Well I gave it a go, doubled the correction doses and even took the insulin up to 50 mins before eating, waste of time, high,low,high,low....spoke to my DN today and she's going to put novorapid back on my prescription, oh well back to trial and error.
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Goodbye Lyumjev
- Thread starter Charl
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Any suggestions on what I should try first, at the moment I'm on 1 unit for 10, should I be thinking about tweaking it and by how much to start with, think I was taking it about 20mins before food, should I be trying longer will that make a lot of difference, any advice appreciated.
Lucyr
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Don’t change multiple things at once or you won’t know what is doing what
Inka
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I’d keep it simple to start with. Go with 1:10g and choose a time in advance and stick to it for a few days to get some data. You’ll then see if things need tweaking. It’s very common to need different meal ratios for different meals (ie breakfast, lunch, etc) and different advance bolus times. I’d also keep your meals simple and easy to carb count to begin with.
Don’t expect everything to be right. Expect that you’ll need to make tweaks.
Is it to early to change my carb from 1,10
First day back on rapid
Woke up to 15
Took 7.5 which included 3 as a correction
30 mins later had breakfast
2 hrs from having breakfast
My readings had went up to 16.6 from 15.7
Is it to early for a change.
Any help appreciated.
First day back on rapid
Woke up to 15
Took 7.5 which included 3 as a correction
30 mins later had breakfast
2 hrs from having breakfast
My readings had went up to 16.6 from 15.7
Is it to early for a change.
Any help appreciated.
rebrascora
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Your problem is waking up on 15. You need to sort out your basal insulin dose first before you think of messing with your carb ratios. You would likely need a bigger correction in this case to bring you down due to insulin resistance from being so high. If you had woken up in range then your carb ratio may well have worked fine.
You certainly can't judge your carb ratio from this situation because it isn't normal circumstances. The key to good diabetes management is adjusting your basal insulin dose so that it is keeping you steady in the absence of food, so your overnight graph should be as horizontal as you can get it. I am guessing/hoping you didn't go to bed on 15 so it seems that it has risen overnight yet again. If this is a regular trend, it tells you your basal dose needs increasing.
You certainly can't judge your carb ratio from this situation because it isn't normal circumstances. The key to good diabetes management is adjusting your basal insulin dose so that it is keeping you steady in the absence of food, so your overnight graph should be as horizontal as you can get it. I am guessing/hoping you didn't go to bed on 15 so it seems that it has risen overnight yet again. If this is a regular trend, it tells you your basal dose needs increasing.
Proud to be erratic
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Hello @Charl, I've tried reading back into your past posts but I kind of got lost (sorry) but gleaned and reminded myself that you were originally diagnosed T2 then "promoted" to T1 in Apr 23 and it seems that you've had a fair share of turbulence since then.
Can I confirm you are still on Tresiba as your basal? If so, then your overnight basal tests (plural) already exist from looking at your Libre reports for last night and previous nights. Plural basal tests, because you don't want to be altering your basal without some confidence that you have a repeating trend - particularly since Tresiba is so long lasting. The key here is to establish that your basal is holding you steady throughout the fasting period. It doesn't matter if that steady is continuously higher or lower - the steadiness confirms that your basal is doing its job. PARTICULARLY if your basal is Tresiba; some shorter life basals are used to provide a shorter term degree of regulation of one's BG and some members here change their basal quite a lot, which is not relevant to Tresiba.
So if you start tonight near 15 take a bolus correction before going to sleep and DO NOT use tonight's fasting period as a basal test. But if below 10 don't consider correcting just see where that leaves you tomorrow morning. I appreciate this might seem to conflict slightly with the advice from @rebrascora; but it really isn't. I totally agree that you must get your basal as close to right as is possible first, but best to do that while generally in range (4-10) rather than use a basal test while a fair bit high, which should be considered as not normal. Our bodies can behave differently when our BG is not in range. If in doubt about this have a further look at some of the advice and explanations in your post "Lyumjev Timing".
I'm anticipating that you know that in general Tesiba can only be optimised for part of any 24 hr period and usually that is the late evening into morning, when most of us are naturally fasting. But it can be any block or part of a day, within a 24 hour period, according to what anyone's routines are. [Eg night shift workers would be having their longer fasting period at a different time]. I'm also assuming that such overnight fasting tests are only valid if those periods aren't made invalid by late snacks etc or indeed a genuine alarm/ alert that needed a low response snack or a high response bolus correction.
Look forward to hearing how you got on in due course. If you are in doubt about how to get the best out of Tresiba just ask. It is very different to other basals and needs a different mindset; but that does not mean it can't work for you.
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Glad to hear you are back on what will (hopefully) eventually be a more reliable and stable insulin for you, once you’ve tweaked it into submission 🙂
Going to try and do a basal test over the weekend or sooner, this morning's breakfast was about 43 carbs, took my usual 15 tresiba but made a change to my correction dose, took 4.5 for food but doubled my correction from 4 to 8 (novorapid) 2 hrs after eating it had only dropped 3 ,as shown by the readings it has now decided to take a nose dive where I've had a snack to correct it, as usual any advice appreciated.
rebrascora
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Doubling your correction dose was too much for you. A bigger correction was needed but not double. Looks like timing wise for your bolus you were about right, as you haven't gone any higher after injecting but just that the correction was too much and caused you to crash. Try one and a half times instead of double when you are mid teens. Ideally though, you need your basal sorted so that you don't wake up high in the first place. Can you show us yesterday's graph, so that we can see what happens in the evening as well as overnight. What level are you going to bed on and are you routinely having a bedtime snack as it may be as simple as not having a betime snack rather than altering your basal and as @Proud to be erratic explained, with Tresiba, you don't need to do a formal basal test as such, you just need to get your levels in range at bedtime with no food or bolus insulin acting after you go to bed, so eat early and don't have anything which will slow release like pizza or pasta with a creamy sauce or whatever. Just something simple like meat and potatoes and veg about 7pm and look to be in range ie below 10 at bedtime but not too low obviously.
Lucyr
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When making changes don’t double the dose, it’s too much change at once. If 4 wasn’t working I’d have tried slightlymore like 4.5 or 5 or stuck with 4 and done another correction when it wore off not changed it to 8. Insulin works for longer than 2 hrs so that’s why it dropped more later
trophywench
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I've used Novorapid continuously since the late 1990s - and for me. I'd say it lasts 4.5 hours. ie bit longer than 4 but not as much as 5. Its activity drops off gradually by 3.5ish hours after injecting it. So on a pump, you tell it that its duration is 4-ish hours. People usually find that Humalog lasts longer, in that its activity starts dropping off at 3 to 3.5 hours - then has another burst of activity at 4ish hours - in other terminology 'it has a sting in its tail' - so you'd tell a pump that it lasts for 5ish hours.
Evening meal was in there around 7 ish (sorry forgot to log it ) had a snack around 9 when it was dropping 8.2...
rebrascora
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Ok, so it looks like it is the snack that is the problem rather than your basal. What was the snack you had?
Have you been given advice on a suitable level to go to bed on and if so what is it?
I appreciate that 8.2 with a vertical downward arrow looks scary but you will still have had food digesting at that time and Libre tends to exaggerate these things, so in your situation I would have kept a close eye on it and waited to see if it leveled out in the 6s or even went back up. I am not suggesting you leave it as late as me but I can stop and turn around a 4.2 with a vertical downward arrow with 2 jelly babies (10g carbs) before it hits the red, so 8.2 with a vertical downward arrow means you still have plenty of time to wait and see what happens. If you get to 6.2 and it is still dropping fast, try one jelly baby or whatever you chosen fast acting carbs are and chew it well or swill around your mouth if liquid (the glucose will absorb faster through your mouth than your stomach particularly as a Type 3c) and see if that slows the drop down and the arrow starts to slope or level off, but remember that Libre has a lag when levels are changing fast so it may take 20 mins or more to register the change. It's about getting confident with those lower numbers and being able to just nudge them a bit rather than having big snacks and ending up with it going back up too high.
Have you been given advice on a suitable level to go to bed on and if so what is it?
I appreciate that 8.2 with a vertical downward arrow looks scary but you will still have had food digesting at that time and Libre tends to exaggerate these things, so in your situation I would have kept a close eye on it and waited to see if it leveled out in the 6s or even went back up. I am not suggesting you leave it as late as me but I can stop and turn around a 4.2 with a vertical downward arrow with 2 jelly babies (10g carbs) before it hits the red, so 8.2 with a vertical downward arrow means you still have plenty of time to wait and see what happens. If you get to 6.2 and it is still dropping fast, try one jelly baby or whatever you chosen fast acting carbs are and chew it well or swill around your mouth if liquid (the glucose will absorb faster through your mouth than your stomach particularly as a Type 3c) and see if that slows the drop down and the arrow starts to slope or level off, but remember that Libre has a lag when levels are changing fast so it may take 20 mins or more to register the change. It's about getting confident with those lower numbers and being able to just nudge them a bit rather than having big snacks and ending up with it going back up too high.
Usually if I go to bed on that number my alarm will be bleeping on 5.6 to wake me up, I then have to decide what to eat that will see me through till morning, dont like to leave alarm on a lower number as I usually end up on the 15..15 . situation where I have a sleepless night...Thanks
Lucyr
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Put whatever you’d need to eat if alarm goes off by the bed then there’s no getting up and deciding.
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