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In range glucose
- Thread starter Meme35
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Meme35
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Ok I will do thank you
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I agree with others. You should take your basal / background insulin even if your glucose is in range.
However as someone who is relatively newly diagnosed you may be slightly worried that your basal insulin may be slightly overreaching - in which case you might want to play on the safe side and set an alarm for around 3am just to make sure you don’t dip low?
However as someone who is relatively newly diagnosed you may be slightly worried that your basal insulin may be slightly overreaching - in which case you might want to play on the safe side and set an alarm for around 3am just to make sure you don’t dip low?
Proud to be erratic
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Hi @Meme35
It's all a bit confusing in the early days and you have been started on Multiple Daily Injections, with NovoRapid as your quicker acting insulin for meals and corrections and Tresiba as your basal (or background) insulin.
A background or basal insulin is dealing with glucose that your body is getting from internal glucose releases, particularly by your liver - releases that you frequently have no control over, but are happening 24 hrs a day for all sorts of reasons. There is wide agreement that it is best to get one's basal insulin optimised first, then deal more thoroughly with bolus dosing (ratios for carbohydrates being eaten and corrections when needed). If the basal isn't close to correct the bolus is chasing a moving target!
Tresiba (also known as Degludec) is a bit different in how it behaves in relation to other basal insulins. It has a long profile which lasts around 40 hrs; many of the other basals last c.24hrs or less. So Tresiba needs just one dose daily, with the consequence that today's dose adds to what is remaining from yesterday. This can be where advice on basal insulins can feel confusing, but it doesn't need to be!
Because of this longevity of Tresiba it is often referred to as an inflexible insulin and sometimes this is regarded as a difficulty or shortcoming. But that inflexibility is also a great strength: the way Tresiba is released into your bloodstream provides a very steady and reliable effect and once set up to best effect can generally provide consistent hypo free nights. Shorter basals 'run out' over their profile time, sometimes needing a dose first thing for the day and a second (can be different) dose for the night. BUT Tresiba taken once daily provides full 24 hr background cover and because of the overlapping from yesterday to today the timing of daily Tresiba doses is NOT AT ALL important; so you might have a routine to take your basal Tresiba on waking, which could be early for a working day, but much later on any 'lie-in' day. The basal cover will continue, regardless. One disadvantage is that changing the size of a Tresiba dose takes at least 48hrs to start and realistically dose changes should be kept at least 4 days apart - to allow time for the change to take effect.
One caveat: our basal needs vary across any 24 hr period, so what is needed in the background can be different from night to day. So it is normal to optimise Tresiba dosing to cover nights (or sleeping times if one works nights). Shift workers switching between early days, late days and nightshifts might find it too much hassle to juggle Tresiba for that circumstance. But if their shifts were well predicted then they might find a way to work through that as well.
Once we've got Tresiba dosing optimised to provide stable nights, any other insulin needs can ONLY be provided by the quicker acting NovoRapid - which for most people only lasts 4 hrs (for some a little longer); then the NovoRapid no longer has any effect. So bolus insulin is needed to cover food eaten, and potentially any other BG rises that need correcting (lowering).
I say potentially, because exercise and activity can and often does result in one's BG going lower. Some of us make a concious use of exercise or activity to help bring our BG down - I certainly do this, when it's convenient, not least because I like to kid myself that I'm keeping fit and healthy by exercising or being generally active. Activity can be quite short duration and not very vigorous - there is no formula, just trial and learning. Managing Diabetes and exercise is not easy and has been something I'm still learning after 3 yrs; it is more of an art than a science and exercise can create lingering BG lowering effects for up to 3 days (just to further confuse). But because Tresiba is my basal insulin, I don't have to look back at any one day that hasn't gone as well as I might have hoped and question myself if it's my basal or bolus that is wrong. My Tresiba is pretty fixed for weeks or months at a time and my choices are simply:
When low eat a snack and if there is a recurring trend of going low at a certain time I look at my carb counting and bolus ratios.
When high I correct with exercise or NovoRapid - sometimes a bit of both. I find it simpler to not correct if I'd taken a bolus dose in the last 4 hours and so avoid any possibility of stacking NovoRapid on top of any other bolus that is 'on board'; I recommend that to you at this early stage. Being high for a modest period is not damaging, whereas this is not so true about being low.
Libre is a great help. I invariably look at the trend arrows first rather than the actual reading. And I have my low alert quite high, often at the upper end of its limits. I want to be alerted when I'm going low and intercept a downwards trend straightaway or at the very least be aware that there is a downwards trend and monitor much more closely. For me there is no point in being told by an alarm that I'm about to go hypo - when I can be alerted well before that occurs.
Good luck. All my comments come from learning and latterly experience, I have no medical qualifications. Also we are all different and learn different lessons. In respect of Tresiba there don't seem to be so many users of it on this forum and I have now met 2 DSNs who told me they don't come across it so often. So people's comments about basal can be a bit misleading since they think in terms of shorter basals such as Levermir and their perception of Tresiba's inflexibility. I was started on Levermir, but find Tresiba works very well for me and I like and appreciate it's predictability. I live a very varied and active life and am happy to take extra bolus corrections for my highs, when necessary.
It's all a bit confusing in the early days and you have been started on Multiple Daily Injections, with NovoRapid as your quicker acting insulin for meals and corrections and Tresiba as your basal (or background) insulin.
A background or basal insulin is dealing with glucose that your body is getting from internal glucose releases, particularly by your liver - releases that you frequently have no control over, but are happening 24 hrs a day for all sorts of reasons. There is wide agreement that it is best to get one's basal insulin optimised first, then deal more thoroughly with bolus dosing (ratios for carbohydrates being eaten and corrections when needed). If the basal isn't close to correct the bolus is chasing a moving target!
Tresiba (also known as Degludec) is a bit different in how it behaves in relation to other basal insulins. It has a long profile which lasts around 40 hrs; many of the other basals last c.24hrs or less. So Tresiba needs just one dose daily, with the consequence that today's dose adds to what is remaining from yesterday. This can be where advice on basal insulins can feel confusing, but it doesn't need to be!
Because of this longevity of Tresiba it is often referred to as an inflexible insulin and sometimes this is regarded as a difficulty or shortcoming. But that inflexibility is also a great strength: the way Tresiba is released into your bloodstream provides a very steady and reliable effect and once set up to best effect can generally provide consistent hypo free nights. Shorter basals 'run out' over their profile time, sometimes needing a dose first thing for the day and a second (can be different) dose for the night. BUT Tresiba taken once daily provides full 24 hr background cover and because of the overlapping from yesterday to today the timing of daily Tresiba doses is NOT AT ALL important; so you might have a routine to take your basal Tresiba on waking, which could be early for a working day, but much later on any 'lie-in' day. The basal cover will continue, regardless. One disadvantage is that changing the size of a Tresiba dose takes at least 48hrs to start and realistically dose changes should be kept at least 4 days apart - to allow time for the change to take effect.
One caveat: our basal needs vary across any 24 hr period, so what is needed in the background can be different from night to day. So it is normal to optimise Tresiba dosing to cover nights (or sleeping times if one works nights). Shift workers switching between early days, late days and nightshifts might find it too much hassle to juggle Tresiba for that circumstance. But if their shifts were well predicted then they might find a way to work through that as well.
Once we've got Tresiba dosing optimised to provide stable nights, any other insulin needs can ONLY be provided by the quicker acting NovoRapid - which for most people only lasts 4 hrs (for some a little longer); then the NovoRapid no longer has any effect. So bolus insulin is needed to cover food eaten, and potentially any other BG rises that need correcting (lowering).
I say potentially, because exercise and activity can and often does result in one's BG going lower. Some of us make a concious use of exercise or activity to help bring our BG down - I certainly do this, when it's convenient, not least because I like to kid myself that I'm keeping fit and healthy by exercising or being generally active. Activity can be quite short duration and not very vigorous - there is no formula, just trial and learning. Managing Diabetes and exercise is not easy and has been something I'm still learning after 3 yrs; it is more of an art than a science and exercise can create lingering BG lowering effects for up to 3 days (just to further confuse). But because Tresiba is my basal insulin, I don't have to look back at any one day that hasn't gone as well as I might have hoped and question myself if it's my basal or bolus that is wrong. My Tresiba is pretty fixed for weeks or months at a time and my choices are simply:
When low eat a snack and if there is a recurring trend of going low at a certain time I look at my carb counting and bolus ratios.
When high I correct with exercise or NovoRapid - sometimes a bit of both. I find it simpler to not correct if I'd taken a bolus dose in the last 4 hours and so avoid any possibility of stacking NovoRapid on top of any other bolus that is 'on board'; I recommend that to you at this early stage. Being high for a modest period is not damaging, whereas this is not so true about being low.
Libre is a great help. I invariably look at the trend arrows first rather than the actual reading. And I have my low alert quite high, often at the upper end of its limits. I want to be alerted when I'm going low and intercept a downwards trend straightaway or at the very least be aware that there is a downwards trend and monitor much more closely. For me there is no point in being told by an alarm that I'm about to go hypo - when I can be alerted well before that occurs.
Good luck. All my comments come from learning and latterly experience, I have no medical qualifications. Also we are all different and learn different lessons. In respect of Tresiba there don't seem to be so many users of it on this forum and I have now met 2 DSNs who told me they don't come across it so often. So people's comments about basal can be a bit misleading since they think in terms of shorter basals such as Levermir and their perception of Tresiba's inflexibility. I was started on Levermir, but find Tresiba works very well for me and I like and appreciate it's predictability. I live a very varied and active life and am happy to take extra bolus corrections for my highs, when necessary.
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Take care using exercise to reduce levels. If too high, exercise can put a straw n on the body causing levels to rise further rather than fall. Plus combining exercise with insulin can make the insulin more "potent" leading to hypos when levels fall faster than expected
To add to the challenge of managing diabetes, out bodies are different and react differently. Therefore, when first diagnosed, you may require some trial and error to find out how your body reacts and what technique works best for you.
What works well for someone else should be taken as a suggestion rather than fact. Useful to try but not gospel
Proud to be erratic
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Yes, 2 good comments. I deliberately, but probably wrongly, tried to avoid discussing levels of exercise - particularly aerobic (moderate to low level) and anaerobic (more vigorous) exercise. Partly because these terms are subjective and can be interpreted differently and probably because these days, on the wrong side of 73, I generally stay in the aerobic zone. That said I found myself striding furiously uphill while in Gibraltar last week and I certainly stretched my normal limits AND got a slightly surprising rapid BG drop. Surprising, because strenuous exercise usually initially pushes my BG up and while it does subsequently drop again (without any bolus help) guaging that follow-on response is still a bit of a mystery to me.
Also, I agree, blending exercise and insulin is a bit 'chancy' and my remark is a bit blasé; but I do this knowingly and happily lean on my CGM alerts to allow me to monitor myself and ready to respond if necessary.
I always have an array of simple response snacks near by. This happened during my first 10 months after surgery and chemo, when I was either dreadfully high or low and really struggled to break that roller coaster effect. But trial and learning led me to having choices of lowish fat snacks handy. Jelly babies of course for the hypo times, but gradually a mix of fairly plain medium glucose biscuits (no or little chocolate) in different sizes ranging from 4 gms of carbs per biscuit to a full cookie at around 12 gms. The variation in carb content according to what I initially guessed and after getting Libre what I guaged I might need; the variation in types for ... well ... variety!
Also agreed, as each month goes by the more I think I'm getting the hang of this D malarkey, the more I realise I know so little, that nothing seems to be a fixed rule or set in concrete and invariably as I start to feel I've got 'a success in train' then the rules change and it all seems I'm back to square one. Trial and learning remains essential for me.
But after any unsatisfactory day I look to see if there is a trend to pick up on or a lesson to be learnt and then MOVE ON. Tomorrow WILL be better!
trophywench
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.... and your monthly female hormones can quite easily mean that you need different amounts of basal insulin when they're putting their oar in, so it's by no means 'easy' to adjust doses for any length of time. Exercise can also affect blood glucose for up to 48 hours thereafter - but like most things diabetes - nobody can tell anyone exactly what that will do or when. Just have to closely observe your own bodily reactions and learn to react accordingly.
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