Help Required!

[astbury1]

Hi all. Have type 1 and am novorapid and levemir

Levemir I take 18 units at about 5ish in the eve and novorapid usually 1-10 ratio

I have a very seditary job sitting in an office. At the weekend I was going into town so I thought to myself I will be moving alot more so i reduced basal to 16. Hadnt even done much walking and by about 3 hours I was at 5 and falling fast( not usual). I had some dextrose and a few oat cakes and then later after I had eaten my lunch( reduced my ratio a bit to) and before tea I was in the 5's and fallling fast again. The question here is, do I need to seriously reduce my levemir like some thing down to about 12 or should I reduce my ratios? Or both?:confused

Am going to Thailand in April and a bit worried now about walking around alot expecially in the heat?!

It seems to me that even a tiny bit of walking or housework effects me alot!

 

[everydayupsanddowns]

Hi all. Have type 1 and am novorapid and levemir

Levemir I take 18 units at about 5ish in the eve and novorapid usually 1-10 ratio

First question: how did you get to those values?

Have you done much in the way of testing to see whether your basal dose is right this month/week/year?

Good guide to basal testing here: http://www.diabetes-support.org.uk/info/?page_id=120

Once you have checked (or rechecked) your basal, then you can start thinking about tweaking boluses - but do basal first otherwise you'll end up chasing your tail 🙂

 

[astbury1]

Hiya thanks for replying! My basal was orginally set at 12 and ratios set at 1-20. I was getting numbers of 8-9 in the morning and high peaks after eating even though my novorapid wuld bring me back into range after 4-5 hours. The diabetes nurse and the consultant told me to up the basal 2 units at a time to see if this would help. I have never been shown how to basal test or even had it mentioned to me?!

Over time my ratios have changed to try and get me into range as they started being higher than I was wanting.

And increasing the basal doesnt seem to have made much difference to my morning numbers?

By the sounds of it maybe I should start from scratch again? I shall try the bsal test. By the sounds of it do you think it may end up alot less basal and more units of novorapid to carbs rather than the way amn doing it at present?

 

[everydayupsanddowns]

Hiya thanks for replying! My basal was orginally set at 12 and ratios set at 1-20. I was getting numbers of 8-9 in the morning and high peaks after eating even though my novorapid wuld bring me back into range after 4-5 hours. The diabetes nurse and the consultant told me to up the basal 2 units at a time to see if this would help. I have never been shown how to basal test or even had it mentioned to me?!

Over time my ratios have changed to try and get me into range as they started being higher than I was wanting.

And increasing the basal doesnt seem to have made much difference to my morning numbers?

By the sounds of it maybe I should start from scratch again? I shall try the bsal test. By the sounds of it do you think it may end up alot less basal and more units of novorapid to carbs rather than the way amn doing it at present?

Not necessarily... but without testing you'll never know. And without your basal being as right as it can be (in either one or two doses, whichever suits your body best) then your meal doses will always be more difficult as they will be covering/compensating for basal override/shortfall at different times of day.

Similarly I was never told to basal test on injections, I learned it from a forum like this one. As soon as I read it I just thought *why has no one ever told me to do this before?!?*. Perhaps it is because they think few people will bother with it?

Apparently most non-Ds have pretty much a 50:50 split of insulin secreted to cover food and background, and it's usually similar for T1s too. Somewhere in the 40:60 - 60:40 range is normal.

 

[HOBIE]

There is no perfect answer is there Good luck getting to bottom of this & enjoy your holi 😎

 

[DeusXM]

Similarly I was never told to basal test on injections, I learned it from a forum like this one. As soon as I read it I just thought *why has no one ever told me to do this before?!?*. Perhaps it is because they think few people will bother with it?

I suspect it's probably more because doctors know that when a patient starts doing this, they'll start asking hard questions about how their treatment regime and how it's administered. Questions that mean at the very least, a lot more reading and heaven forbid, finding your patient won't nicely take the statin you're paid to force on them without kicking up a fuss.

 

[astbury1]

Right I shall give it ago! Although am usure whether I will beable to even last without breakfast or lunnch to this lol

Is it best to do the basal test with a 'normal day' or a busier moving around day?

Or should this not matter? I was preuming that if i was having a very sctive day that I would have to reduce a bit (just not as much!)

 

[everydayupsanddowns]

Right I shall give it ago! Although am usure whether I will beable to even last without breakfast or lunnch to this lol

Is it best to do the basal test with a 'normal day' or a busier moving around day?

Or should this not matter? I was preuming that if i was having a very sctive day that I would have to reduce a bit (just not as much!)

You should only do one 'block' in a day (so don't miss consecutive meals)

Don't run a test if you've had a hypo in the predecing few hours

You shouldn't be unusually active (and certainly not exercising).

The test should start 4-5 hours after your last bolus (so that all the previous injection is out of your system).

Ideally you should test each block more than once to make sure that 'oddities'/freak results are ruled out

It will take time, probably a period of several weeks, to get all the time blocks done, so be patient. And of course you'll need to retest if you change your dose to see what effect has been had.

The good news is that once you have established your basic 'pattern' (which is tough going) any changes are likely to be broadly 'up' or 'down' but following the same basic profile.

It may be that you discover your single basal jab seems to be running out... or is too much here/not enough there. On a single dose, this is tricky. You can work on optimising the timing, or try splitting into two (not necessarily even) doses.

Often on MDI basal ends up being 'least worst', but at least you will know generally what is going on and which boluses are helping out where.