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Looking for some advice

Woodywoodpecker

Well-Known Member
Relationship to Diabetes
Type 1
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Hi looking for some advice. At bed time take 5 levimer have dropped it from 6, but have noticed I shoot right down instead off having a straight line, was wondering if I should drop to 4. Previously I have had supper at 8 and taken insulin, I have stopped that and just have a snack at bedtime but find still shooting down
 
Hi looking for some advice. At bed time take 5 levimer have dropped it from 6, but have noticed I shoot right down instead off having a straight line, was wondering if I should drop to 4. Previously I have had supper at 8 and taken insulin, I have stopped that and just have a snack at bedtime but find still shooting down
Hello Donna @Woodywoodpecker,
Others may suggest clearer ways forward. But my instinctive thought is a change from 6 to 5 units of Levermir is already a significant drop of some 17% and if you were to now go from 5 to 4 units that's a further 20% change. Have you tried to get a 1/2 unit pen for your Levermir which would be very appropriate for your existing small doses? I appreciate that such a change of pen will take days rather than being instant, but getting more controllable insulin supply is worth you making this a priority future step.

I found Levermir unsatisfactory and despite my (then) DSN's guidance for my 1st 12 months I never felt my BG was well managed, nor did my logbook readings reflect any stability. You might find a much longer profile basal, such as Tresiba, more helpful to you moving forward. I was over 70 when I had my pancreas removed; I was physically fit and active before and again now - but it would be fair to note that I had already stopped structured exercising such as going to a gym and working out. So I feel my basal needs are more stable now than when I was in my 40s, working irregular hours as the main bread winner and being run ragged trying to keep up with children coming into their teens. With a long duration basal I spent a few weeks optimising it for late evenings through to breakfast, then only needing to adjust my basal for the changes in seasonal weather. This has, for me, the huge advantage that I manage my BG without the additional variable of changing basal. I use food (carbs counted in), bolus insulin to mitigate those carbs and (of course) using exercise and general activity to further help my BG management.

At the very least it would help to see the bigger picture. Has your Time in Range (TIR) changed significantly with these recent higher readings? Have you also been adjusting your bolus arrangements? Are your bedtime drops happening after significant changes in daytime exercise and activity? What is your total daily insulin (ie basal and bolus)? The ratio of basal to bolus can be a useful indicator for BG management, not least because it can provide clues to how much natural insulin resistance you might have.

I know you are very new to this D malarkey, diagnosed last April (?) and it does take time to find a balance between time spent on BG management in relation to just getting on with your life! In his book "Think Like a Pancreas" the author Gary Scheiner astutely tells us that Diabetes is Complicated, Confusing and Contradictory. You are probably seeing and feeling each of those 3 Cs! Have you come across this book? I found it very useful and was about 9 months into my D management when I read it.
 
Hello Donna @Woodywoodpecker,
Others may suggest clearer ways forward. But my instinctive thought is a change from 6 to 5 units of Levermir is already a significant drop of some 17% and if you were to now go from 5 to 4 units that's a further 20% change. Have you tried to get a 1/2 unit pen for your Levermir which would be very appropriate for your existing small doses? I appreciate that such a change of pen will take days rather than being instant, but getting more controllable insulin supply is worth you making this a priority future step.

I found Levermir unsatisfactory and despite my (then) DSN's guidance for my 1st 12 months I never felt my BG was well managed, nor did my logbook readings reflect any stability. You might find a much longer profile basal, such as Tresiba, more helpful to you moving forward. I was over 70 when I had my pancreas removed; I was physically fit and active before and again now - but it would be fair to note that I had already stopped structured exercising such as going to a gym and working out. So I feel my basal needs are more stable now than when I was in my 40s, working irregular hours as the main bread winner and being run ragged trying to keep up with children coming into their teens. With a long duration basal I spent a few weeks optimising it for late evenings through to breakfast, then only needing to adjust my basal for the changes in seasonal weather. This has, for me, the huge advantage that I manage my BG without the additional variable of changing basal. I use food (carbs counted in), bolus insulin to mitigate those carbs and (of course) using exercise and general activity to further help my BG management.

At the very least it would help to see the bigger picture. Has your Time in Range (TIR) changed significantly with these recent higher readings? Have you also been adjusting your bolus arrangements? Are your bedtime drops happening after significant changes in daytime exercise and activity? What is your total daily insulin (ie basal and bolus)? The ratio of basal to bolus can be a useful indicator for BG management, not least because it can provide clues to how much natural insulin resistance you might have.

I know you are very new to this D malarkey, diagnosed last April (?) and it does take time to find a balance between time spent on BG management in relation to just getting on with your life! In his book "Think Like a Pancreas" the author Gary Scheiner astutely tells us that Diabetes is Complicated, Confusing and Contradictory. You are probably seeing and feeling each of those 3 Cs! Have you come across this book? I found it very useful and was about 9 months into my D management when I read it.
I’m supposed to be getting half pen for nova rapid, but at time off hospital appointment my levimer was ok fairly straight line at night. Apparently I’m in the honeymoon phase, find go ok for a while then e everything changes. I take 6 levimer in morning and 5 nova rapid for breakfast spike, usually 5 for lunch and tea varies. Will have a look at the book you suggested. Tir is high 70s to 80 not much change there, activity the same. I’m usually about 8-9 after bedtime snack
 
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I’m supposed to be getting half pen for nova rapid, but at time off hospital appointment my levimer was ok fairly straight line at night. Apparently I’m in the honeymoon phase, find go ok for a while then e everything changes. I take 6 levimer in morning and 5 nova rapid for breakfast spike, usually 5 for lunch and tea varies. Will have a look at the book you suggested. Tir is high 70s to 80 not much change there, activity the same. I’m usually about 8-9 after bedtime snack
I was spared the honeymoon phase, surgery took me straight to full on D. But I can see that you have that underlying progressive change won't help. Also, as a now 75 yr old male, I'm less vulnerable to hormonal changes.

But I have found that since moving to the 1x daily long profile basal of Tresiba my daily decision making is eased - one part of my management toolkit is effectively resolved. When my daily BG graphs from my CGM give me that clear picture alerting me that my overnight graphs repeatedly are showing fluctuations, only then do I need to reassess my basal. Anyway, this is just my passing observation, just don't feel that you can't look into and discuss with your DSN alternative solutions for your BG management. Incidentally I understand NovoNordisk are going to discontinue Levermir in the nearish future; it might be worth investigating how that is going to be managed within NHS Scotland.

Meanwhile do consider 1/2 unit pens for both insulins, given your overall small total insulin doses. My daily needs are only a little more than you. My cousin, longstanding T1 of well over 40 years, needs much more insulin for both his basal and bolus. He clearly has a lot of insulin resistance. I'm grateful that my needs are small; I think large insulin doses introduce the possibility for further Complications, Confusions and Contradictions!

Has anyone mentioned to you the list of 42 factors that can affect our BG?
 
I was spared the honeymoon phase, surgery took me straight to full on D. But I can see that you have that underlying progressive change won't help. Also, as a now 75 yr old male, I'm less vulnerable to hormonal changes.

But I have found that since moving to the 1x daily long profile basal of Tresiba my daily decision making is eased - one part of my management toolkit is effectively resolved. When my daily BG graphs from my CGM give me that clear picture alerting me that my overnight graphs repeatedly are showing fluctuations, only then do I need to reassess my basal. Anyway, this is just my passing observation, just don't feel that you can't look into and discuss with your DSN alternative solutions for your BG management. Incidentally I understand NovoNordisk are going to discontinue Levermir in the nearish future; it might be worth investigating how that is going to be managed within NHS Scotland.

Meanwhile do consider 1/2 unit pens for both insulins, given your overall small total insulin doses. My daily needs are only a little more than you. My cousin, longstanding T1 of well over 40 years, needs much more insulin for both his basal and bolus. He clearly has a lot of insulin resistance. I'm grateful that my needs are small; I think large insulin doses introduce the possibility for further Complications, Confusions and Contradictions!

Has anyone mentioned to you the list of 42 factors that can affect our BG?
Still waiting on novarapid half pen, not been put through yet from last hospital appointment. Yes herd levimer is getting discontinued 2026 I think. Not herd off 42 factors
 
Still waiting on novarapid half pen, not been put through yet from last hospital appointment. Yes herd levimer is getting discontinued 2026 I think. Not herd off 42 factors
This link comes from a US based organisation called Diatribe.
https://diatribe.org/42factors, published in 2018.

The author, Adam Brown, is a journalist who regularly contributes to Diatribe and elsewhere. This list of factors and the explanations give us an insight into just how complex our D can be. I'm not saying that we all "enjoy" every one of these factors, but when my D management is not behaving well, I can often find a degree of explanation within the 42 factors and having some sort of explanation to cling to is at least reassuring (sort of) and possibly pointing to things to avoid in the future.
 
As far as I'm concerned Woody is so new to having T1 that she'll have to do quite a few more basal dose changes before she changes her basal insulin - and no way Pedro can I envisage Tresiba being ideal for anyone with a normal body which I know too damn well uses varying amounts of basal insulin throughout any given 24 hours.

I understand very well that T3c absolutely does not behave as T1 so if Tresiba suits you, great.
 
Hi looking for some advice. At bed time take 5 levimer have dropped it from 6, but have noticed I shoot right down instead off having a straight line, was wondering if I should drop to 4. Previously I have had supper at 8 and taken insulin, I have stopped that and just have a snack at bedtime but find still shooting down
I have recent experience of the dreadfully named "Honeymoon Period" - and it is very erratic - how often has this happened at night? - I would not recommend going any lower on your evening dose before looking at any patterns (II feel for you as I've been there!!)
 
I have recent experience of the dreadfully named "Honeymoon Period" - and it is very erratic - how often has this happened at night? - I would not recommend going any lower on your evening dose before looking at any patterns (II feel for you as I've been there!!)
About the last month, thought it was insulin I was having for my supper at 8pm that was making me go low, have now stopped supper to see what difference that made, was still going low so put levimer down from 6 to 5 and just having snack at bedtime. Last few nights have noticed on graph from 11pm to 3am line goes straight down, used to have fairly straight line all night. Some honeymoon feel I’m getting good periods, then it all goes south
 
Try this @Woodywoodpecker - a basal test may help (but in the honeymoon period it may be futile as your pancreas does wakeup from time to time - it's terrible and I feel your pain!)

 
Try this @Woodywoodpecker - a basal test may help (but in the honeymoon period it may be futile as your pancreas does wakeup from time to time - it's terrible and I feel your pain!)

Thank you will give it a try. Not had the best off days, had friends round and ordered a Chinese. I always get the same thing, so done my usual 6 units nipped to the loo, when I came down they had sent me wrong meal so sitting bit higher than normal
 
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