First time sick since diagnosed, basal insulin confusion

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StephanieMLW

StephanieMLW

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Relationship to Diabetes
Type 1
Apologies if this post is a repeat of questions previously asked - I've had a search through previous threads but I couldn't quite find the answer to my specific question 🙂

I caught a nasty cold last week, it's the first time I've been sick since diagnosed. At first my sugars were being very nicely behaved and I thought I'd gotten away with it, but after 24 hours I was getting overnight mountains and high alerts on my Libre.

I increased my Lantus dose from 4 to 5, and have been a bit more aggressive with my Novorapid (I'm on a 1:10 carb ratio; my diabetes nurse said if I was high two hours after eating when sick I was allowed to give a correction dose). This seemed to really work, but then I started to get a couple of low alarms overnight. These weren't proper hypos, just the 'you're at 4.3' alerts, which I dealt with by having a little snack in the night.

My question is - when do you know when to go back to your 'normal' insulin regime? I'm still feeling under the weather but nothing like as bad as I was. Because of that, I went back to my normal lantus dose of 4 units, and my sugars seem to be higher again. Do you normally wait until you're completely better before going back to your normal regime?

Thank you in advance
 
@StephanieMLW I normally only keep an increased basal for a day or two. I then just do corrections if necessary (you’d use your fast-acting insulin for that). I prefer to do that and have little corrections going in than have a basal that might be too high. It’s slightly different because I’m on a pump but I did the same when on injections. I was always loathe to increase the basal unless unavoidable. I tested lots and corrected as needed. I find sugars go back to normal quite quickly ie can change overnight, so be prepared and test/scan lots. You could also put your Low alarm higher to catch any drops. I have mine in the 5s.

Hope you’re better soon - so tedious being ill with diabetes.

P.S - ask whatever you want. It doesn’t matter if others have asked too 🙂
 
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I agree with @Inka - normally always taken the 'little but often' route rather than 'let's whack it ALL up' method. Seems to have worked so far, anyway!
 
Are you double checking the "near hypos" at night with a finger prick before treating them. If you are ill, then you may be more restless in your sleep and toss and turn more with the increased likelihood of lying on the sensor and causing compression lows, so always important to double check any low readings unless of course you clearly feel hypo.

With such a small dose of Lantus, you might be best to ask for a half unit pen. The difference between 4 and 5 units can be quite significant, but the important thing is to adjust it so that you are not at risk of hypos overnight and then fire fight daytime highs with your bolus insulin or possibly ask if you can split the Lantus dose or try Levemir, which is designed to be split dose. Then you can adjust your daytime and night time doses separately. Obviously, if this is just the illness then that is probably a bit drastic, but the cold virus could cause your immune system to kill off a few more beta cells and leave you with a longer term problem like this, as you are likely in the honeymoon period, so that is worth considering if you continue to have daytime highs when Lantus is adjusted for optimum overnight levels.
 
rebrascora said:
Are you double checking the "near hypos" at night with a finger prick before treating them. If you are ill, then you may be more restless in your sleep and toss and turn more with the increased likelihood of lying on the sensor and causing compression lows, so always important to double check any low readings unless of course you clearly feel hypo.

With such a small dose of Lantus, you might be best to ask for a half unit pen. The difference between 4 and 5 units can be quite significant, but the important thing is to adjust it so that you are not at risk of hypos overnight and then fire fight daytime highs with your bolus insulin or possibly ask if you can split the Lantus dose or try Levemir, which is designed to be split dose. Then you can adjust your daytime and night time doses separately. Obviously, if this is just the illness then that is probably a bit drastic, but the cold virus could cause your immune system to kill off a few more beta cells and leave you with a longer term problem like this, as you are likely in the honeymoon period, so that is worth considering if you continue to have daytime highs when Lantus is adjusted for optimum overnight levels.
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I had no idea compression lows were a think until reading this, so this is very useful! I have almost no hypo awareness unless I'm in the low 3s for a sustained period, so I don't often feel them unless for some reason they've gone untreated. Must admit that I'm not as good at checking my bloods when I've been woken in the middle of the night, so I've now put one of my spare testing kits next to my bedside lamp - no excuses!!
I also didn't think about half units for Lantus. I've recently got a half unit pen for my Novorapid and it has made a big difference, so I'll mention this to my DSN.

Thanks @Inka for the reassurance about the post - I sometimes feel like I'm asking a lot of questions all the time :D 'Tedious' is definitely the word I'd use for being sick with diabetes too - my husband has had the same virus, I'm trying to hold myself back from rolling my eyes every time he complains it's making him fed up - at least he doesn't have glucose and ketones to worry about!
 
Apparently there isn't an official half unit pen for Lantus BUT the Lantus cartridges fit into the Lilly Humapen Luxura HD pen which is half unit, so that is what you would need.
Definitely double check any overnight lows with finger pricks before treating. A bit like not rolling out of bed, I think you can learn not to lie on the Libre arm and sometimes just moving the placement slightly more round to the back helps if you are getting compression lows.
 
rebrascora said:
Apparently there isn't an official half unit pen for Lantus BUT the Lantus cartridges fit into the Lilly Humapen Luxura HD pen which is half unit, so that is what you would need.
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Not sure where you got this information from but it’s incorrect. It’s the same half unit pen for lantus as for apidra. The Sanofi juniorstar, available in red blue or silver.
 
It was the usual quick internet search. I had a feeling there was a "junior" Lantus pen, but it didn't come up when I looked.
Thanks for the correction.
 
When I google lantus half unit pen the first thing that comes up is an article from 9 years ago about the new Sanofi juniorstar half unit pen for lantus and apidra. It’s still the same pen now, hasn’t changed whatsoever. Ring the company and they just send you one.
 
StephanieMLW said:
I had no idea compression lows were a think until reading this, so this is very useful! I have almost no hypo awareness unless I'm in the low 3s for a sustained period, so I don't often feel them unless for some reason they've gone untreated.
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I learnt on my recent DAFNE course that - strictly speaking - hypo is actually 3.5 mmol/L, or below. Are your low 3s measured from finger pricking of actual BG or from Libre 2 reading interstitial fluids and lagging actual BG?

The first conundrum with this number of 3.5 is how accurate is the instrument doing the measuring?
Also, in American units, hypo should be treated at 70mg/dl, which was a threshold agreed at international symposiums a long time ago and included an element of rounding up; 70mg/dl (÷18) converts to 3.8889 mmol/L, ie 3.9, and then in turn rounded up to 4.0 mmol/L for European and UK use (hence 4 is the floor). So low 3's is potentially fine for hypo awareness, depending on the instrumentation accuracy and specifically your body's responses.
StephanieMLW said:
Must admit that I'm not as good at checking my bloods when I've been woken in the middle of the night, so I've now put one of my spare testing kits next to my bedside lamp - no excuses!!
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I don't always FP in the middle of the night. I pay much more attention to the CGM trend arrow than I do to the actual number. This is partly because my body and Libre are not good friends and, from experience, I gauge (guess!) what my response needs to be.

We're all different, with different views as well as body responses and I don't think it's essential to FP before treating in the middle of the night - not just because of sleepiness (or my laziness). If the low is a genuine and serious low, then I believe treat first is my best response - the time taken to sleepily fumble around and get a reliable actual blood test is time wasted. The trend, in conjunction with the reading tells me something.

I do have my Libre alert (alarm) set above 5. I want to know when I'm dropping and potentially heading for a hypo; then intercept that. I can count on one hand my real hypos during 2022; my HbA1c is good and my time in range (4-10) is above 80%; my time below 4 is negligible

I might eat one JB, which is sweet, instant and needs minimal chewing or a 6gm biscuit; then turn over and go back to sleep. If the alert is false and carbs aren't really needed the 5 or 6 gms of CHO are not going to be super-critical. If they turn out to be insufficient then the 2nd, later, alert does usually make me pay more attention.
 
StephanieMLW said:
I had no idea compression lows were a think until reading this, so this is very useful! I have almost no hypo awareness unless I'm in the low 3s for a sustained period, so I don't often feel them unless for some reason they've gone untreated. Must admit that I'm not as good at checking my bloods when I've been woken in the middle of the night, so I've now put one of my spare testing kits next to my bedside lamp - no excuses!!
I also didn't think about half units for Lantus. I've recently got a half unit pen for my Novorapid and it has made a big difference, so I'll mention this to my DSN.

Thanks @Inka for the reassurance about the post - I sometimes feel like I'm asking a lot of questions all the time :D 'Tedious' is definitely the word I'd use for being sick with diabetes too - my husband has had the same virus, I'm trying to hold myself back from rolling my eyes every time he complains it's making him fed up - at least he doesn't have glucose and ketones to worry about!
Click to expand...

This is a bit worrying @StephanieMLW You’re so newly diagnosed and you really don’t want to blunt or lose your hypo awareness. I suggest you try to avoid low sugars (whether they’re technically hypo or not) as much as possible. Obviously compression lows don’t count, but the rest of the time be strict about going too low and you should find your awareness improves.

I’ve had Type 1 30 fun (!) years and I now eat a few grams of carbs if I’m in the 4s. This has really sharpened up my awareness even though I thought it was ok before. I set my Libre Low alarm in the 5s - again this helps me avoid lows because I can ward them off (plus the Libre isn’t accurate if you’re dropping fast).
 
Inka said:
This is a bit worrying @StephanieMLW You’re so newly diagnosed and you really don’t want to blunt or lose your hypo awareness. I suggest you try to avoid low sugars (whether they’re technically hypo or not) as much as possible. Obviously compression lows don’t count, but the rest of the time be strict about going too low and you should find your awareness improves.

I’ve had Type 1 30 fun (!) years and I now eat a few grams of carbs if I’m in the 4s. This has really sharpened up my awareness even though I thought it was ok before. I set my Libre Low alarm in the 5s - again this helps me avoid lows because I can ward them off (plus the Libre isn’t accurate if you’re dropping fast).
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Thanks @Inka - that's really useful. My DSN also advised me that if I'm in the 4s and my arrow is trending down, to have a small amount of carbs to avoid dropping too far. I've been experimenting with what to eat in that scenario - half a digestive seems to do it!
 
Sorry to hear you’ve had the lurgy @StephanieMLW

I find my BG response to colds defies convention or expectation!

Sometimes I get raging highs, other time, no effect at all. Sometimes the BG impact comes before the cold symptoms, other times it waits until the cough/cold really gets going.

And it doesn’t seem to be predictable based on how lousy I’m feeling or how bad the cold is.

It’s all a bit flexible and random!

So I just try to roll with it, and cut myself some slack 🙂

And if I’ve needed to raise my doses I keep a close eye out for dose ‘overshoots’ to wind things back down again 🙂
 
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