Levemir v/s Tresiba

[Amity Island]

Yes, I did. Over 3 nights. Three of the pm /am readings could not be different than each other.

Seeing my all night hyper numbers, i started taking 1 extra unit of levemir at night time. Still no satisfactory outcome.

Moved down by 1u cos I was waking up to almost hypo in the early hours. In fact 14u gave me hypos and 13u hypers. No half unit pens at my disposal.

The DSN is going to call me on Tuesday. Followed by a telephonic appointment with the Consultant in May. So fingers and toes crossed.

What sort of meals do you eat, typically from day to day? I find any high fat or high protein meals can effect blood sugars hours and hours after.

 

[Purls of Wisdom]

What sort of meals do you eat, typically from day to day? I find any high fat or high protein meals can effect blood sugars hours and hours after.

I eat Oats porridge with berries for breakfast. Would love to eat Weetabix but it gives me a steep high.

My lunch is usually Oats with a banana or an apple cos it is easy. It also could also be homemade soup or cheese sandwich. During holidays, salad and eggs are eaten frequently.

Dinner used to be homemade curry or lentils with 2 small chapattis, which also gave me all night hypers. So grudgingly I have stopped eating whole meal chapattis and replaced them with 1 slice of bread. Another fav is pan-fried fresh vegetables with seeds and light sprinkling of cheese.

During height of winter, I used to treat myself to a cup of hot milk, this also gave me all night hypers. Gave up on that too. Now I drink Barley Cup Fibre drink with ⅓ semi skimmed milk and the rest water.

I am culprit of taking sugar free tablets in my breakfast cereal and tea. Something i am not proud of but can't give up.

I try not to snack. Digestive biscuits or KIND nut bars are my go to slow releasing carbs choices.

I have spend months blaming food and self beating. On many days I get very hungry.

 

[Purls of Wisdom]

Put it in writing that you are struggling with your diabetes management and would like a referral onto a DAFNE (Dose Adjustment For Normal Eating) course and send a copy to your GP and a copy to your Consultant. Your DSN has no right to exclude you from an education course because he/she feels it will not help you.

I shall persevere.

There is no "best time" to take basal and bolus insulin, only what is best for your body. You have to experiment to find what works for you. That involves keeping records and spending some time going through them to figure it out. Once you figure it out, then you may need a bit of tweaking every now and then but mostly you find a routine which works well most of the time for your body and the insulin you use and the food you eat.
For me, that is injecting my morning basal and breakfast bolus (usually + 1-2 units) as soon as I wake up and before I get out of bed. Usually around 7am but if I wake up earlier and I am getting up then it might be 6am or if I have a lie in it might be 8 or even 9am. My evening basal is usually before bed but sometimes I go through spells where my levels start to drift upwards on a night and I need to take it at 7 or 8pm instead of the usual 11pm-12midnight. My evening basal dose needs regular tweaking depending upon what I have done during the day, so a mostly sedentary day will mean I need 1-2 units more at night, a very active day will mean less. 2 physically active days in a row and I don't need any evening basal..... but my average evening dose is 2-3units so dropping to zero isn't a massive drop.

Impossible for me to even think about reducing insulin.

I need about 45mins prebolus time with Fiasp before my usual yoghurt and berries low carb breakfast and 10-20 mins at other times of day. If my levels are 8 or above when I inject I will need to wait longer, if they are in the 4s I will need to wait less time or can sometimes eat straight away.

Is my choice of breakfast wrong? Oats or weetabix? I enjoy eating them and find them satisfactory. This is coming from someone who did not eat breakfast before being diagnosed.

when you are waiting for longer before eating, do you take correction dose too?

These timings and adjustments work well for me but it has taken me 4 years to understand how my body and insulin works and fine tune this regime to fit. I can almost guarantee that it will not work for your body, because you eat different food and have a different gut biome and metabolism and different lifestyle and different insulin.

Understandably too.

I have no idea what you mean about Dr Bernstein suggesting that morning and evening doses being 8.5 hours apart although if you mean 8.5 hours between evening Levemir and morning, I suppose that is pretty much what I do.... when I need an evening dose, but often I don't need any evening basal. Exercise the previous day takes care of Dawn Phenomenon for me and I inject the +1-5-2 units of bolus insulin mentioned above before I get out of bed to deal with Foot on the Floor Syndrome.

I have watched the occasional You Tube video by Dr Bernstein and it is interesting.... and he is very impressive, but I "follow" what my body tells me rather than anybody else.... and that includes my consultant. I will bounce thoughts and ideas off my consultant but ultimately I make the decisions because I have to live with my diabetes and I know it and my lifestyle far better than he does. I think it is dangerous to take guidance from any one person, which is why this forum works so well, because it gives you an array of answers to choose from and then you experiment to find what works for you personally. It is one of the reasons I didn't offer to mentor you a month or so ago when you were asking. Discussing things on the open forum is where you have checks and balances to ensure that if I say something incorrect, someone else will spot it and correct me or say "that might work for you but it could be dangerous for someone else to try".
Taking advice from a range of sources and then figuring out if it will work for you is always better than just following one person's advice.

I must admit that I am a better pupil. I prefer to be explained what to do and why. Decisions left upon me will probably never see the day light.

If these doses keep your levels relatively steady in the absence of food, day and night (I note you only mention overnight basal testing... which is really only half the picture and I assure you you will not starve if you skip a meal once a day to test daytime levels), then Tresiba may well be a good choice for you BUT I very much doubt it will solve your diabetes management issues. Learning about how your body works will.... and DAFNE will help you to understand that.

I have only tried to test Basal rate and that to variable outcomes. Never had the opportunity to take it further. Reasons being, lack of knowledge. Rarely been in the desirable numbers. etc etc

Good that you are enquiring about a half unit pen but I don't understand your comment about only basal insulin needing it. I find half unit pens useful for bolus and basal and use the half unit option regularly.

Lack of knowledge again. Did not know that Bolus can also be administered in ½units. I am learning things the hard way, too hard if you ask me.

One of the main benefits of these pens though is that they tell you roughly how long ago your last dose was and how much you injected. This is incredibly useful for those "Did I or Didn't I" inject my insulin before this meal or before bed or whatever. After a while injecting becomes so automatic, I can do it whilst I am half asleep (if my high alarm wakes me in the night) and I can be back to deep sleep in minutes afterwards and not even need to put the light on and plenty of times I decide on a dose and then have a change of heart and add a bit more or less and then 5 mins later when I come to record it on my Libre reader I can't remember which dose I settled on in the end, but my Novo Pen Echo has it recorded, so it is a function that I use regularly.... and perhaps it is partl;y old age that I forget what I decided or if I injected when I got my pen case out or if I got distracted by that phone call and actually didn't inject as intended. I doubt I am alone in having these "senior" moments and being able to check the pen and see what I did really helps me keep on the straight and narrow..... Especially the time I injected 24 units of Fiasp before I got out of bed instead of 24 units of Levemir one morning!! 😱 Then I had to inject the 24 unts of Levemir correctly and then start eating carbs to soak up the Fiasp like my life depended on it. 🙄.... which of course it did! .

These are not senior moments. I have lost my so called marbles. I openly admit that I am not able to understand or retain information. I am v forgetful these days. Adds to my already heightened stress.

Is there a formula to determine how much basal one requires in a day? Based on one's body weight?

Do you seriously take 24u of Levemir each day?

Anyway, I am very aware that I have typed too much as usual. 🙄 Hopefully you will be able to follow most of my ramblings. If you have any questions, just ask.

Thank you.

If you want to post some photos of your Libre showing particular problems then do so,

I definitely will send you a couple days screen shots in the hope that you will be able to make some sense. I could not.

but first and foremost, you need to establish that your basal dose is correct during the day as well as the night, so perhaps do some basal testing as your basal dose is key to everything else making sense.... and log as much info on Libre as you can at least for the time being whilst you are having problems.

Please correct me if I am wrong ... in order to do night time Basal rate test, I take my bolus at 6:00 and eat dinner. Take a finger prick reading. Inject Basal at 11:00pm, giving 6:00pm bolus a chance to finish working and basal to take over. Take note of the numbers I wake up to.

does this need repeating on 3 nights or once is enough? Should I follow it for the entire week?
do I need to finger prick test during the night too?
if yes, then how many hours apart?
here, i have not even looked into day time rate testing. Fun and games, eh?

keep asking for a DAFNE course and put it in writing to make it difficult for them to say "NO" and ask for a written explanation of why they will not refer you onto it if they keep saying "NO" Make it easier for them to just say YES and chase it up if you don't hear anything afterwards.

Focus on just one aspect of your diabetes at a time. So basal first. Get that reasonably well sorted and maybe take at least a week just to work on that and just go through the motions with everything else and then look at individual meal times and ratios, maybe one week to get breakfast sorted and then next week lunch and then evening meal.

It is impossible to focus on sorting one meal as same breakfast gives different readings on each day! I stuck to the initial ratios until now. They obviously have not worked. Experimenting with changing them, to my utter dismay. There is so much happening inside my body and so much more to learn. I feel as if i am fighting a losing bettle and there is no end to the complexities of T1.

Then move on to working out corrections.

Another bain of my life. All i ve understood is that if my numbers are higher than10mmol/L and it has been 4 hours since last bolus then i should take a correction dose (1unit to correct 3mmol/L). If it is less than 4 hours and i am about to eat, then i should add those correctional units to the meal i am going to eat. Honestly speaking, i ve tried following all these rules but in vain. Stress overload.

Then move on to timing of your bolus doses. Gradually once you start to get things ironed out a bit, you will start to not just see the wood for the trees but be able to identify the species of tree. You need to approach it slowly and systematically though.

Why am I not able to understand the basic ways to manage this horrible life long ailment? Everyone must be fed up of listening to my problems by now.

 

[Purls of Wisdom]

@Purls of Wisdom to expands a little on what @rebrascora wrote about basal testing (yes, there is a lot to it), the reason why it is useful to do a basal test during the day as well as during the night is that our basal needs often vary between the day and night. And, confusingly, we are all different. Some may need more during the night and some may need more during the day. The great thing about Levemir (especially compared to Tresiba) is that you can take different mount sof basal for the day and night. I think you mentioned that you spend your days running around after children. If that is the case, it is very likely you may need less during the day. You may even find you need different doses when you have days off because you are not running around as much - I used to have a weekend and a week day dose. This is not possible with Tresiba because takes 3 or 4 days for a change to take effect.

The consultant had suggested the same. 13u for the weekday mornings and 14u for the weekends. 14u before bed time.

This is a very longwinded way of agreeing with rebrascora to do a day time basal test so you can work out what your morning Levemir dose should be. It is very unusual for it to be the same as your night time dose.

Once I get all the right information, I will be conducting the basal rate test. Specially since I am off work these days.

 

[rebrascora]

Is my choice of breakfast wrong? Oats or weetabix? I enjoy eating them and find them satisfactory. This is coming from someone who did not eat breakfast before being diagnosed.

when you are waiting for longer before eating, do you take correction dose too?

There is no wrong choice of breakfast as long as you bolus correctly for it. However I am sure I have mentioned to you before that you don't need to eat breakfast if you don't want to. I sometimes head out very early on just a cup of coffee and either have brunch or lunch later in the day. The benefit of a basal/bolus insulin regime is that you can eat your meals when you like or not eat at all ie skip meals or graze all day long. You just have to inject insulin as and when you need it.

I inject my bolus for breakfast plus any correction if I am above range, plus another 1.5-2 units to cover Foot on the Floor Syndrome BEFORE I get out of bed. Then I visit the bathroom and make a coffee and make my breakfast and sit down to catch up with the news here on the forum whilst I wait for my insulin to kick in (usually 45 mins) and then I eat my breakfast. I scan regularly to watch for my levels starting to come down and usually mid 5s is when I eat my breakfast.
If I am not going to have any breakfast I will still inject that 1.5-2 units to cover Foot on the floor and any correction needed, but not the actual breakfast bolus.

Please correct me if I am wrong ... in order to do night time Basal rate test, I take my bolus at 6:00 and eat dinner. Take a finger prick reading. Inject Basal at 11:00pm, giving 6:00pm bolus a chance to finish working and basal to take over. Take note of the numbers I wake up to.

I just look at my graph for my overnight basal test, in fact I just look at my graph for all my basal tests. I don't go off actual readings, I go off if my graph is drifting upwards or drifting downwards or nice and level.
I often skip meals because I don't feel the need to eat 3 meals a day, so I regularly check my basal is holding me steady at different times of the day and night without really planning a basal test as such, I just do it naturally/instinctively so it is quite hard for me to advise you on this.
The general DAFNE guidance is that if you need corrections during the day 3 days in a row then you need to look at increasing your basal insulin. Then you are supposed to leave it for 3 days to assess the impact of your change before you consider changing it again. When you get it right, everything is so much less frustrating.

Why am I not able to understand the basic ways to manage this horrible life long ailment? Everyone must be fed up of listening to my problems by now.

Do you only scan 8 times a day? For comparison, I average 35 scans a day over the past 30 days. All that information gives me a much better insight into what my levels are doing and whether I need to take any action or not. If I only scanned 8 times a day, I might as well just be finger pricking.

What do you have your high and low alarms set at?

To be honest, your graph is of much more use to you than the log as it shows all the ups and downs.

So.... the first of April one...
Am I right in thinking you went to bed on 13.3 and woke up on 16.3. What did you have for tea and what time did you eat? If you hadn't injected any insulin in the previous 4 hours before bed, did you consider injecting a correction at bedtime to bring those levels down a bit more into range?
I would have jabbed a couple of units if there was no longer any active bolus insulin in my system. If your correction factor is 3 then that would have brought you down to about 7.3, assuming I knew my evening basal dose was correct and holding me steady. Looking at your graph will help you to see if your basal is holding you steady, unless you ate late or your meal contained slow release foods.
You have mentioned that you have a milky drink at bedtime I think.... Do you bolus for that drink?

Am I right in thinking you woke up at 8.38am on 16.3. Did you inject your basal insulin at that time? Also, did you inject your breakfast bolus and any correction? How much bolus did you inject in total and can you explain how you came to that total? Was that reading whilst you were still in bed or had you got up and perhaps gone to the bathroom and maybe even having a coffee in the kitchen before you scanned? That is all really relevant information which will help you figure out what is going on.
What was your BG when you ate breakfast and how long did you wait?

It looks like your levels peaked in the 20s at 11.52am. Was there any particular reason why you scanned at that time? and did you take any action? Did you perhaps have a mid morning snack and possibly do a correction with it because your levels have dropped a reasonable amount by just over an hour later when I am guessing you bolused for lunch and then they have continued to drop into the afternoon which might suggest that morning basal is too high or might be that you have stacked correctios or seriously miscalculated a bolus injection at lunch. Do you have any notes that you can explain what you ate and how much insulin you calculated for it and how much correction you took and if you had any snacks or did any corrections.
Having checked the next day's log, it shows the reverse pattern so you can't make any judgement on basal from those two days results ie no clear pattern, so skipping meals over a few days is going to be the only way to give you a clear picture.

When you treat hypos, how disciplined are you?
On the 2nd of April, you scanned at 11.50 again and your levels were 9.9 and dropping rapidly (vertical downwards arrow) If that had been me, I would have scanned again in 10 mins and again in another 10 mins rather than wait until I was hypo and have to treat it. You can have a Jelly baby or a small amount of whatever you use to slow down a rapid drop like that if you get to 7 or 6 and it is still dropping to prevent yourself from having a hypo.
When you treated the 3.8 hypo at 1355hrs, what did you have? It would appear that you may have over treated it, since your levels bounced back up so high. I grade my hypo treatments according to how bad the hypo is. A 3.8 with a horizontal arrow would probably just get 1 or 2 jelly babies at most because it isn't significantly dropping any more and especially if it was just before I intended to have a meal as I want to keep my levels between 4 and 5 at the start of the meal, because it will only go upwards once I eat.
If I was 3.0 with a downward sloping arrow I would give it the full 3 jelly babies ie. 15g carbs. BUT my Libre alarm is set at 4.2 so when my alarm goes off, I have a jelly baby or two to prevent it going any lower.... again depending upon the arrow. If it was 4.2 with a vertical downward arrow, I might even have the full 3 JBs, definitely 2. I almost never have slow acting carbs afterwards otherwise they will send my levels into orbit. I am very sensitive to carbs and my levels go up much easier than they come down so I have to be very stingy with my hypo treatment. Without knowing what you used for this hypo it is hard to tell if your liver kicked in and helped you out or if you too need to be mean with your hypo treatment OR perhaps you ate lunch straight after without bolusing for it.... or bolused after you had eaten lunch which would cause levels to go sky high again.

Anyway, that is a very minor breakdown of some of the results over those two days, but without knowing exactly what you did when in detail, the amounts of insulin and the amounts af carbs and the timing of insulin and food and testing relative to getting put of bed etc, it is mostly speculation. I find looking at the graphs more helpful, but you still need to know all the background information for it to make sense like what your bolus was and how many carbs that was to cover and was there a correction involved and if so, how you come to that number of units. There is far too little data in what you have provided, but if you can answer all my questions above, I will look at it again.

 

[rebrascora]

Do you seriously take 24u of Levemir each day?

Yes most days, but some days I just need 20 if I am doing a lot of physical activity for a few days. That is actually a lot compared to some people but there are others who need more. It is very individual.

 

[Purls of Wisdom]

Yes most days, but some days I just need 20 if I am doing a lot of physical activity for a few days. That is actually a lot compared to some people but there are others who need more. It is very individual.

And that is once a day or twice? I know my body could be needing more insulin than someone else to cover the same meal.
I think I am almost over dosing with 27u, split over morning and night time.

 

[rebrascora]

And that is once a day or twice? I know my body could be needing more insulin than someone else to cover the same meal.
I think I am almost over dosing with 27u, split over morning and night time.

22units in the morning and 2 units at night, give or take a couple of units from day to day so yes, an average total basal dose of 24 units but we are all different. There are ladies on this forum who need much less and some who need more. There was a lady on my DAFNE who had been Type 1 for 50 years and only needed 2 units of basal insulin a day and hypoed almost every night sometimes very badly but was in the mid teens most mornings and she only needed 3-5 units of bolus insulin for her one meal a day, so a total of about 7 units for the whole day and night. There is a HUGE variation in what people need for bolus and basal insulin. It isn't just about food but metabolism and activity levels and yes body weight plays a part and hormones and insulin resistance, which isn't a finite thing but more a sliding scale and goodness knows what else. Lots of factors, which is why none of us can tell you what to do, because you will be different to each one of us.

 

[Leadinglights]

You don't seem to have been given all the tools to help you make these judgements for your self based on what and when you are eating, what activity you have been doing so everything seems confusing. You must press for the DAFNE course or have you tried the on line BERTIE course which I think was mentioned ages ago when you were struggling.
I would suggest you keep really good notes either electronically or even in a note book of exactly what you are doing, what you eat and when and what activity you do. It might help spot patterns or indeed if there are no patterns which can be just as useful. I know it sound a phaff and intrusive but it may help to focus you.

 

[Purls of Wisdom]

There is no wrong choice of breakfast as long as you bolus correctly for it. However I am sure I have mentioned to you before that you don't need to eat

OMG! Just the thought of not eating has sent God's fear in me. I can't seem to move away from the thought of feeling hungry, specially at night time.

breakfast if you don't want to. I sometimes head out very early on just a cup of coffee and either have brunch or lunch later in the day. The benefit of a basal/bolus insulin regime is that you can eat your meals when you like or not eat at all ie skip meals or graze all day long. You just have to inject insulin as and when you need it.

I used to be like that. Had tea and off i went to work.

I inject my bolus for breakfast plus any correction if I am above range, plus another 1.5-2 units to cover Foot on the Floor Syndrome BEFORE I get out of bed.

The range given to me is 10mmol/L. I am not happy about it but there is nothing i can do, despite all my hard efforts. How do you establish FOTF Syndrome? Do you take it every day irrespective of your readings? And correctional dose? How much are you out of range before adding extra units? What if it is a case on every morning? I ve been advised that 1u for 2 or 3mmol/L. I work it on the basis of 1:3. Not that it works anyway.

Then I visit the bathroom and make a coffee and make my breakfast and sit down to catch up with the news here on the forum whilst I wait for my insulin to kick in (usually 45 mins) and then I eat my breakfast. I scan regularly to watch for my levels starting to come down and usually mid 5s is when I eat my breakfast.

I wait for 15 to 20mins, as told. Honestly speaking, I got told off by the DSN when told her that I waited for much longer than anticipated before eating. How long do you wait for? was my next question, but you ve already answered that.

If I am not going to have any breakfast I will still inject that 1.5-2 units to cover Foot on the floor and any correction needed, but not the actual breakfast bolus.

Does that not send you in a hypo? I only did this once where I basaled and not bolused for a day and half. I ended up in the hospital with sharply rising ketones. It is called a liver dump, I was told.

i just look at my graph for my overnight basal test, in fact I just look at my graph for all my basal tests. I don't go off actual readings, I go off if my graph is drifting upwards or drifting downwards or nice and level.

I tend to avoid the graphs as they make no or very little sense to me.

I often skip meals because I don't feel the need to eat 3 meals a day,

I can eat for two, if i could. Always hungry. Even tried going to bed to distract myself. It works sometimes.

so I regularly check my basal is holding me steady at different times of the day and night without really planning a basal test as such, I just do it naturally/instinctively so it is quite hard for me to advise you on this.

Fair enough. I am sure i will reach there one day.

The general DAFNE guidance is that if you need corrections during the day 3 days in a row then you need to look at increasing your basal insulin. Then you are supposed to leave it for 3 days to assess the impact of your change before you consider changing it again. When you get it right, everything is so much less frustrating.

Yes, when one gets it right but when is that going to come my way? Re corrections - i understand the 3 days rule. What if one needs corrections more than once in a day for 3 days?

Do you only scan 8 times a day? For comparison, I average 35 scans a day over the past 30 days. All that information gives me a much better insight into what my levels are doing and whether I need to take any action or not. If I only scanned 8 times a day, I might as well just be finger pricking.

I am not making this up, the DSN ticked me off for scanning. You are constantly scanning. Then you are looking at those readings and getting yourself in a knot. Not necessary, she told me. In the days before the readers and scanners, people only checked 2 times a day and that's it.

What do you have your high and low alarms set at?

my low alarm is set at 4.5 and high at 13mmol/L.

To be honest, your graph is of much more use to you than the log as it shows all the ups and downs.

I need to learn to read the graphs correctly.

So.... the first of April one...
Am I right in thinking you went to bed on 13.3 and woke up on 16.3. What did you have for tea and what time did you eat?

I went to bed on 31st March at 12.7mmol/L. Scanned in the middle of the night and it read 13.3mmol/L. I woke up in the morning at 8:40, reading 16.3mmol/L. I basaled (14u) and bolused (9u) plus 1u as correctional dose. Breakfast usually is 32g of Carbs. Looking back it is not making sense to me either.

I was borderline hypo L2 3.9 and on GM 4.4, around 7:00pm. Pan-fried veg with salad and a pear. Total carbs 55g. Bolused 8u NR. Ratio 1:7.

Around 11:00, it read 7.7. I basaled 14u and went to sleep.

On April 2nd at midnight it read 13.0. Woke up in the morning, to 11.1. Bolused and basaled, ate breakfast around 9:00am. Went out to the Craft store. By 11:00, I was going down, 9.9mmol/L. At 2:00pm, it read 3.8 on L2 and GM read 4.2. I ate a small banana as I was heading home.

6:00pm the reading was 13.1. It continued going up. At 7:45 it went as high as 20.0mmol/L on the scanner. Then it started going down to L2 16.8 (14.8 on the GM) and then 16.0. At bed time I was 14.6. I basaled and went to bed only to be woken up reading 19.4.

Would it help if i send you the images of graphs?

If you hadn't injected any insulin in the previous 4 hours before bed, did you consider injecting a correction at bedtime to bring those levels down a bit more into range?

I would have jabbed a couple of units if there was no longer any active bolus insulin in my system. If your correction factor is 3 then that would have brought you down to about 7.3,

How do i establish what my real correction factor is? I just go with 3u per extra unit.

assuming I knew my evening basal dose was correct and holding me steady. Looking at your graph will help you to see if your basal is holding you steady, unless you ate late or your meal contained slow release foods.
You have mentioned that you have a milky drink at bedtime I think.... Do you bolus for that drink?

In that milky drink it was mere ⅓ cup of milk, less than 100ml (<4g) and the rest was water. So I did not see the need to bolus.

Am I right in thinking you woke up at 8.38am on 16.3. Did you inject your basal insulin at that time? Also, did you inject your breakfast bolus and any correction? How much bolus did you inject in total and can you explain how you came to that total? Was that reading whilst you were still in bed or had you got up and perhaps gone to the bathroom and maybe even having a coffee in the kitchen before you scanned? That is all really relevant information which will help you figure out what is going on.

Yes, I injected later than usual due to holidays. I took 14u of Levemir, cos thats what i am told, no maths required. Took 10u NR. 9u for 32g of carbs breakfast and 1 as correction dose. I used to follow 1:5 ratio but decided to be brave and lowered the ratio plus 1 extra unit. I usually sit up in bed and scan. Go to bathroom and inject. Prepare the breakfast and shower and then eat. It roughly takes 30mins.

What was your BG when you ate breakfast and how long did you wait?

I usually miss scanning at the time of eating.

It looks like your levels peaked in the 20s at 11.52am. Was there any particular reason why you scanned at that time? and did you take any action?

I usually scan around that time when i am about to go to the PG duty which is longer than an hour. No action taken.

Did you perhaps have a mid morning snack and possibly do a correction with it because your levels

no snack and no action taken.

have dropped a reasonable amount by just over an hour later when I am guessing you bolused for lunch and then they have continued to drop into the afternoon which might suggest that morning basal is too high or might be that you have stacked correctios or seriously miscalculated a bolus injection at lunch.

No idea what made it drop. Only bolused 5u for lunch. No corrections or stacking for that matter. Mind boggles.

Do you have any notes that you can explain what you ate and how much insulin you calculated for it and how much correction you took and if you had any snacks or did any corrections.

It must ve been a cheese sandwich with salad. None to the rest.

Having checked the next day's log, it shows the reverse pattern so you can't make any judgement on basal from those two days results ie no clear pattern, so skipping meals over a few days is going to be the only way to give you a clear picture.

That's what the real problem is. There aren't 2 days which are same. It confuses my already frazzled brain.

When you treat hypos, how disciplined are you?

if it is a real hypo. I treat it with 3 Lift glucose tabs. Scan again after 10 or so mins and usually i am on my way up. Lately the L2 has been showing false hypos. I always finger prick to double check.

On the 2nd of April, you scanned at 11.50 again and your levels were 9.9 and dropping rapidly (vertical downwards arrow) If that had been me, I would have scanned again in 10 mins and again in another 10 mins rather than wait until I was hypo and have to treat it. You can have a Jelly baby or a small amount of whatever you use to slow down a rapid drop like that if you get to 7 or 6 and it is still dropping to prevent yourself from having a hypo.

Thank you explaining with real numbers. 9.9 somehow means normal to me. I was told to eat something slow releasing if I am at 5 and am going to be out and about such as leaving work or going to PG duty.

When you treated the 3.8 hypo at 1355hrs, what did you have?

i was out. The GM read 4.2. I ate a medium banana to stop the downward trend. It must have been the late lunch which sent readings shooting upwards.

It would appear that you may have over treated it, since your levels bounced back up so high. I grade my hypo treatments according to how bad the hypo is. A 3.8 with a horizontal arrow would probably just get 1 or 2 jelly babies at most because it isn't significantly dropping any more and especially if it was just before I intended to have a meal as I want to keep my levels between 4 and 5 at the start of the meal, because it will only go upwards once I eat.
If I was 3.0 with a downward sloping arrow I would give it the full 3 jelly babies ie. 15g carbs. BUT my Libre alarm is set at 4.2 so when my alarm goes off, I have a jelly baby or two to prevent it going any lower.... again depending upon the arrow. If it was 4.2 with a vertical downward arrow, I might even have the full 3 JBs, definitely 2.

If there is one thing i am sure about re diabetes is not to over treat a hypo. If i am going low, i would take 1 gluco tablet. Check again. Still going down then i will take the other 2. Going low before pg duty or finishing work definitely demand a piece of fruit or a digestive. I am under the impression that after treating a hypo, must eat 10g of slow releasing carbs.

I almost never have slow acting carbs afterwards otherwise they will send my levels into orbit. I am very sensitive to carbs and my levels go up much easier than they come down so I have to be very stingy with my hypo treatment. Without knowing what you used for this hypo it is hard to tell if your liver kicked in and helped you out or if you too need to be mean with your hypo treatment OR perhaps you ate lunch straight after without bolusing for it.... or bolused after you had eaten lunch which would cause levels to go sky high again.

None of the above. No lunch straight after bolusing. No after the meal bolusing. Never.

Anyway, that is a very minor breakdown of some of the results over those two days, but without knowing exactly what you did when in detail, the amounts of insulin and the amounts af carbs and the timing of insulin and food and testing relative to getting put of bed etc, it is mostly speculation. I find looking at the graphs more helpful, but you still need to know all the background information for it to make sense like what your bolus was and how many carbs that was to cover and was there a correction involved and if so, how you come to that number of units. There is far too little data in what you have provided, but if you can answer all my questions above, I will look at it again.

Thank you for putting so much effort into my case scenario. I shall keep a detailed diary starting from tomorrow morning. Hoping for a positive outcome after all this hard work.

Thanking you again. Good night! Sleep well!!

This last image is of today's graph.

 

[Purls of Wisdom]

OMG! I woke up to 4.9 with a horizontal trending arrow. Supposedly been in a hypo for hours while asleep. Looking back at the readings, they are so inconsistent that it is hard to decide whether to take a Basal reduction or not.

Last night, I ate a full portion of weetabix as my dinner at 6:30. Basaled at 10:30. Usually weetabix gives me a high reading but yesterday, I was 6.6 at bedtime. The BG stay within the range till 3:00am and then dipped. I did not feel any symptoms.

 

[rebrascora]

Did your alarm not wake you up? What is your alarm set at? Could it be that you slept on your side all night and it is a compression low rather than an actual hypo?.... Assume you didn't wake up and test with a finger prick?

 

[Purls of Wisdom]

Did your alarm not wake you up?

no, it usually does not.

What is your alarm set at?

4.5

Could it be that you slept on your side all night and it is a compression low rather than an actual hypo?....

I hope so otherwise the consequences could be fatal.

Assume you didn't wake up and test with a finger prick?

Not this time.

 

[Purls of Wisdom]

I have been keeping detailed notes as suggested. Please take your time to read them and advise. Thanks. Much appreciated.

Saturday

Woke up - 4.6mmol/L
Basal - 14u
Bolus - 9u
Breakfast reading 6.2mmol/L
Carbs - 32g
Porridge Oats with milk, frozen berries and chia seeds. Tea.
Waiting time - 30 mins
Ratio - 1u:3.55g
Physical activity - light household chores, showered and out for a small food shopping.
* unsure about the FOTF Syndrome
2 hours later the BG jumped to 12.3
2 hours later the BG is back to 8.4

Lunch 1:30pm
Reading 8.4
Bolus - 10u
Carbs - 50g
2 x slices of seeded WM bread (34g)with 2 sunnyside up eggs. ½ small can of Heinz beans (16g). Tomato and Cucumber salad. Tea.
Waiting time - 45 mins. Got delayed as cooking for the football crazy family.
Ratio - 1:5
Physical activity - Tidying up after lunch and laundry. Watched TV for a while.
2.5 hours after eating BG jumped to 9.6
1.5 hours after the BG is 5.2

Dinner - 7:15pm
Bolus - 10u
Carbs - 49g
Dinner reading - 6.3mmol/L
Yellow Lentil pasta with veg and store bought sauce. Lindhal KVARK with granola.
Waiting time - 15 mins
Ratio - 1:5
Physical activity - Tidying up kitchen, a girls' movie night in.
2 hours later the BG jumped to 14.8mmol/L
Ate small amount of microwave popcorn.
2 hours later the BG went further up to L2 22.4 and on Gluco Meter 20.4. Ketones 0.2

Basal - 14u
Correctional Bolus 3u

Thru the night BG kept up rising and reached 25+mmol/L by midnight. The only difference I can see is the waiting time. I was 5.2mmol/L that's why I did not wait for longer. Or my insulin needs are different. Or carb calculation was wrong. This sort of pattern is not new to me, BG behaves for part of the day and then goes up sharply and takes a long time to come down in range.


Sunday

Breakfast - 9:00am
Woke up - 15.0mmol/L
Basal - 14u
Bolus - 9u + 2u
Breakfast reading 15.6mmol/L with downward trend.
Carbs - 32g
Porridge Oats with milk, frozen berries and chia seeds. Tea.
Waiting time - 55 mins
Ratio - 1u:3.55g
Physical activity - usual Sunday household chores, cleaning, too much excitement due to pre wedding event in the evening.
2 hours later the BG read 6.1mmol/L
20mins later it was 4.5mmol/L
Ate 1 glucose tablet
30mins later - 6.3 with diagonally upwards arrow
30mins later - 4.4mmol/L Flat arrow
2 hours later the BG is back to 3.0
Took 2 glucose tablets

Lunch 2:00pm
Reading 3.0
Bolus - 8u
Carbs - 44g
A thin seeded WM bagel(33.5g)with cheese and an apple(10g). Tea.
Waiting time - 55 mins.
Ratio - 1:5
Interuppted lunch to treat a hypo.
Physical activity - preparing for the evening event. A close family affair.
3 hours after lunch BG was 7.6
Left home for the venue.

Injected 4u before eating the refreshments and later starters, 2 hours later, BG rose to 18.4.

It continued rising. Another hour later, it read 23.4 on L2 and 19.7 on GM.
Injected 15u before the main meal, 12u for dinner plus 3 as correction.

Returned home after midnight. The L2 scanned 15.1.
I basaled 14u and bolused 2u. Slept all night. Woke up to 10.1mmol/L

Breakfast Easter Monday

Basaled 14u and bolused 9u.
Porridge Oats with milk, chia seeds and frozen Raspberries.
2.5 hours later 7.8mmol/L

Lunch 2:00pm
Reading - 4.5 ate 2 sm chocolates
Eating time reading was 7.1
Bolus - 8u
Carbs - 40g
A thin seeded WM bagel(33.5g)with cheese and half an apple(6g).
Waiting time - 1.10mins
Ratio - 1:5

Activity - sorted some paper work

3 hours after lunch BG was 5.7

Dinner
Bolus - 10u
Reading at insulin time 8.7
Waiting time - 65mins
Carbs - 50g
Ratio - 1:5
Reading after 35mins 5.9
Reading at eating time 4.2mmol/L

Weetabix (26g). 300ml semi skimmed milk (14g) 100g frozen raspberries (5g). Too many I gathered after eating. Only 80g in one portion.

Activity- An hour of TV watching. Washing and Tidying up after dinner. An early night for me.

Thanking you from the bottom of my heart.

 

[Purls of Wisdom]

A couple of more questions as always ...

What is better - waiting for longer after NR before eating or taking extra units to bring BG down?

Can NR be taken under 4 hours from the previous dose if need be? Will that cause stacking?

Is it safe to take correction dose more than once in a day? I know correction doses 3 days in a week, indicates change in basal dose.

 

[helli]

What is better - waiting for longer after NR before eating or taking extra units to bring BG down?

Waiting is definitely better. Otherwise you are giving yourself too much insulin and will hypo. Assuming your carb counting and insulin to carb ratio is correct.

Can NR be taken under 4 hours from the previous dose if need be? Will that cause stacking?

Yes, bolus can be taken under 4 hours apart but you need to take into consideration ”insulin on board” (iob) which is the unused bolus. This is usually calculated assuming NR lasts for 4 hours and is used at a constant rate. So, after 1 hour, 3/4 of the dose remains; after 2 hours, half of the last dose remains and, after 3 hours, a quarter remains.

Is it safe to take correction dose more than once in a day? I know correction doses 3 days in a week, indicates change in basal dose.

Yes you can take more than one correct per day but I would not take a second correction dose within 4 hours of the last correction.
I disagree that correction dose 3 days in a week indicates change in basal. It could mean your bolus ratio is incorrect, incorrect carb counting or that you are stressed (physically or mentally) such as a tough meeting, tough exercise or an injury or hay fever or …

 

[rebrascora]

Well Saturday looks good until after your evening meal, so most of the day was really great.
My gut feeling is that you under estimated the carbs for your evening meal. 49g carbs for the pasta and sauce and kvarg with Granola seems like an under estimation unless they were very small portions. I also wonder if the yellow lentil pasta might be releasing more glucose than the nutritional info suggests. There are some people whose digestive system seems to be able to extract more carbs from lentils than the info says. Add to that figuring out how much dry weight of pasta gives you the carbs in the cooked weight usually quoted on the packaging can be confusing. They are also usually quite slow release carbs so they will often continue "giving" well into the night.

Having more carbs (popcorn) when your levels were already high (14) will have added to the problem and then sitting watching a movie afterwards may all have contributed to those levels going high. I doubt it is the timing.

I think lentils and lentil pasta may need a lot more experimentation for you to figure out if you are like me and others who get almost twice as much carbs from them as they are supposed to contain. Doesn't mean you can't eat them but you may need to inject more insulin for them.

Sunday, I am wondering if your chores are perhaps a bit more exertive and that caused your levels to drop too low by lunchtime, or perhaps the excitement of the event in the evening.

Sunday

Breakfast - 9:00am
Woke up - 15.0mmol/L
Basal - 14u
Bolus - 9u + 2u
Breakfast reading 15.6mmol/L with downward trend.
Carbs - 32g
Porridge Oats with milk, frozen berries and chia seeds. Tea.
Waiting time - 55 mins
Ratio - 1u:3.55g
Physical activity - usual Sunday household chores, cleaning, too much excitement due to pre wedding event in the evening.
2 hours later the BG read 6.1mmol/L
20mins later it was 4.5mmol/L
Ate 1 glucose tablet
30mins later - 6.3 with diagonally upwards arrow
30mins later - 4.4mmol/L Flat arrow
2 hours later the BG is back to 3.0
Took 2 glucose tablets

Great that you had a dextrose tablet to try to ward off the hypo, but after rising to 6.3, levels dropped again to 4.4 and in your position I would have had another 1-2 Dextrose tablets at that point to nudge levels up a bit again, since the drop in levels was being persistent. I would also have made a point of testing regularly during that time to keep a close eye on things because levels were dropping lower than expected. Waiting until you were hypo with a reading of 3.0 was just a missed opportunity to avoid a hypo, if you had had them earlier.

Lunch 2:00pm
Reading 3.0
Bolus - 8u
Carbs - 44g
A thin seeded WM bagel(33.5g)with cheese and an apple(10g). Tea.
Waiting time - 55 mins.
Ratio - 1:5
Interuppted lunch to treat a hypo.
Physical activity - preparing for the evening event. A close family affair.
3 hours after lunch BG was 7.6
Left home for the venue.

I am very much hoping that this is the 3.0 that you treated with 2 Dextrose tablets and that you didn't inject your bolus for lunch until your levels were back up above 4. Did you really then wait 55mins before eating lunch? If so, this will be why you hypoed again during lunch. Your levels had been dropping throughout the morning and were low at lunchtime so that should warn you that you are at risk of another hypo and you will need much less prebolus time, if indeed any prebolus time in that situation.

Do you understand that prebolus timing varies with the time of day and the type of food you are eating? So for instance, I need 45 mins prebolus time at breakfast but only 15-20 mins at lunchtime or evening meal, sometimes less. If my levels are low before my meal (in the 4s and 5s), I will need less prebolus time if any, compared to when my levels are in the 6s and 7s before a meal when I will need to wait a bit longer.
If I am going to have something fast release like a banana I will need more prebolus time than if I am going to eat pizza or lentils which are slow release because the insulin needs more of a head start when you are eating something with fast release carbs and less or no head start with slower release carbs.

Falling asleep right now as it is well past bedtime, so I will try to find time to comment on the rest later.

Hope you had a lovely time at the pre wedding event. X

 

[Purls of Wisdom]

Yes, bolus can be taken under 4 hours apart but you need to take into consideration ”insulin on board” (iob) which is the unused bolus. This is usually calculated assuming NR lasts for 4 hours and is used at a constant rate. So, after 1 hour, 3/4 of the dose remains; after 2 hours, half of the last dose remains and, after 3 hours, a quarter remains.

What to do when this is the case? The reason I need to understand is, there is a family wedding coming up. There will be diabetes unfriendly food and at different and more times of the day. Like you must ve read the example of my Saturday evening.

Yes you can take more than one correct per day but I would not take a second correction dose within 4 hours of the last correction.

I am aware of that, thanks.

I disagree that correction dose 3 days in a week indicates change in basal. It could mean your bolus ratio is incorrect, incorrect carb counting or that you are stressed (physically or mentally) such as a tough meeting, tough exercise or an injury or hay fever or …

Since I ve changed the bolus ratio, I am staying at borderline numbers. A tricky move as things can go low fairly quickly.

 

[Purls of Wisdom]

Well Saturday looks good until after your evening meal, so most of the day was really great.
My gut feeling is that you under estimated the carbs for your evening meal. 49g carbs for the pasta and sauce and kvarg with Granola seems like an under estimation unless they were very small portions.

They were not small portions by any means. I am told not to count carbs for vegetables. But i understand where you are coming from. Lentil pasta was a medium portion and granola was just a sprinkling.

I also wonder if the yellow lentil pasta might be releasing more glucose than the nutritional info suggests. There are some people whose digestive system seems to be able to extract more carbs from lentils than the info says. Add to that figuring out how much dry weight of pasta gives you the carbs in the cooked weight usually quoted on the packaging can be confusing. They are also usually quite slow release carbs so they will often continue "giving" well into the night.

Anything is possible.

Having more carbs (popcorn) when your levels were already high (14) will have added to the problem and then sitting watching a movie afterwards may all have contributed to those levels going high. I doubt it is the timing.

I understand. What about when a cup to tea without any snack gives me a sharp spike?

I think lentils and lentil pasta may need a lot more experimentation for you to figure out if you are like me and others who get almost twice as much carbs from them as they are supposed to contain. Doesn't mean you can't eat them but you may need to inject more insulin for them.

Sunday, I am wondering if your chores are perhaps a bit more exertive and that caused your levels to drop too low by lunchtime, or perhaps the excitement of the event in the evening.

I think we were more excited. A fun evening to be had.

Great that you had a dextrose tablet to try to ward off the hypo, but after rising to 6.3, levels dropped again to 4.4 and in your position I would have had another 1-2 Dextrose tablets at that point to nudge levels up a bit again, since the drop in levels was being persistent. I would also have made a point of testing regularly during that time to keep a close eye on things because levels were dropping lower than expected. Waiting until you were hypo with a reading of 3.0 was just a missed opportunity to avoid a hypo, if you had had them earlier.

I get worked up regarding over treating the hypos.

I am very much hoping that this is the 3.0 that you treated with 2 Dextrose tablets and that you didn't inject your bolus for lunch until your levels were back up above 4. Did you really then wait 55mins before eating lunch? If so, this will be why you hypoed again during lunch. Your levels had been dropping throughout the morning and were low at lunchtime so that should warn you that you are at risk of another hypo and you will need much less prebolus time, if indeed any prebolus time in that situation.

I was extra busy and time flew by me. My aim is to wait for 20 to 30 mins but it did not work out the way I had intended.

Do you understand that prebolus timing varies with the time of day and the type of food you are eating? So for instance, I need 45 mins prebolus time at breakfast but only 15-20 mins at lunchtime or evening meal, sometimes less. If my levels are low before my meal (in the 4s and 5s), I will need less prebolus time if any, compared to when my levels are in the 6s and 7s before a meal when I will need to wait a bit longer.
If I am going to have something fast release like a banana I will need more prebolus time than if I am going to eat pizza or lentils which are slow release because the insulin needs more of a head start when you are eating something with fast release carbs and less or no head start with slower release carbs.

Falling asleep right now as it is well past bedtime, so I will try to find time to comment on the rest later.

Hope you had a lovely time at the pre wedding event. X

I shall try reducing the waiting time from an hour to 30mins.

I was not expecting to hear from you straight away. So, thanks for sharing your precious time with me.

The evening event was great fun bar the greater hyper afterwards.

Do my notes give you the right pic or me you want me to persevere with the notes? Thanks.

 

[Lucyr]

They were not small portions by any means. I am told not to count carbs for vegetables. But i understand where you are coming from. Lentil pasta was a medium portion and granola was just a sprinkling.

Do you mean you aren’t counting the carbs in lentils or lentil pasta when you do your carb count? I certainly need to count carbs in pulses like lentils and beans when they are the main part of the meal, and your bg going high after them suggests that you do too.