Group 7-day waking average?

[rebrascora]

Sorry if this is a silly question ... I'm guessing this is a personal choice/feeling and it doesn't matter how much insulin we use? I only ask as I'm always worried I'm using too much/little!

Sorry, I guess that is a bit of a controversial thing to say. "We need what we need" to a large extent, but we can influence it through exercise and I know I am not doing enough exercise at the moment and that shows in my increasing basal doses. Those increased basal doses will also have an impact on weight. I am not saying they cause me to gain weight but they are an indication that my body is storing more than it is burning off ie I am getting fatter. At least that is how I perceive it.

I think you have to understand and accept that during the honeymoon phase your needs will increase and it is difficult to know when that comes to an end. I was quite resistant to increasing my basal doses initially, but since my levels stabilized after the last big hike 2 years ago (which was 2 years from diagnosis), my basal dose ranges have pretty well stayed the same, with my morning dose being between 20 and 24 and my evening dose between 0 and 5. It goes up and down in that range according to how much/little I exercise. I am at the top end of both those doses and I am simply not doing enough exercise at the moment. The bottom end of those ranges are where I am fitter and healthier and slightly "leaner". I am not sure if this is specific to me and my body or if my low carb diet has some relevance in this "equation" but I do see my basal doses as a strong indication of whether I am losing weight or putting on weight and for me exercise is the factor which seems to tip the balance, although the more I exercise the less hungry I become, so the less I eat, which obviously plays a big part too.... but the higher basal doses are the indicator for me that it is time to get my backside into gear and that is where it has the most notable impact, so I use those higher basal doses to trigger me to take action and reduce them and feel healthier. I don't expect to lower them below 20 and 0 although I might get it down to 18 if I really work hard at it, but it isn't sustainable. 20 units of basal a day seems to be a good sustainable level for my body to be healthy and my weight right/stable and me to feel fit and my BG stable in the absence of food.

My daily bolus units vary so dramatically from one day to the next depending upon if I am fire fighting with corrections because my basal isn't right from one day to the next or I am hungry one day and not hungry another or I exercised a lot and needed a bit less or none for meals or I was motivated with my diet and very low carb that day, so almost no bolus insulin, so I can't see any real correlation with bolus insulin, whereas with my basal insulin, there is a clear (to me) connection between dose, exercise and weight so that is where I balance things. It probably doesn't apply the same to other people and it is just my irregular lifestyle and diet which throws up this 3 way balancing act. The higher doses are the kick up the pants I need 🙄 to do more exercise which brings down my high doses to the lower end of my range and burns the weight off me. I don't think or worry about food other than maintaining low carb, I just continue to eat what I want, when I want it, but the exercise curtails the wanting quite a bit.

 

[pawprint91]

Sorry, I guess that is a bit of a controversial thing to say. "We need what we need" to a large extent, but we can influence it through exercise and I know I am not doing enough exercise at the moment and that shows in my increasing basal doses. Those increased basal doses will also have an impact on weight. I am not saying they cause me to gain weight but they are an indication that my body is storing more than it is burning off ie I am getting fatter. At least that is how I perceive it.

I think you have to understand and accept that during the honeymoon phase your needs will increase and it is difficult to know when that comes to an end. I was quite resistant to increasing my basal doses initially, but since my levels stabilized after the last big hike 2 years ago (which was 2 years from diagnosis), my basal dose ranges have pretty well stayed the same, with my morning dose being between 20 and 24 and my evening dose between 0 and 5. It goes up and down in that range according to how much/little I exercise. I am at the top end of both those doses and I am simply not doing enough exercise at the moment. The bottom end of those ranges are where I am fitter and healthier and slightly "leaner". I am not sure if this is specific to me and my body or if my low carb diet has some relevance in this "equation" but I do see my basal doses as a strong indication of whether I am losing weight or putting on weight and for me exercise is the factor which seems to tip the balance, although the more I exercise the less hungry I become, so the less I eat, which obviously plays a big part too.... but the higher basal doses are the indicator for me that it is time to get my backside into gear and that is where it has the most notable impact, so I use those higher basal doses to trigger me to take action and reduce them and feel healthier. I don't expect to lower them below 20 and 0 although I might get it down to 18 if I really work hard at it, but it isn't sustainable. 20 units of basal a day seems to be a good sustainable level for my body to be healthy and my weight right/stable and me to feel fit and my BG stable in the absence of food.

My daily bolus units vary so dramatically from one day to the next depending upon if I am fire fighting with corrections because my basal isn't right from one day to the next or I am hungry one day and not hungry another or I exercised a lot and needed a bit less or none for meals or I was motivated with my diet and very low carb that day, so almost no bolus insulin, so I can't see any real correlation with bolus insulin, whereas with my basal insulin, there is a clear (to me) connection between dose, exercise and weight so that is where I balance things. It probably doesn't apply the same to other people and it is just my irregular lifestyle and diet which throws up this 3 way balancing act. The higher doses are the kick up the pants I need 🙄 to do more exercise which brings down my high doses to the lower end of my range and burns the weight off me. I don't think or worry about food other than maintaining low carb, I just continue to eat what I want, when I want it, but the exercise curtails the wanting quite a bit.

Thank you for this - I totally understand where you are coming from - I, too, have been a bit unhealthy recently, and I can see this in my increase in insulin needs too! (Plus, I feel like a pincushion if I am snacking etc!!) How long may I ask did it take you for you to get to your morning dose of Levemir? I am still on single figures for the morning doses and attribute this to the honeymoon period. Also, just in your opinion/experience, do you think cracking on an extra unit of basal might stop my random spikes up to 14 that I seem to be getting overnight at the moment?

 

[rebrascora]

Thank you for this - I totally understand where you are coming from - I, too, have been a bit unhealthy recently, and I can see this in my increase in insulin needs too! (Plus, I feel like a pincushion if I am snacking etc!!) How long may I ask did it take you for you to get to your morning dose of Levemir? I am still on single figures for the morning doses and attribute this to the honeymoon period. Also, just in your opinion/experience, do you think cracking on an extra unit of basal might stop my random spikes up to 14 that I seem to be getting overnight at the moment?

Gosh! Going to have to wrack my brain cells.... I know I had 3 clear phases within my honeymoon period when my basal needs increased..... The increase each time wasn't overnight but over a period of weeks where I was firefighting with corrections until I upped my basal a bit and then a few days later I would start needing corrections again and I would resist adjusting the basal again until I got totally frustrated and upped it again. I think I started off on a single dose of Levemir and it was just 6 units and by my DAFNE course 8 months later it was up to 14 units which they asked me to split into 2 7s the weekend before my course started. Then I adjusted it to about 13 and 5 I think not long after my DAFNE and that held reasonably steady for a few months and then just after my first Covid vaccine it started to increase again and I had 3 months of frustration when it just continued to rise until I was up to 25 and 7 and then I hypoed 7 times in one day .... I knew I would drop off a cliff edge with it at some point and that day was particularly hectic and a fine warm sunny day in May....so I dialed it back a bit and it has now been at that 20-24u and 0-5 for the past 2 years. I believe that is a larger dose than most women but I am very solid and muscular and it is what I need, but you may not ever need that much or even double figures. There was a lady on my DAFNE course who only needed 2 units of Lantus a day and she had been Type 1 for 50 years and that caused her to hypo quite badly most nights but end up mid teens in the morning..... she got a pump to manage it because she needed such tiny doses. Sad that she pent so many years battling those levels and having regular paramedic attendance for severe hypos during the night and her family having to cope with that.

Anyway, as regards your spikes during the night, I can't really advise you to increase basal, but I would say that I learned most from experimenting to see what worked for me and my body. If you do decide to experiment by increasing it, do it on a night when you don't need to be at work the next day and make sure your alarms are working and maybe go to bed with levels a little higher than you would normally. Those are all precautions I would take to mitigate the risk of a nocturnal hypo and dealing with the potential fall out. Also consider if those spikes are possibly slow release carbs or protein from your evening meal although generally those will be hills and plateaus on your graph rather than spikes.
Could the spikes be caused by a digestive issue where you have delayed digestion. Are you getting hypos after meals and then these spikes later? That might suggest gastroparesis I believe. Just some things to think about.

 

[freesia]

Levemir does seem easier to adjust depending on exercise, food intake etc. Being on Tresiba, it is harder to make changes as it can take 3 days or so to see any difference.

 

[pawprint91]

Gosh! Going to have to wrack my brain cells.... I know I had 3 clear phases within my honeymoon period when my basal needs increased..... The increase each time wasn't overnight but over a period of weeks where I was firefighting with corrections until I upped my basal a bit and then a few days later I would start needing corrections again and I would resist adjusting the basal again until I got totally frustrated and upped it again. I think I started off on a single dose of Levemir and it was just 6 units and by my DAFNE course 8 months later it was up to 14 units which they asked me to split into 2 7s the weekend before my course started. Then I adjusted it to about 13 and 5 I think not long after my DAFNE and that held reasonably steady for a few months and then just after my first Covid vaccine it started to increase again and I had 3 months of frustration when it just continued to rise until I was up to 25 and 7 and then I hypoed 7 times in one day .... I knew I would drop off a cliff edge with it at some point and that day was particularly hectic and a fine warm sunny day in May....so I dialed it back a bit and it has now been at that 20-24u and 0-5 for the past 2 years. I believe that is a larger dose than most women but I am very solid and muscular and it is what I need, but you may not ever need that much or even double figures. There was a lady on my DAFNE course who only needed 2 units of Lantus a day and she had been Type 1 for 50 years and that caused her to hypo quite badly most nights but end up mid teens in the morning..... she got a pump to manage it because she needed such tiny doses. Sad that she pent so many years battling those levels and having regular paramedic attendance for severe hypos during the night and her family having to cope with that.

Anyway, as regards your spikes during the night, I can't really advise you to increase basal, but I would say that I learned most from experimenting to see what worked for me and my body. If you do decide to experiment by increasing it, do it on a night when you don't need to be at work the next day and make sure your alarms are working and maybe go to bed with levels a little higher than you would normally. Those are all precautions I would take to mitigate the risk of a nocturnal hypo and dealing with the potential fall out. Also consider if those spikes are possibly slow release carbs or protein from your evening meal although generally those will be hills and plateaus on your graph rather than spikes.
Could the spikes be caused by a digestive issue where you have delayed digestion. Are you getting hypos after meals and then these spikes later? That might suggest gastroparesis I believe. Just some things to think about.

Thank you for taking the time to reply in such detail. I would say I only hypo after meals if I a) leave it too long with bolusing or get the bolus incorrect or b) if I end up being slightly more active after a meal than I anticipated. But the spikes have definitely started showing up later and later each time so always different things to think about. Thank you for your advice, I know obviously you're not a medical professional but I really appreciate just being able to speak to someone about it and ask advice! 🙂

 

[Proud to be erratic]

Levemir does seem easier to adjust depending on exercise, food intake etc. Being on Tresiba, it is harder to make changes as it can take 3 days or so to see any difference.

Yes, but no, but .... Knowing that Tresiba is not readily adjusted even from week to week, makes it really easy for me to select either my bolus or exercise as my correction options. I'm not wrestling with the extra question of should I alter basal or bolus!

There's enough going on with: did I assess the carbs well enough; are my current ratios about right still; could I have got the pre-bolus timing any better; am I still recovering from 2 very full on days at the weekend; have any of the other 35 BG affecting factors kicked in..... ?? I appreciate that a Levermir adjustment has more longevity and possible consequence, than a bolus change. But my CGM gives me plenty of visibility about has the bolus change worked exactly as planned and if not has that bolus change got me nearer enough right? Retirement means for me that its very rare for 2 successive days to be similar. So I like the relative certainty that my Tresiba basal keeps me steady through the night and I "only" need to manage the days.

Of course its not really that simple! I'd settle for a pump and looping most days in 2023!

 

[rebrascora]

Thank you for taking the time to reply in such detail. I would say I only hypo after meals if I a) leave it too long with bolusing or get the bolus incorrect or b) if I end up being slightly more active after a meal than I anticipated. But the spikes have definitely started showing up later and later each time so always different things to think about. Thank you for your advice, I know obviously you're not a medical professional but I really appreciate just being able to speak to someone about it and ask advice! 🙂

Maybe you should start a new thread about nocturnal spikes and post some of your Libre graphs illustrating the problem and then you will get more input from other people. It is always best to have a broad spectrum of approaches and ideas to choose from...

 

[pawprint91]

Maybe you should start a new thread about nocturnal spikes and post some of your Libre graphs illustrating the problem and then you will get more input from other people. It is always best to have a broad spectrum of approaches and ideas to choose from...

I apologise for getting into a discussion on this thread, I got carried away Thank you for taking the time to reply.

 

[rebrascora]

Yes, but no, but .... Knowing that Tresiba is not readily adjusted even from week to week, makes it really easy for me to select either my bolus or exercise as my correction options. I'm not wrestling with the extra question of should I alter basal or bolus!

There's enough going on with: did I assess the carbs well enough; are my current ratios about right still; could I have got the pre-bolus timing any better; am I still recovering from 2 very full on days at the weekend; have any of the other 35 BG affecting factors kicked in..... ?? I appreciate that a Levermir adjustment has more longevity and possible consequence, than a bolus change. But my CGM gives me plenty of visibility about has the bolus change worked exactly as planned and if not has that bolus change got me nearer enough right? Retirement means for me that its very rare for 2 successive days to be similar. So I like the relative certainty that my Tresiba basal keeps me steady through the night and I "only" need to manage the days.

Of course its not really that simple! I'd settle for a pump and looping most days in 2023!

I was just about to make comment about it being a question of which is better for the individual, regarding Tresiba or other long acting basal and Levemir. Having to make decisions about your basal dose on top of carb counting and corrections with your bolus insulin can be overwhelming for some people and many people do not understand that it needs tweaking and how best to tweak it to get the results they want. That takes time to learn and is not something that most DSNs really understand fully or could teach you..... and some of it becomes very instinctive rather than "calculated". Most nights I have to make a decision on how much Levemir I need tonight, more less or the same as the night before and if different, by how much. Thankfully my daytime needs are more stable so there is less tweaking of the morning dose for me but other people are the other way around and need to adjust the daytime one more.
The benefit for me is that I have a simple 1:10 ratio for every meal which hasn't changed since diagnosis and I adjust my basal doses to give me a flat line to work off. Added to that there is no way I could manage with Tresiba on the many occasions I need zero Levemir during the night but 22 (+2 units of Fiasp) in the morning to give me that flat baseline.

I do think people should be encourage to try different basal insulins to see what works best for them particularly if they are having problems but without the right support and knowledge, I can also see that it might be a waste of time.

 

[rebrascora]

I apologise for getting into a discussion on this thread, I got carried away Thank you for taking the time to reply.

No need to apologize at all. Just thought a new thread might benefit others in a similar situation as well as yourself and more likely to attract comment from experienced people who don't normally frequent this thread.

 

[MikeyBikey]

Maybe something to do with ships? Didn't England build ships with oak back in the day. We ruled the waves... good ol' oaks. 🙂 Trees worth their weight in diamonds and stuff.

7.7 today. Have a good day all.

And the 90th is the granite anniversary but I believe only one has ever been recorded and the GBOR no longer recognise it!

 

[PattiEvans]

@pawprint91 I note that as yet no one has mentioned Basal testing (I could be wrong here, but I didn't see it). I strongly suggest you do basal testing sooner rather than later. This needs doing 2 or 3 times a year - usually when weather is cooling down or warming up. I need to tweak my basal insulin at least that number or times a year. I attach instructions.

 

[Eternal422]

Congratulations @MrPixels on your HS!

 

[pawprint91]

@pawprint91 I note that as yet no one has mentioned Basal testing (I could be wrong here, but I didn't see it). I strongly suggest you do basal testing sooner rather than later. This needs doing 2 or 3 times a year - usually when weather is cooling down or warming up. I need to tweak my basal insulin at least that number or times a year. I attach instructions.

Thanks for this - I've done the day time ones before but never missed dinner. So am I clear in thinking to check whether this is a basal need you need to not eat dinner (or eat a no carb dinner I suppose as I am sure I would be kept awake with hunger were I not to have eaten since lunch!) and then test throughout the night?

 

[PattiEvans]

Obviously if you have the Libre you won't need to test through the night cos you can see what happens. What I do on the odd occasion I have to, is reverse dinner and have it instead of lunch. Best done at a weekend if you work. Personally I don't seem to be able to have a "no carb" meal when doing basal testing because in the absence of carbs both protein and fat will raise BGs.

 

[ColinUK]

Happened to test just before dinner this evening and scored a 5.2!

Can I carry that over to the morning?

And yes I know I said I wasn’t testing.

 

[42istheanswer]

Happened to test just before dinner this evening and scored a 5.2!

Can I carry that over to the morning?

And yes I know I said I wasn’t testing.

There is a before tea thread, you can claim it there

 

[Northerner]

Good morning 🙂 6.1 for me today 🙂

 

[Gwynn]

Good morning everyone.

BG 5.1 laughing at me (and I ate tons of carby sweet stuff yesterday too)
Pulse 55
BP 122/72 seems to be slightly better than before

Tired today. Painting is hard work.

I found a very old full 2.5 litre 'tin' of special colour paint (for the woodwork- pelmet, skirting board, ledges) yesterday. Sadly an almost solid lump!!! Tried to give it a stir and stiff dampish crystaline shards was the best it produced. Totally unusable. Not to be defeated, I added some water and used my small electric blender on it and left it to sort itself out overnight. Had a quick peek this morning whilst making a cup of tea and it seems to be a lot better. Hmmm might even become useable. Hope so. A bit like this...only much worse...



Today lots more painting...

Have a great day today whatever you are doing

 

[ColinUK]

@Gwynn are you sure that’s not either cheese or clotted cream?