Insulin needs plummeting!

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CivicFreak said:
It's difficult sometimes to get the balance right. I tend to find that I might have a few weeks of relative stability, and then out of the blue it goes a bit haywire and suddenly my carb ratios no longer work for example, and I need to change them - usually this means I need more insulin, never less.

I know about the so-called "honeymoon period" where your pancreas slowly stops producing insulin can have a big impact, and as it dies off then needs tend to increase, and I suspect this is happening to me, and possibly you too, given you were only diagnosed 8 months ago, and I in December 2020. We're both still "new" to this I guess 🙂
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It was 8 months ago I was diagnosed too I'm diffinatlly think I need less at certain times then others
 
CivicFreak said:
Yes that is what I suspected also, as my needs have increased throughout the last year and a half-ish. Generally my honeymoon period (no idea why the call it that, it's far from a honeymoon) has been pretty good, with long periods of stability, followed by few days/weeks of rising sugars, panic, confusion and increase in background after chatting with my DSN, then the cycle continues. I have to say after a rocky start I've really found the Libre 2 invaluable for the data it collects. I wouldn't say I have a straight line right now, it's kind of like a mountain range, but rather than being in target for only 3% of the time as I was at one point last week, I am currently sitting at 80% in target range. Of course this does drop depending on what I'm eating and if I have calculated my bolus correctly, which seems a bit unpredictable right now.

I'm not familiar with Levemir - when you say you have 20 units basal in the morning and 2 at night, how does this work? I use Tresiba, which I use only once a day, in the mornings. Being able to take basal more than once a day seems to be a bit more flexible than Tresiba with its once daily application. You're right about adjustments with Tresiba being slow as well. When I make a change it can be several days before I see the effects. I've kind of got used to this now though.
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Basically, Levemir just lasts about 16 hours so there is a little bit of overlap between doses but it is just the tail end and you don't have to worry too much about that. I can make changes to my Levemir every day and night if I need to and change the timing of the doses as well to cope with odd rises in my levels from liver output, like Dawn Phenomenon/Foot on the Floor etc. I tend not to have a regular routine with lifestyle or meals so I often skip meals and Libre really helps me to see on a day by day basis when my basal needs change. I have a standard 1:10 ratio for carbs throughout the day and have never needed to change that because the Levemir allows me to adjust to accommodate my basal needs really well. It is very much instinctive now but it does take some time to develop the skill and confidence to adjust Levemir to your particular needs. I personally LOVE my Levemir and can't imagine ever wanting to change to a different basal but it does take more thought and obviously 2 injections instead of one. If you have a more routine lifestyle and perhaps more even day and night time basal needs, I imagine Tresiba can be easier, but it wouldn't work for me.
If you are getting 80% TIR with your Libre then you are doing really well and I wouldn't worry about changing anything too much.
 
rayray119 said:
Everyone's talking about insulin needs going down however mine are going up . Fought however mine appear to be going up.
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CivicFreak said:
Same here! I've had to increase my Tresiba by 2 units and I may have to increase further.
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Yes I think you are right @CivicFreak it’s probably that you’ve lost a few of your remaining beta cells.

I remember that happening for a year or so after diagnosis, and then my doses seemed to settle, and have just settled into a cycle of ”up a bit… down a bit…” with *some* predictability and quite a lot of randomness.
 
everydayupsanddowns said:
Yes I think you are right @CivicFreak it’s probably that you’ve lost a few of your remaining beta cells.

I remember that happening for a year or so after diagnosis, and then my doses seemed to settle, and have just settled into a cycle of ”up a bit… down a bit…” with *some* predictability and quite a lot of randomness.
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Yes I do need to be be doing background tests but it hasn't seemed like the best idea not to eat recently so trying to figure things out the best I can. Then hopefully once things are figure out with what's going on with me things might get a little bit easier to work out
 
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I’m on increasing my doses too but the suggestion today was that having had covid can damage pancreatic function, my control has been worse since having it and does feel like my pancreas is giving up after struggling with doing anything much for the last 14 years
 
everydayupsanddowns said:
Yes I think you are right @CivicFreak it’s probably that you’ve lost a few of your remaining beta cells.

I remember that happening for a year or so after diagnosis, and then my doses seemed to settle, and have just settled into a cycle of ”up a bit… down a bit…” with *some* predictability and quite a lot of randomness.
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I agree. I think this is exactly what is happening.

I haven't yet experienced my insulin needs change based on the season either - they have only increased so far. Still early days though. I hear you on the randomness though. I find it so odd that I can have fairly long periods of stability and all of a sudden everything is thrown off and it feels like going back to square one - for no apparent reason. The human body is definitely a strange and complex machine.
 
Yes, there is definitely an ebb and flow effect with my diabetes management and I will have weeks of stability, often with the same basal doses and then it all goes haywire and that usually means I need to tweak my basal and then after a period of turmoil, when I do my best and try not to get too concerned about it, it will settle down again. I am learning that this is just the nature of the beast and roll with it and it will come right again in due course.

I dropped another 2 units off my basal last night (down to 0 now so no evening Levemir injection :D ), so that is 6 units I have reduced in a day and a half, as I hypoed the night before last twice and Libre showed me in the red several times yesterday although finger pricks were low 4s. Will be interesting to see if that settles it or if I need to reduce any more.
 
rebrascora said:
Yes, there is definitely an ebb and flow effect with my diabetes management and I will have weeks of stability, often with the same basal doses and then it all goes haywire and that usually means I need to tweak my basal and then after a period of turmoil, when I do my best and try not to get too concerned about it, it will settle down again. I am learning that this is just the nature of the beast and roll with it and it will come right again in due course.

I dropped another 2 units off my basal last night (down to 0 now so no evening Levemir injection :D ), so that is 6 units I have reduced in a day and a half, as I hypoed the night before last twice and Libre showed me in the red several times yesterday although finger pricks were low 4s. Will be interesting to see if that settles it or if I need to reduce any more.
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Blimly I couldn't imagine taking no evening livermirr even if I had a really busy day. Like depending on how things(weather things are worked out I get expected for shift) I might work a few hours 12 hour shifts with about 5 hours of travel I still couldn't imagine taking nothing)
 
rayray119 said:
Blimly I couldn't imagine taking no evening livermirr even if I had a really busy day. Like depending on how things(weather things are worked out I get expected for shift) I might work a few hours 12 hour shifts with about 5 hours of travel I still couldn't imagine taking nothing)
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If you were hypoing through the night twice on 2 units, then it is the logical thing to do! It would be stupid to continue taking 2 units at bedtime when it is dropping my levels too low and it meant I could comfortably go to bed on 4.8 instead of bumping up my reading with carbs at bedtime.

I was on 6 units at night last week and then 5 and and then 4 and then 2 and now 0 and morning dose has come down from 25 to 20 in the last week. This is why I love Levemir, My body's needs vary so much and along with Libre, it allows me to adjust it so easily and that is how i keep my TIR mostly in the 90s or high 80s.
Having the information (from Libre and skipping meals/low carb) and confidence (gained from experience and DAFNE course) to make those changes, is key to my good management along with having a basal insulin which allows me to make those changes in real time and see the results.
 
rebrascora said:
If you were hypoing through the night twice on 2 units, then it is the logical thing to do! It would be stupid to continue taking 2 units at bedtime when it is dropping my levels too low and it meant I could comfortably go to bed on 4.8 instead of bumping up my reading with carbs at bedtime.

I was on 6 units at night last week and then 5 and and then 4 and then 2 and now 0 and morning dose has come down from 25 to 20 in the last week. This is why I love Levemir, My body's needs vary so much and along with Libre, it allows me to adjust it so easily and that is how i keep my TIR mostly in the 90s or high 80s.
Having the information (from Libre and skipping meals/low carb) and confidence (gained from experience and DAFNE course) to make those changes, is key to my good management along with having a basal insulin which allows me to make those changes in real time and see the results.
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No I wasn't saying you were doing the wrong thing I just couldn't imagine that would be me basically saying I think my body would still need something.
 
Your body can and will change, maybe not tomorrow or next month or next year but I think you can "never say never" with diabetes. The goal posts change and you have to change with them. I may need a unit or two of Levemir tonight if I don't get out for a walk or chop and stack that pile of logs that is waiting for me. I will have a good idea tonight from what my evening levels are doing as to whether I will need some.
Our wonderful ex administrator @Northerner doesn't use any basal insulin at all and hasn't for the last 10 years. I would be more than happy to get to that situation myself, but think it is unlikely.
 
Speaking of athough DAFNE I keep getting excited vwhen either get post thinking maybe it's the referral letter but it never is. I'm actually stugellinf with evening dose of livermir I can't get it right at moment. Oh yes I know goal posts change
 
rebrascora said:
Hope I didn't jinx you! 😱
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Nah it just seems to be that 5 units of livermir in the evening is not enough but 5.5 is too much for the middle of the night.
 
rayray119 said:
Nah it just seems to be that 5 units of livermir in the evening is not enough but 5.5 is too much for the middle of the night.
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Then adjust your BG before bed, so have a few carbs to push your levels up a bit higher than normal and use the 5.5 or if your levels are about 5 or 6 you could just use 5 units.
This is what I did last night.... I didn't take any Levemir so I went to bed on a lower number (4.8) than I normally would because I knew 0 units was likely not quite enough but 1unit would probably be too much and I really wasn't going to be bothered to inject just half a unit when it wasn't necessary. Normally I wouldn't go to bed lower than 6, usually about 7 but no higher than 8, so going to bed on a lower number mitigated not having quite enough basal in my system and there was very little chance of me hypoing because there was only the very tail end of my morning dose.
 
rebrascora said:
Then adjust your BG before bed, so have a few carbs to push your levels up a bit higher than normal and use the 5.5 or if your levels are about 5 or 6 you could just use 5 units.
This is what I did last night.... I didn't take any Levemir so I went to bed on a lower number (4.8) than I normally would because I knew 0 units was likely not quite enough but 1unit would probably be too much and I really wasn't going to be bothered to inject just half a unit when it wasn't necessary. Normally I wouldn't go to bed lower than 6, usually about 7 but no higher than 8, so going to bed on a lower number mitigated not having quite enough basal in my system and there was very little chance of me hypoing because there was only the very tail end of my morning dose.
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I did eat before bed problem Is I think I still might need more in early hours of morning as well. So diffinatlly cant get things right with the evening livermirr at the moment no matter what I do. I'm tried all sorts of things.
 
rayray119 said:
I did eat before bed problem Is I think I still might need more in early hours of morning as well. So diffinatlly cant get things right with the evening livermirr at the moment no matter what I do. I'm tried all sorts of things.
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Well in not entirely sure I do if that's but to me it doesn't seem like a good idea to to do something I know might cause issues in the middle of night eppasilly knowing ive seplt though hypos(I woke up this time because I was plumting") in the past and probably still sometimes do so don't really so without something to alerm me I can't really justify it.
 
Also I don't always take my livermirr when I go to bed. As I take it around 9 in the evening. Remember I don't have something telling me what's going all the time at the moment so can't apply that logic 🙂
 
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