BS variations

[Fagor]

I've had three separate trends over last few weeks, anyone any ideas?

First was 13 consecutive days of almost all BSs' between 4 and 10, no big spikes or drops. Time-in-target over 7 days was 96%. Very happy at these levels. 🙂 🙂

Second had similar BSs' with more a bit higher (max just over 11) and some lower.. Had several drops of about 4 between 1 and 2 hours after meals, even if just listening to radio, so no extra activity. Reduced Levemir to 7u am and pm over several days (from 11 & 11) and trimmed ratios. Reasonably happy at these levels.🙂

Did I reduce too much and upset my system and cause the third trend.

Third was BSs trending upwards. There were a few spikes between 01:00 and 02:00 of over 13 from about 8 before bed. Recently had 9 consecutive pre-meal BSs' between 10.5 and 15.5, despite reducing daily carbs from around 60g to 20g. Half slice of bread seemed to cause a BS spike of 4. Increased Levemir to 10u am and pm, and upped ratios a notch. Not at all happy - Time-in-target over 7 days was 58%. Also co-ordination and concentration seem to drop while high – broke my favourite penguin mug.

All change last night. Several warnings of low BS, and this morning more like second phase with drop from 9 to 5 between 09:00 & 10:00.

Is there a sweet spot combination of Levemir & Novarapid which I haven't yet found.
Will leave things for a few days and maybe adjust ratios again.

 

[trophywench]

There are sweet spots whichever combination of insulins you happen to use on MDI - however it is still using a sledgehammer to crack a nut and won't last ever so long anyway - and you have all your life ahead to get used to constantly having to adjust to whatever your body happens to be doing at that time. Once I had been adjusting every couple of months for a couple of years I got fed up with it so asked to try a pump instead.

You still have to bolus test of course - but as you tweak by the hour on a pump (once you first get it set up correctly for your needs) they are much finer dose adjustments.

But anyway - only change ONE thing at a time so with Levemir that's either the am or pm dose and see what that does to your BG over the next 24 hrs - with a Libre that's even easier to do than it was with a BG meter. I always went higher between dinner at night and bedtime and sorted that by moving my bedtime dose of Lev closer to between dinner and bedtime. Hence, for me, from roughly 11-11.30pm to nearer 9.30-10pm. I needed 14 or 15u in a morning around 7am and another 4 or 5u in the evening - very generally 14/4 during the summer when it was warmer, moved more, ate less carby stuff and winter 15/5 when colder, moved less, ate more carbs.

Within that, during very hot summer holidays in eg Greece, I only needed to bolus with dinner even though eating more carbs during the day but I did move a lot more.

You can usually tell within 12ish hours whether what you did is paying dividends - if it's a complete disaster then you can revert back again pdq - and then wise to wait a day or two before fiddling again, but really if it looks successful but needs more adjustment - or need to change the other dose, you can. Levemir does not take 3 days to show its true colours, unlike Lantus. Never EVER change your basal insulin dose(s) AND your bolus ratios at the same time.

 

[rebrascora]

You made some quite radical changes to your Levemir going from 11 to 7 both morning and night. That is a daily decrease from 22 to 14 if I am understanding you correctly which is about a 30% drop. Most DSNs recommend just a 10% change and then wait for a few days and see how you go, so that would be more like reducing your total daily dose by 2 units, but it may be that your body doesn't need an equal split of Levemir as @trophywench and myself. Most people find they need much less basal insulin through the night than the day, so you might have been better leaving the morning dose as it was and just reducing the nighttime dose by 1 or 2 units and seeing how that worked put. Just as another example to compare with trophywench above, my morning Levemir dose is pretty settled at the moment at 22 units and that keeps me reasonably level during the day but I need anywhere from 0 to 7 units on a night depending upon how much exercise I did during the day and perhaps the previous day, how hot it was etc. My evening dose has become a bit of an educated guess.... sometimes not so educated, but always less than my morning dose. That is just me though. There will no doubt be some people who need more through the night. If you have Libre sensors it makes it so much easier to see what is going on and adjust what needs adjusting. Do be aware though that lying on your Libre sensor arm can cause a compression low and suggest that you have hypoed through the night when you may not have done, so unless you woke up and did a finger prick to check, don't take Libre graphs at face value. If it shows night time lows where you haven't woken up and checked then set an alarm for through the night and do a finger prick check to be sure of what is happening before adjusting your basal insulin dose.... which may turn out not to need adjusting.

As Jenny says, only adjust one thing at a time and starting with your basal dose is probably best because if your basal isn't right then nothing makes sense, but it can take quite a bit of tweaking on a regular basis. I find I can go weeks or months and the dose is spot on and then for some reason I am having to adjust it every few days and sometimes every day and then I will hit a nice stable patch again.... seasons/day length/temperature, activity levels, hormones, illness, aches and pains etc can all have an impact on your basal needs and a lot more besides. Learning how to balance your basal dose with what you need is a bit of a dark art but you will get better with practice. I would urge you to make smaller changes though and whilst Levemir will deliver a result to that change within that 24hours, it may be best for you to give it a few days before adjusting again until you get more experienced and no more than 10% in total daily dose at a time.

 

[Fagor]

Whoops, @trophywench & @rebrascora, looks like I should have provided a bit more detail. But thanks for your refresher replies and suggestions, it's easy to get complacent over time.

I didn't do any radical changes, my latest changes in BI were over a period of about 18 days, I follow the DAFNE guidelines. I almost increased my BI on consecutive days, but resisted - and probably just as well. I am now fairly stable again so now in tweaking mode.
I used to have differing am & pm Levemir units, my DSN suggested reducing the difference, and it seemed to work for me.
Change my BI because I have periods of high values for no apparent reason.
The only reason I can think for this one is I had a hospital check-up scan so had to stop eating before it, and had a problem with my accommodation, so was a bit stressed and BGs high. This might have been my system getting back to normal.
I have my Libre low set to 4.5 and usually wait and re-check as it seems to dip then come back up again, then have a snackette as required. With Libre 2, I now have fewer lows (followed by rebound spikes), as a small adjustment earlier works for me.

J