Insulin use

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Northerner said:
I am Diabetes Freak Man! 😱 😉
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So I'm another Diabetes Type 1 Freak Man! Some of you may remember that my biggest control problem was getting large and variable BG drops overnight (early morning hypos), and neither my consultant nor I could figure out the root cause.

However, after getting guidance from this web site on better understanding of how to check basal level, insulin-carb ratios and developing a complex spreadsheet for monitoring, I think I now have the answer ..... I don't need any Lantus, just Humalog bolus.

This is how it has changed ...

Up to: Feb 2013:
1. TDD of 65 with 12 Lantus (18%). Overnight drop (ave) = 5, Max = 8 to 9 mmol/L!! This caused hypo on waking (<3) often 2/week.

2. Basal fasting tests at various times of day always gave variable results .. just not consistent .. but 12 Lantus seemed 'reasonable'. Often got unexplained BG drop late afternoon.

3. Large overnight BG drop often associated with high bolus dose for evening meal (>22u). So Humalog seems to carry on working well past the normal 4-5hrs in my body. So this provides enough background insulin

4. Did trials with no evening meal/bolus .... NO real BG drop so confirmed likely cause due to too much insulin (in total) overnight.

5. Ave evening meal was 48 carbs

March 2013:
1. Gradually reduced Lantus to ZERO for a month .. now let's see what happens? Checked for Ketones .. all OK (I have never experienced any raised ketones in 43 yrs of Type 1.)

2. TDD of 65-ish with 0 Lantus (0%). Overnight drop (ave) = 2 (so half what it was), Max = 3 to 4 mmol/L!! No hypo on waking (<3) apart from one high Humalog dose for evening meal.

3. Reduced evening meal carbs from ave 48 to 38

BUT ... End April 2013:
1. Diagnosed with new autoimmune disease (No.5 for me!) - "Vasculitis (inflammation of the blood vessels)" .... http://www.vasculitis.org.uk/about-vasculitis/what-is-vasculitis

2. Large steroid dose required, so had to restart Lantus to get enough background insulin to counteract the increased BG caused by steroid Prednisolone.

3. A few hypos on waking again, but starting to reduce steroid dose and Lantus level, so not yet sure about future dose.

I am convinced I now know the root causes of my large overnight BG drops. Having a detailed spreadsheet over the past 9 months has really made this analysis relatively easy.

Jonty
 
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Fascinating Jonty! 😱 It would seem that we are:

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Which one are you? :D We need another member!
 
Yeah .. I like your sense of humour!!

BTW: the Vasculitis that I have is affecting my lungs (asthma sufferer .. so breathlessness), and luckily NOT my heart and kidneys ....

That website I linked is very good at explaining all the varieties in some detail. Like all UK medical sites .... generally much better than their US cousins :-(
 
JontyW said:
Yeah .. I like your sense of humour!!

BTW: the Vasculitis that I have is affecting my lungs (asthma sufferer .. so breathlessness), and luckily NOT my heart and kidneys ....

That website I linked is very good at explaining all the varieties in some detail. Like all UK medical sites .... generally much better than their US cousins :-(
Click to expand...

I hope that the treatment goes well Jonty.
 
My daughters TDD can be between 30 and 60 units, it all depends what she eats. Her basal total is approx 16 units per day (can't be exact as she is at school with her pump), the rest is bolus. She is around 30/70 with 30% being basal
 
According to Adam the pump my 14 day averages were:

TDD 27.65u broken down as 12.4u basal and 15.25u bolus for 266g of CHO.

Think I need to eat less :(
 
40/50 units per day with approx 55% basal. Quite often miss lunch. Enjoy brecky & T 🙂
 
I am very insulin resistant.....

basal 46 Units:

00.00 - 03.00 - 1u per hr
03.00 - 04.00 - 2u
04.00 - 08.00 - 3.5u
08.00 - 12.00 - 2u
12.00 - 16.00 - 1u
16.00 - 23.00 - 2u
23.00 - 00.00 - 1u

bolus on average about 80 units daily.

The addition of Metformin has not really reduced my insulin requirement :(
 
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