Calculating Long acting Insulin

[trophywench]

This was specifically discussed with a whole gang of T1s on the CARBS 4 1 course (local equivalent of BERTIE = d a f n e) that I attended in the noughties - ie that strenuous exercise affects the normal human body for up to 48hrs thereafter and for that purpose, one has to assume to begin with that the rest of our body still does everything 'normally' other than those ruddy Beta cells being deficient. Whether in fact they actually do or don't of course, remains thereafter to be discovered by each individual, er, individually.

Like practically every other ruddy thing about the treatment of T1 - some things are absolute facts whoever we are - and other things are only general guidelines.

 

[everydayupsanddowns]

Whilst Rapid Acting insulin is calculated to carbs intake.
What are the considerations to calculate long acting insulin.
At present I use Nova Rapid, and long acting insulin is Levimir

There’s such a huge variability from person to person, that I’m not sure how helpful these general rules of thumb are in practice, but I did grab this slide from a presentation at a diabetes conference some years ago.



These would only ever be a starting point, of course, and as others have said, starting cautiously is often wise (to reduce the risk of hypos).

Systematically checking your basal is probably a more straightforward and personalised way to evaluate whether your basal insulin is currently doing what it is meant to be. There are instructions on a framework for checking basal performance here:

How To Successfully Test Your Basal Rate

Are you looking for basal rate information and testing instructions? Perfect! You're in the right place!

www.mysugr.com

 

[Proud to be erratic]

Whilst Rapid Acting insulin is calculated to carbs intake.
What are the considerations to calculate long acting insulin.
At present I use Nova Rapid, and long acting insulin is Levimir

Hello @Keithjdonnelly,
It's becoming clear from the responses so far that the main consideration is not so much basal that you constantly go hypo. But that glib answer is probably not a lot of help to you.

Since you are currently using Levermir and this would more normally be a 2 x daily basal, which do not have to be equal between am & pm. But are you taking a single Levermir dose or twice daily?

From whatever your existing doses are the best thing for you to now do is carry out some basal testing. The logic is that if your basal is not about right then adjusting your Bolus or Rapid insulin dosing is made much more tricky because the bolus can be chasing a basal that is itself "adrift".

These links should help you in getting you started on that:

https://www.diabetes-support.org.uk/info/?page_id=120 and

How To Successfully Test Your Basal Rate

Are you looking for basal rate information and testing instructions? Perfect! You're in the right place!

www.mysugr.com

But I see that on 1 Jan this year you asked about Blood Monitors and you got several replies explaining that all T1s are now entitled to Continuous Glucose Monitors (CGM) and @SB2015 replied:

​

Welcome to the forum @Keithjdonnelly ​

The sensors should be standard provision for anyone with T1 In England.​

Your GP should be able to prescribe them but some GPs have needed a push from consultants in the past. This should no longer be necessary. If you haven’t got a sensor you should definietely be provided with a finger prick lancet, monitor and test strips. ​

If you are happy to do so, let us know how you manage your T1. ​

What insulins are you using? ​

Do you have appointments at the hospital or just your GP?​

If you have any other questions just ask. Nothing is considered silly on here and there is loads of experience to tap into.​

​

I wonder if you need better support with your T1 and indeed whether you are in reasonably close liaison with a Hospital based Diabetes Team, including a Consultant and a Hospital based Diabetes Specialist Nurse (DSN). Your questions are very valid, members of this forum can help with information and suggestions - but to get the best of forum member's help it would be useful to know just a little bit more about where you are with your D management. So one extra question as well as those asked above: how long have you been T1?

Look forward to hearing from you.

 

[Purls of Wisdom]

Returning to forum after a short absence, I am facing the extact issues with my ratios and calculations.

A couple of weeks prior to Christmas period, I had variable hypers. My time in range went <25%. I upped my basal doses and tightened things a bit. Luck be hold, by end of the week I was nearing 60% time in range and average glucose fell to under 8.0mmol/L for once. Chuffed with myself, I was willing to do anything to stay where i was. I was also taking a few top up units of fiasp late at night cos reading were up. The thought of possible stacking played heavily on my mind.

Come 2nd week of January, went back to work and this is where things went pear shaped. I started waking up to hypos, genuine and false readings alike. I knew it couldn't have been the extra Fiasp cos that would ve completely worn off by 6:00am. I started onto reducing both basal and bolus, but the hypos are still persistent. Over 5% time in range in 7 days.

Fiasp I know is quick acting and I like the idea of no waiting time before eating. I also know that it is contributing in my hypos, which usually happen twice or thrice daily.

The real problem is by the time I get my head around during work days, the weekend arrives and need i say that I am not as active as the weekdays? Back to the drawing board again ...

Before I sign off, I am taking 13u of Levemir in the morning and 13.5u before bed time. Reason being the readings are usually on the up. 5u, 6u and 8+u of Fiasp thru out the day.

Does anyone think it is too much? I do not have the guts to increase the no of units but I feel fairly hungry after most of my meals. I am aware that in order to eat more, I need to inject more Fiasp.

For the record, I weigh 49.5kg now, same as I weighed in 1986!

All the suggestions are welcome. Thanks.

 

[Satan’s little helper]

There’s such a huge variability from person to person, that I’m not sure how helpful these general rules of thumb are in practice, but I did grab this slide from a presentation at a diabetes conference some years ago.

View attachment 28875

These would only ever be a starting point, of course, and as others have said, starting cautiously is often wise (to reduce the risk of hypos).

Systematically checking your basal is probably a more straightforward and personalised way to evaluate whether your basal insulin is currently doing what it is meant to be. There are instructions on a framework for checking basal performance here:

How To Successfully Test Your Basal Rate

Are you looking for basal rate information and testing instructions? Perfect! You're in the right place!

www.mysugr.com

Thanks for posting this. The slide calculation for me would be too much basal, going by the calculation. (If I was to follow it.)
Thankfully, basal testing has never been easier with the advent of sensors & CGMs.

 

[everydayupsanddowns]

Returning to forum after a short absence, I am facing the extact issues with my ratios and calculations.

A couple of weeks prior to Christmas period, I had variable hypers. My time in range went <25%. I upped my basal doses and tightened things a bit. Luck be hold, by end of the week I was nearing 60% time in range and average glucose fell to under 8.0mmol/L for once. Chuffed with myself, I was willing to do anything to stay where i was. I was also taking a few top up units of fiasp late at night cos reading were up. The thought of possible stacking played heavily on my mind.

Come 2nd week of January, went back to work and this is where things went pear shaped. I started waking up to hypos, genuine and false readings alike. I knew it couldn't have been the extra Fiasp cos that would ve completely worn off by 6:00am. I started onto reducing both basal and bolus, but the hypos are still persistent. Over 5% time in range in 7 days.

Great to hear you have had a period of some stability @Purls of Wisdom - I know you‘ve had a tricky time of things since diagnosis, with not much support from your clinic, so you’ve definitely earned it and your determination has paid off!

Sorry it’s gone a bit pear shaped since

Seems to be the nature of things with diabetes, when routine changes. So frustrating!

I wouldn’t worry about increasing meal doses to have larger meals personally. As the old forum saying goes - you need what you need.

50kg (ish) seems quite slight to me. Have you checked your BMI to see if you are in a reasonable weight range for your height?

Hope you are able to find basal doses that settle your meal ratios back into working again. Personally, I tend to find that my basal fluctuates far more than my meal ratios through the year. Getting basal back on track seems to pull things back into line again.

Hope you are able to ditch those overnight hypos soon - they are exhausting!