Disastrous basal tests, any suggestions?

[Pigeon]

Did some basal testing recently (thanks TrophyWench for the prompt!) for the first time ever. the results were:

27/6/16
7:00: 8.0 No breakfast, 9.5u levemir
9:30: 14.1
11:30: 14.7

22/6/16:
13:00: 7.0 No lunch
15:10: 7.5
17:00:6.3

26/07/16:
17:00: 15.6 (Had misjudged a flapjack at lunch- did not take any Novorapid to correct for this)
18:10: 14.4. "Courgetti" and pesto- 0 carbs. 3.5u levemir
21:40:10.7
23:00:9.1
03:00: 4.6 (Had 10g carbs at this point to avoid a hypo)
07:00: 9.1

So the daytime test had good results but the morning and nighttime ones were fairly disastrous!

I'm thinking to try splitting the levemir more equally and trying that for a while. Do you think this is the best thing to try? I've split my basal approximately 9u am and 3.5u pm for a few years now, which was the result of having night time hypos- I kept reducing my evening levemir and found I had to then increase the morning dose correspondingly- but perhaps it doesn't work the way I thought it did. Certainly dropping a reading of 11mmol/l between 17:00 and 3:00 concerns me- but I wonder if I dropped the night time levemir any more would that make the morning rise worse, hence I was thinking to split the doses more equally. Any suggestions would be appreciated!

Have emailed my DSN and dietician who I saw recently for advice, but they were quite textbook oriented so I thought I see what pearls of wisdom the lovely people on here have too!

Thanks in adance!

 

[AndBreathe]

Did some basal testing recently (thanks TrophyWench for the prompt!) for the first time ever. the results were:

27/6/16
7:00: 8.0 No breakfast, 9.5u levemir
9:30: 14.1
11:30: 14.7

22/6/16:
13:00: 7.0 No lunch
15:10: 7.5
17:00:6.3

26/07/16:
17:00: 15.6 (Had misjudged a flapjack at lunch- did not take any Novorapid to correct for this)
18:10: 14.4. "Courgetti" and pesto- 0 carbs. 3.5u levemir
21:40:10.7
23:00:9.1
03:00: 4.6 (Had 10g carbs at this point to avoid a hypo)
07:00: 9.1

So the daytime test had good results but the morning and nighttime ones were fairly disastrous!

I'm thinking to try splitting the levemir more equally and trying that for a while. Do you think this is the best thing to try? I've split my basal approximately 9u am and 3.5u pm for a few years now, which was the result of having night time hypos- I kept reducing my evening levemir and found I had to then increase the morning dose correspondingly- but perhaps it doesn't work the way I thought it did. Certainly dropping a reading of 11mmol/l between 17:00 and 3:00 concerns me- but I wonder if I dropped the night time levemir any more would that make the morning rise worse, hence I was thinking to split the doses more equally. Any suggestions would be appreciated!

Have emailed my DSN and dietician who I saw recently for advice, but they were quite textbook oriented so I thought I see what pearls of wisdom the lovely people on here have too!

Thanks in adance!

Just to clarify, when you mark the test "No breakfast", and "No lunch", and I correct interpreting that as your reading before breakfast, and lunch, respectively?

Yes, I am Miss Picky-old-baggage. I live in Pickyland. 🙂

 

[Pigeon]

It was the reading at the time I would normally have breakfast or lunch. But I didn't eat anything at that time on those days.

 

[trophywench]

You didn't need 3.5u of Levemir at night, did you? No you did not because not only did it wipe out the Flapjack - it carried on reducing your BG till you were hypo. The FBG the following morning was only that high cos of your body's shenanigans in the night and because of that, it negates the lot, and actually - you should ignore everything after the flapjack. If you eat carbs or go hypo - the whole 6 hour test it falls in, is scrap and everything after it, for the next 24 hours at least if not 48 hours. Sorry!

So what we have now is only half the day to look at - when you got up to when you ate the flapjack - and you'll have to repeat the next two time blocks, on different days, to get the rest of the 24 hours.

PITA this diabetes, innit?

 

[Radders]

You didn't need 3.5u of Levemir at night, did you? No you did not because not only did it wipe out the Flapjack - it carried on reducing your BG till you were hypo. The FBG the following morning was only that high cos of your body's shenanigans in the night and because of that, it negates the lot, and actually - you should ignore everything after the flapjack. If you eat carbs or go hypo - the whole 6 hour test it falls in, is scrap and everything after it, for the next 24 hours at least if not 48 hours. Sorry!

So what we have now is only half the day to look at - when you got up to when you ate the flapjack - and you'll have to repeat the next two time blocks, on different days, to get the rest of the 24 hours.

PITA this diabetes, innit?

I thought the flapjack was at lunchtime, so why does that negate the rest of that day's test? Is it because the starting level was too high? I know that insulin resistance is higher when levels are that high, and to be honest I wouldn't start a basal test if I was that high, but despite that, and eating a low carb meal, Pigeon's blood sugar still dropped sharply between 5 pm and 3 am so doesn't that prove at the very least that the morning Levermir is too high?

 

[Annette]

Pigeon's blood sugar still dropped sharply between 5 pm and 3 am so doesn't that prove at the very least that the morning Levermir is too high?

No, it dropped between 18:10 - the point at which the Levemir was taken, and 3am, when hypo prevention was undertaken. This indicates the evening Levemir was too high.

 

[Radders]

No, it dropped between 18:10 - the point at which the Levemir was taken, and 3am, when hypo prevention was undertaken. This indicates the evening Levemir was too high.

I was looking at profiles of Levermir which show its peak at 10 hours and thinking that the evening dose wouldn't have started working that quickly. I agree that the evening one might be too high as well though.

 

[Radders]

Another thought about your morning rise, Pigeon: I find that not eating breakfast can sometimes cause my liver to dump glucose in a way which does not happen when I eat, therefore if I adapted my basal to cover the rise, which would not happen if I ate, then I would be on too much basal. This seems to depend on how much carb I ate the previous day.
If I saw readings like yours in the morning I would be reluctant to increase my morning dose and I would want to repeat the test to see if it happened again.

 

[trophywench]

I typed this last night and have only just discovered that I didn't post it!!

Maybe - but he needs to take it as soon as he wakes up, not wait until breakfast time if it's soaring by 6.0 between breakfast time and lunchtime, anyway.

It's useful to know that when a pumper does a basal test, and wants to correct a high at say 7am - notwithstanding what your BG is at 5am - that is exactly when you apply the increase - 2 hours before it's actually wanted to affect your BG. However - that's always with 'fast acting' insulin cos that's all you use. One can only assume that the increase started sometime before 8am in Pigeon's case, and then continued to pile on the BG - hence unless he has the jab before he wakes up - he'll still get an increase, cos Levemir or Lantus or Insulatard - any basal insulin used with MDI - won't act as fast as any bolus insulin.

However - because we don't know what really happens in the afternoon/evening or during the night - we ought to find that out first really before messing with anything! However - of course - opinions are only opinions, based on experience personally - so we can differ!

 

[Pigeon]

Thanks for all the replies, guys. The flap jack was indeed at lunch, so my 17:10 reading was over 4 hours after taking my last Novorapid. I know it's not ideal to start a basal test at this level but the previous 2 times I had planned to do it I had 4pm hypos and I felt like I was going to put it off for ever. Anyway, I think it showed there was a problem, to drop by 11 mmol/l over 10 hours!

Radders, I was looking at the profile of Levemir too, which is why I was thinking the nighttime drop might be caused bye the morning levemir being so much more than the evening. The DSN has however said it will be the evening dose that is too high, so to try 3u and see how that goes.

I tend to try and fend for myself between annual appointments, but I feel lately like MDI just will not work (at least not the way I'm doing things now), so I'm planning to pursue this and keep going back to them, with the hope that eventually they might consider recommending a pump on the basis of night time hypos.

 

[Radders]

Thanks for all the replies, guys. The flap jack was indeed at lunch, so my 17:10 reading was over 4 hours after taking my last Novorapid. I know it's not ideal to start a basal test at this level but the previous 2 times I had planned to do it I had 4pm hypos and I felt like I was going to put it off for ever. Anyway, I think it showed there was a problem, to drop by 11 mmol/l over 10 hours!

Radders, I was looking at the profile of Levemir too, which is why I was thinking the nighttime drop might be caused bye the morning levemir being so much more than the evening. The DSN has however said it will be the evening dose that is too high, so to try 3u and see how that goes.

I tend to try and fend for myself between annual appointments, but I feel lately like MDI just will not work (at least not the way I'm doing things now), so I'm planning to pursue this and keep going back to them, with the hope that eventually they might consider recommending a pump on the basis of night time hypos.

Good strategy - I hope you get one!

 

[trophywench]

Meanwhile back at the ranch, have a look at the following Levemir chart. You need your weight in kgs and divid your TDD by that to find your dose per kg. I just used my morning dose since the eving one was negligible - you aren't on much either - to work out which line of 'pins' to follow to see when it's likely to peak, and when it is likely to tail off. I used to up my screen resolution to 400% in order to follow it sufficiently.

http://www.diabetes-support.org.uk/info/?page_id=428

Enjoy! LOL

 

[Pigeon]

Ooh, not seen that graph before! So I take it you only use your levemir dose, ie 12.5u for me. Then weight is 57kg, so 0.2u/kg. So the peak is at about 5 hours, if I'm reading it right? Thanks for the info, very interesting!

 

[Radders]

Ooh, not seen that graph before! So I take it you only use your levemir dose, ie 12.5u for me. Then weight is 57kg, so 0.2u/kg. So the peak is at about 5 hours, if I'm reading it right? Thanks for the info, very interesting!

Total daily dose is all insulin isn't it?