Confused this morning.

[gillrogers]

So dropped my basal this week as getting more active with work. Dropped it again this morning as was expecting to do even more. That didn't happen so I've been just pottering lightly. But I've found my blood sugars have only risen by 1mmol and I've already eaten the equivalent of an insulin unit onto of my breakfast and I've hardly done anything. Now just eaten the equivalent of another insulin unit so I can get busy. You just can't take your finger off the ball. I've double checked with a stick test incase my sensor was stuck or on its way out but its agreeing.

 

[Proud to be erratic]

I know the origins of my diabetes are very different, but this is regularly my experience. I don't adjust my Tresiba basal so much, using my bolus to regulate myself. But the principle is the same: sometimes the insulin overwhelms, leaving me feeding it just to allow me to get active!

I find it interesting, as well as frustrating, since I know I have no pancreas - so this behaviour arises from some other aspect of my metabolism. Somebody (sorry, can't remember who) likened their pancreas to a 3yr old throwing a tantrum, sulking for a while then suddenly back to normal. I meant to reply to that comment - it so naturally described my status periodically, but it wasn't the pancreas misbehaving in my case. Unless I have phantom pancreatic responses!!

 

[gillrogers]

It's so annoying isn't it. It's affecting my job. I e Benn told to to change my ratios but I'm finding my evening one fluctuates, because I need the higher basal in the morning and early afternoon but around dinner I don't always need it. Last night was an example hence me dropping basal today as I knew I would be busy. And I'll knock of half a unit at lunch time today and dinner. Perhaps I need to drop my basal again

 

[helli]

Personally, I find I need to drop my basal dose after activity and the effect can last up to 48 hours.
So, @gillrogers if you were more active during the week, this will affect your blood sugars today.

 

[Proud to be erratic]

I know that people on Levermir (a flexible 2x daily basal) are adamant that its best for them. I moved from Levermir to Tresiba (a significantly less flexible 1x daily basal), partly to reduce my jabs by one, but also my BG was simply out of control and I felt I was chasing 2 moving targets - basal variation and bolus ratios for food.

Since changing, my basal quantity is a fair bit less; total of 10 units daily from total 22 (2x daily). Now, after small adjustments to arrive at that 10 units from watching night time behaviour, I basically just stick with that - but I'm considering a half unit reduction as the warmer weather takes hold. I'm aware my basal dose is a compromise to suit night time and probably imperfect by daytime. But it is very forgiving. Tresiba lasts typically well over 24 hrs, perhaps up to 40 hrs, so time of taking basal each da can vary quite a lot, although each daily dose is effectively stacking on yesterday's dose. But changes take 3 days to have an effect, thus need preferably 5-7 days between successive changes.

So all control lies with my bolus dosing. I find this simpler. I have clear ratios for insulin to carbs, different at different mealtimes - but these are not rigidly fixed, I adjust from time to time if its apparent they aren't so good. And different pre- bolus timings; 45 mins for breakfast to 10 mins in the evening. But activity means the theoretical dose must be significantly altered. I need to assess before breakfast what my activity level is going to be and apply a correction factor; every day is different. Perhaps reduce to 40% of food requirement if going to be very active most of the day, 50-60% if gently active all day and maybe only reduce to 70% if noticeably going to be less active (I'm rarely totally inactive); Hospital and "sick" days apart. The beauty of this, for me, is if my activity assessment doesn't match reality I can correct either by a snack if low or by a lunchtime bolus for food plus correction if I'm a bit high. Whatever my BG state I'm only juggling with one of my insulins.

 

[gillrogers]

I'm beginning to think that this Lyumjev is now to fast for me. Thinking about it I started on it in December after about 6 weeks of high spikes and having to prebolus 30 minutes which was getting dangerous for me. Now it's warmer and I'm busier and more active I wonder if it's just too fast now. I'm not prebolusing and Ive shave off a unit at each meal, dropped day and evening basals and I'm still dropping fast after meals today