1c done is pretty big for me. But, the motivation of wanting a family has meant that at the moment I am managing to drag myself to the docs every 6 weeks for it to be taken... only to find today when I rang for the results from Friday that my thyroid, vit d and full blood count results are there but my hba1c is nowhere to be seen! How on earth do you lose a vile of blood??? So annoyed right now 😡

It's not even a one off, the last time hubby had his blood taken they got some results and then threw the rest out before testing for the main results he needed!

Not looking forward to psyching myself up for Friday and another one now

xx

 

[Vix]

ooops meant to start that as a new thread and don't know how to delete it!! xx

 

[Copepod]

Rather than deleting your last 2 posts, Vix, I'll post the link to the new thread: http://www.diabetessupport.co.uk/boards/showthread.php?t=37372

Hope that's OK?

 

[Pumper_Sue]

Thanks everyone -

Pumper-Sue I looked back, and the general concesus was pump (not an option at the moment) or splitting it... but then I have the same problem as what do I split it to eg. 50/50 as newbs says. All well and good if I can get hold of my DSN, who seems to have disappeared off the planet!

Xx

Vix,
how about taking the bull by the horns and splitting 50/50 for starters, then every 3 days make adjustments as needed?
You need to be able to change your insulin yourself to suit your own needs, esp if you want to carry a child as you will have a lot of insulin changes and needs. Theres no way on earth any hcp is going to be at your beck and call every 5 mins when you need your insulin dose altered. Perhaps the missing dsn is missing for a reason, ie, hopeing you will make changes yourself.
Did you ever buy the books using insulin and think like a pancreas?
Go on be brave and start making your on decissions 🙂

 

[everydayupsanddowns]

Argh!!! As you probably know i've changed my basal from morning to evening (about 6 weeks ago) on the request of my consultant... and I've gone from having about 2 hypos a week to about 2 hypos a day when I changed! I have persisted though to prove my point (I know I'm too stubborn) and was told to lower my basal... so I came down to 16 from 18 and I was going to bed with BGs of 11-13 (was previously 18-20 before increasing bolus ratio) and waking up hypo still so lowered basal to 15 about a week ago and I'm now waking up at 11-13 It seems to go from one extreme to another with just 1 unit of insulin different so I don't quite know what to do... I test in the night and I'm not hypo when I test so can't work it out!!!

Getting Lantus to play nicely is a bit of a dark art. There are four very important (and very individual) things that will govern how to get it to best fit your needs...

1. The actual dose. 1u of Lantus too much or too little always made an impossibly big difference to me - I could easily add (or lose) 4-8u of rapid insulin if my Lantus was 1u too low or too high.
2. How long Lantus lasts for you. Might be 24 hours(ish) but there is absolutely no guarantee. It could be slightly less than 24h, or quite a bit more. Only patient experimentation (preferably by running several series of fasting basal tests) will give you a real picture of what Lantus is doing behind the scenes.
3. How 'peaky' Lantus is for you. It is advertised as being peakless, but in reality this only means 'not very peaky'. If it is having a boost of activity when your body actually needs less basal you will end up in trouble.
4. The timing of the dose(s). Evening works well for some. Morning was my best fit. It could be that you need one dose at eve meal time, lunchtime or mid-morning... Split dose works best for others and might offer more flexibility - though I could never quite get them to work well. Again you need to test and tweak and test again to get the 'best' (least worst) system in place - then review and adjust the dose(s) on an ongoing basis. YDMV 😉

So tempted to go back to morning basal, but can it really make that much difference? My hospital are still not giving me the support I need so am at a loose end... got an appointment next week so will see what happens, and what my hba1c is! Although it does seem a bit silly that to have the green light to start a family it has to be below 7.0 but that seems detrimental to my quality of life and how many hypos I'm having! Having said that who knows what my hba1c will be, just hope it's better than 7.6 not worse...

Ok, rant over!

xx

I guess the targets during pregancy are exceptionally tight with good reason - I think teams are aware that they increase the risk of hypos, but since these are generally sorted fairly quickly I think the feeling is is that's a price worth paying to increase the chances of a healthy pregnancy for mum and baby.

Have you run any basal tests yet? They aren't much fun, but there really is no better way of getting the basics of your basal nailed.

Since you've tried 16u and 15u and one meant hypo the other high it does seem that night time Lantus doesn't work well for you. Have you tried either of those doses with morning Lantus with a 24hr set of fasting basal tests done over a week or so?

Moving back to Lantus in the morning and running basal tests overnight and through each meal 'section' would be my next step in your shoes. 🙂

Good luck with it and keep us posted

 

[Cleo]

Getting Lantus to play nicely is a bit of a dark art. There are four very important (and very individual) things that will govern how to get it to best fit your needs...

1. The actual dose. 1u of Lantus too much or too little always made an impossibly big difference to me - I could easily add (or lose) 4-8u of rapid insulin if my Lantus was 1u too low or too high.
2. How long Lantus lasts for you. Might be 24 hours(ish) but there is absolutely no guarantee. It could be slightly less than 24h, or quite a bit more. Only patient experimentation (preferably by running several series of fasting basal tests) will give you a real picture of what Lantus is doing behind the scenes.
3. How 'peaky' Lantus is for you. It is advertised as being peakless, but in reality this only means 'not very peaky'. If it is having a boost of activity when your body actually needs less basal you will end up in trouble.
4. The timing of the dose(s). Evening works well for some. Morning was my best fit. It could be that you need one dose at eve meal time, lunchtime or mid-morning... Split dose works best for others and might offer more flexibility - though I could never quite get them to work well. Again you need to test and tweak and test again to get the 'best' (least worst) system in place - then review and adjust the dose(s) on an ongoing basis. YDMV 😉

Good luck with it and keep us posted

Thanks for this Everydayupsanddowns - very informative !

 

[everydayupsanddowns]

Thanks Cleo!

If you've not come across the concept of systematically testing basal (I hadn't before I found it on forums) this page might be very helpful:
http://www.diabetes-support.org.uk/info/?page_id=120

 

[Cleo]

Many thanks EDUAD - will def. have a read. 🙂