Did I miss my basal?

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Mumpie_olgran

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Relationship to Diabetes
Type 1
What a dummy.
I honestly can't remember if I did my usual 20(ish)u of basal this morning. I'm normally excellent at doing them and can check because I log them all on my dexcom app. This morning nothing logged and I just can't picture jabbing myself. Maybe that's because it's now becoming second nature to me and it's not sufficiently noteworthy. Maybe it's because I am just a dummy and never jabbed...

I've taken a fair amount of exercise today and things were all normal through to lunch (maybe because of the exercise or maybe the Glargine actually lasts a bit longer than the assumed 24hr). Had an admittedly quite high carb lunch for me (mac n cheese) and now seem to be on the march upwards on BS. Have now taken two correction doses which is quite a lot fro me

Question is, do I just wait it out, see what happens overnight and survive off correction doses before jabbing the normal Glargine levels again in the morning? Or option 2 is stick in some basal now and that get back onto my normal routine tomorrow?

Suspect the right route is option 1 because I don't know for certain if I missed the basal and generally better to be too low insulin on board than too high but please can you wise ones impart some knowledge for me again?
 
Just a thought but do you have a record of, or can remember when you started the pen? If so then you should be able to calculate fairly accurately how much should be left if you took the dose.
 
I'm down to the last 40 or so units so I don't think will be precise enough. Thanks for the suggestion though
 
@Mumpie_olgran I wouldn’t risk injecting any basal today. You’ll have to monitor closely and correct if necessary. Then just inject your basal as normal tomorrow morning.
 
I also, albeit from a far less experienced base, would not try to catch up and would just look to extra bolus corrections. It's all made a bit easier thanks to the improved visibility from CGM.

I've certainly made this mistake and now I have reusable pens from Novonordisk for their insulins those pens give me the possibility of checking against that "did I or didn't I" moment.
 
Another vote for doing corrections when necessary with bolus insulin rather than adding any basal insulin now as whatever you inject would overlap with tomorrow's dose and potentially risk hypos.

It is certainly easy to do and I would be lost without my memory pens. Some people allocate needles for the day so that they can tell if they have a needle left, if they don't have reusable pens with the memory feature.
 
Timesulin pens caps (available from the duk shop) might be another option if you are on disposable pens or like peeps have mentioned, a new reusable pen with memory function (convo to be had with your team about that one).

I think its fair to say we have all been threre n done that. I tend to just use fast acting too to keep levels around something reasonable.
 
Got it thanks all. At the moment I'm bumbling along in the 8s on Dexcomm albeit with a fair amount of Novorapid in me so I'll assume I continue bumbling away now

Appreciate the thoughts and time taken all
 
Just to rpeort back on this one. I did go a little off piste in the end. As the evening wore on I was needing big correction doses and frequently (4u per 2 hrs which is a lot for me). So I concluded that I must have actually forgotten the morning basal.
So the decision was to take this "opportunity" to move to split basal and took 10u before bed last night and 10u this monring (which I definitely took ). Think I may have read a thread where @SimonP commented along these lines and it resonated for me as a potential regime
Given I've got the alarms on the Dexcomm I didn't feel too exposed to an overnight hypo and helpfully I came through this morning with a pretty flat line (mildly ascending) so will stick with this experiment for a while
The science project never ends
 
Glad that it worked out for you and that it has prompted you to try a split dose. Not sure how that works Glargine. I used a split Levemir which made life more flexible. Let us know how you get on.
 
SB2015 said:
Glad that it worked out for you and that it has prompted you to try a split dose. Not sure how that works Glargine. I used a split Levemir which made life more flexible. Let us know how you get on.
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Thank you, maybe puts me on the path for a pump in due course. I'm certain I'll be pumping at some stage just not sure how many hoops I need to jump through first and how much more used to MDI I need to be first
 
Mumpie_olgran said:
So the decision was to take this "opportunity" to move to split basal and took 10u before bed last night and 10u this monring (which I definitely took ).
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Ack! That’s so easy to do @Mumpie_olgran - so well done for seizing the opportunity for a split-basal experiment!

Be interested to see bow you get on with splitting Lantus. I could never quite get it to work for me. I found Lantus was a bit laggy and the splits I tried never quite clicked.

Levemir has a shorter profile and tends to be more responsive - making it easier to have less basal active either overnight or during the day as you need, and and also to reduce your morning dose if you know you have a one-off day packed with activity/exercise.

I was pondering a switch to Levemir when I was approved for pump therapy. 🙂
 
Levemir worked well as a split basal With the shorter profile. We were required to a split dose Levemir before we switched to a pump. It then helped with setting our initial hourly basal rates for the pump.
 
I know that one should give all things diabetes a few days to work through but I've abandoned my split Glargine experiment. It was just too hard for this bear of very little brain.

I did have a couple of statistically irrelevant observations

1) 2 lots of 10 units basal worked out as much less than 1x 20u in the morning. On the split regime I was bolusing multiple times the quantities that I was when single basal dose. In numbers around 12-15 was normal and when split dosing I was up around 30

2) I'm not clever enough to work out which of the split doses I would need to amend or by how much. I think that if I were to switch it would be to increase the morning one. But by how much? Frankly I couldn't be bothered to experiment for long enough to find out!

On the plus side I have worked out a better system for foolproofing whether I've taken the basal. I now leave that pen and the needle on a different part of the bedside table alongside my thyroxine pill. Simples.
 
Sounds like you’ve made some good discoveries and acted on them @Mumpie_olgran 🙂

And developed in ingenious solution to boot!
 
Lantus (abasaglar) seems to work when split (and reduced morning dose) for me when exercising, though I've never tried an alternative
Mumpie_olgran said:
2) I'm not clever enough to work out which of the split doses I would need to amend or by how much. I think that if I were to switch it would be to increase the morning one. But by how much? Frankly I couldn't be bothered to experiment for long enough to find out!
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There are response curves for insulins, so it is theoretically possible to create a response curve across any 24h period for a given insulin/dose/timing plan. Quite why such a thing isn't available with a nice GUI for people to use I don't know, instead one must resort to MATLAB and the like.

Certainly changing dose quantities for long acting insulins is confusing as the effects often occur somewhere other than where you'd expected to see them.

Mumpie_olgran said:
On the plus side I have worked out a better system for foolproofing whether I've taken the basal. I now leave that pen and the needle on a different part of the bedside table alongside my thyroxine pill. Simples.
Click to expand...
As well as logging it on my phone, I have a piece of paper with a grid for the week that lives in the pen case. For trips away I keep a pen/pencil in the case too, to ensure that there is nothing that stops me from ticking the box once I've taken my insulin before I zip the case back up. This is now an habitual "atomic" process (i.e. can't be split, not sure of the etymology of that one these days mind you), which seems to work for me. I find that with logging on the phone I can get distracted by notifications when I switch it on, so sometimes forget to actually log the insulin.

fwiw I also have an alarm and a reminder that pops up on my phone - it's all well and good knowing you've done it, but I also sometimes get distracted (by a lie-in, or being busy in the evening) and forget it needs to be done in the first place!
 
SimonP said:
There are response curves for insulins, so it is theoretically possible to create a response curve across any 24h period for a given
Click to expand...
Yes that makes sense to me, just that I don't feel equipped to work out which one I would drop if for example I did a basal test
Not sure if that puts in the "too hard" bucket or the "not yet" bucket 🙂
 
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