Hi. I'm 57 and been type1 for over 12 years. In my 5th month of a new insulin regime and struggling with it; it's like being newly diagnosed again. Was on 2 injections of Novomix30 now a minimum of 2 injections of Levemir and at least 3 of Novorapid daily - haven't even found the correct Levemir doses yet, let alone Rapid carbs and correction ratios. This is really difficult for me; I'm trying really hard but feel like I'm getting nowhere. Hope others are doing and coping better!
-
Please Remember: Members are only permitted to share their own experiences. Members are not qualified to give medical advice. Additionally, everyone manages their health differently. Please be respectful of other people's opinions about their own diabetes management.
New to this forum. Hi.
- Thread starter Marky7
- Start date
- Status
Bruce Stephens
Well-Known Member
- Relationship to Diabetes
- Type 1
Welcome to the forum. Are you getting any help from whoever changed your regime? Have you been offered the structured education recommended, for example (the best known being DAFNE)?
It's worth looking at the links in the first thread of this forum, which includes one on basal testing: https://forum.diabetes.org.uk/boards/threads/useful-links-for-people-new-to-diabetes.10406/
Many thanks for your reply. I had help from the local senior diabetic nurse but am still struggling. I'm booked onto something called the BERT1E course at the end of this month which supposedly will sort everything out - I can't help being sceptical having had 5 months of changing morning and bedtime Basal doses, altering Bolus carb and correction ratios etc... And they are still changing now! I have a pattern of my glucose levels rising from 9pm to midnight then they drop back to the 9pm level at around 3am from where they drop another 3-4mmols by around 7am. The morning reading can be good but the overnight average is bad. I have no idea how to sort this and because the morning number is generally ok the diabetic experts say I'm doing well - I'm not my average is bad, the worst it been in 12 years - I'm dreading my next HBA1c!
trophywench
Well-Known Member
- Relationship to Diabetes
- Type 1
Hiya! I echo what Bruce said. If you don't get the basal insulin doses as right as you can get them, it's a lot of a waste of time trying to get the bolus ones right, cos they work hand in hand. In the case of Type 1, Levemir's the chicken and Novorapid's the egg!
I'm a huge fan of Levemir. I describe it as being very biddable - ie when you think you need a bit more of it and increase it (or less and so reduce it) you can see whether that worked or not within 12 hours. If it's helped somewhat but not enough - tomorrow add or reduce a bit more. If it's an utter disaster - don't use the same dose again, revert back to what it was before and try summat else tomorrow.
All this thing about dose adjusting yourself, is a completely alien concept to you - am I correct in saying that? Cos it was alien and scary when I started doing it too.
We'll all support you on here - nobody can tell you what to do, all we can say is, Ah, well, what worked for me was X so you could try that if you wanted to, as long as you test test test while you're experimenting so you can avoid suddenly dropping to LO or increasing to HI and at least stay at a level your meter can still measure, you haven't killed yourself so you can start again tomorrow!
I'm a huge fan of Levemir. I describe it as being very biddable - ie when you think you need a bit more of it and increase it (or less and so reduce it) you can see whether that worked or not within 12 hours. If it's helped somewhat but not enough - tomorrow add or reduce a bit more. If it's an utter disaster - don't use the same dose again, revert back to what it was before and try summat else tomorrow.
All this thing about dose adjusting yourself, is a completely alien concept to you - am I correct in saying that? Cos it was alien and scary when I started doing it too.
We'll all support you on here - nobody can tell you what to do, all we can say is, Ah, well, what worked for me was X so you could try that if you wanted to, as long as you test test test while you're experimenting so you can avoid suddenly dropping to LO or increasing to HI and at least stay at a level your meter can still measure, you haven't killed yourself so you can start again tomorrow!
trophywench
Well-Known Member
- Relationship to Diabetes
- Type 1
Ah, I've now read the next bit. (BERTIE's great, you'll enjoy it) What times do you have your 2 Lev jabs?
rebrascora
Well-Known Member
- Relationship to Diabetes
- Type 1
- Pronouns
- She/Her
Hi and welcome from me too.
What time is your evening meal and when do you inject your NovoRapid for it. It sounds like you might be going high after your evening meal suggesting that your bolus wasn't enough or the timing of it was wrong but then your evening basal (Levemir) dose might be too high if you are dropping from 12-7am.
It is important to get your basal doses as close to holding you level as you can and then sort out your carb ratios after that. Only adjusting one thing at a time and then seeing how that impacts things before then adjusting it again if necessary or adjusting something else. You can adjust the timing of your insulin as well as the doses. I found that taking my Levemir at 7.30 am and 11pm worked better for me but it was no where near an even split. If I have had a very active day, I sometimes don't need any Levemir at all on an evening. Adjusting your basal doses is a bit of a dark art and there is an element of intuition about it which Libre and experience help you to develop. It is a slow learning process.
It is good that you are doing an intensive education course as that will really help to iron out the kinks. I know there is a BERT1E online course but hopefully the one you are doing will be face to face as I think you get a lot more out of mixing with other Type 1s and learning from each other and building up a rapport with the educators, who will go through your results with you and help you to figure out whether it is a basal or bolus issue.
What time is your evening meal and when do you inject your NovoRapid for it. It sounds like you might be going high after your evening meal suggesting that your bolus wasn't enough or the timing of it was wrong but then your evening basal (Levemir) dose might be too high if you are dropping from 12-7am.
It is important to get your basal doses as close to holding you level as you can and then sort out your carb ratios after that. Only adjusting one thing at a time and then seeing how that impacts things before then adjusting it again if necessary or adjusting something else. You can adjust the timing of your insulin as well as the doses. I found that taking my Levemir at 7.30 am and 11pm worked better for me but it was no where near an even split. If I have had a very active day, I sometimes don't need any Levemir at all on an evening. Adjusting your basal doses is a bit of a dark art and there is an element of intuition about it which Libre and experience help you to develop. It is a slow learning process.
It is good that you are doing an intensive education course as that will really help to iron out the kinks. I know there is a BERT1E online course but hopefully the one you are doing will be face to face as I think you get a lot more out of mixing with other Type 1s and learning from each other and building up a rapport with the educators, who will go through your results with you and help you to figure out whether it is a basal or bolus issue.
Wow thanks for all your advice. I inject Levemir at @ 7am and 9:30pm every day. My evening meal is between 17:15 and 18:00. I inject my Novorapid 15-20 mins before eating. My evening meal is the biggest meal of my day, I do the carb calc but don't no how to adjust for fat and protein content which varies quite a bit I think. Your words give me hope I might be able to sort it and I did reduce my Levemir last night but stupidly up'ed the Rapid very close to a pre-dinner hypo; had an horrific hour under 4mmols, briefly under 3! Had a lot of jelly babies and OJ to sort it but consequently was around 11/12 all night! Hopefully will have a better idea of the change tomorrow, if I don't do anything dumb again - have restabilised my sugars reasonably today. Many many thanks again, have already made notes on the basal testing. Mine is top heavy but was on 70% basal for 12 years of Novomix30! Thanks again.
And yepp ALL this correction stuff is completely new. I used to how the same doses of Novomix30 at the 2 same times of day and roughly the same carbs at the same every day. If I exercised or had alcohol I had extra carbs - that was it! Didn't do finger prick tests at all! The sensor data is overwhelming as I had no data before only the way I felt.
nonethewiser
Well-Known Member
- Relationship to Diabetes
- Type 1
Switch to something like lantus which is longer lasting basal, failing that push team for insulin pump Mark.
Bruce Stephens
Well-Known Member
- Relationship to Diabetes
- Type 1
A longer lasting basal might be beneficial, but there's surely nothing much wrong with Levemir?
And given that they're not (yet) prescribing Libre and he's barely starting basal/bolus MDI, I'd guess them offering a pump is some way off.
nonethewiser
Well-Known Member
- Relationship to Diabetes
- Type 1
Personally found levemir was like injecting water Bruce S.
It takes while to move to pump, my move was 3 months heard some say it can take year, so don't see harm in mentioning it so all bases are covered should basal bolus not produce the goods. Just own opinion.
rebrascora
Well-Known Member
- Relationship to Diabetes
- Type 1
- Pronouns
- She/Her
Were you happy on the mixed insulin and was it giving you decent results?
Just wondering why they changed you if you were managing well with it. You could ask to go back to it if you are struggling with your current insulin regime although I am pretty sure you will manage a lot better after your BERT1E course and if you stick around the forum here as we can offer you lots of tips and advice.
I absolutely love Levemir as a basal as it allows me the flexibility to adjust daily if necessary and with my lifestyle that can be absolutely necessary. I also need a lot less insulin during the night than I do during the day, so a longer acting basal would mean I needed to do lots of corrections during the day to keep me level. Today I have taken 22 units this morning but will only need anywhere between 0 and 5 tonight. It sounds like Levemir is likely a good basal insulin for you if your levels are dropping through the night but obviously you need to get the dose right. Once you have your basal doses correct, everything makes much more sense and is a lot less frustrating. I know that if my levels become difficult to manage/erratic, it is almost always because my basal insulin dose is wrong. It is a huge relief when I get it right and things start to go smoothly again, so I can imagine you must be pretty much tearing your hair out if you have had that frustration for FIVE MONTHS!!
Absolutely gobsmacked that you were not testing your blood when you were using a mixed insulin. I very much hope you don't drive!!
Setting up and tweaking (because things never stay the same) requires a detailed understanding of basal and bolus. Plus there is a the rare chance that a pump will fail so you need to be able to revert back to MDI at short notice under stressful circumstances (pumps never fail at a "good time") so MDI should be second nature before considering a pump.
I am sorry you had a bad experience with Levemir but it sounds as if the problem @Marky7 is having is related to getting the right basal dose rather than having a dose which does not work at all.
My advice would be to focus on the night time basal needs as it is easier to do nothing overnight than during the day and check the levels stay flattish. A free Libre trial maybe useful for this.
Hi
I have only had type 1 for 2 years but have had amazing nurse from diabetic team at hospital - she has taught me so much step by step
I got carb and cals app which is brilliant
Levermir and novarapid
I started 4 units levermir morning and before bed
And 1 unit rapid to 10
Units of carbs - count carbs only (Not fat or protein
Your rapid only lasts 4 hours and after 4 hours your levermir should hold you in range - if you too high you you can up levemir or if low lower
Also if you exercise cut rapid when eating - and if you have a low don’t eat loads you only need about 10 carbs to come back up
My mum is on mixed and it’s so
Different - I find the diabetic nurses at gp surgery don’t understand diabetes at all - info they give is terrible (they don’t have enough knowledge) -
trophywench
Well-Known Member
- Relationship to Diabetes
- Type 1
If you are eating a reasonable amount of carbs, you usually wouldn't need to worry about the protein or fat - only if you usually eat a scant amount of normal carbs with your meals. When I say normal I mean ordinary things like eg breakfast cereal, spuds, bread, rice, pasta, root veg, fruit. But anyway - you'll be able to discuss all this during BERTIE - roll it on!!
Everyone on earth has their lowest BG of the 24hrs in the early hours of the morning, so you're normal. But - are you going hypo a lot of nights or don't you actually sink quite that low? - you need to find out by setting an alarm and waking yourself up deliberately to test. Then everybody's BG starts increasing, naturally. This is literally everybody - not only people with diabetes. It's a characteristic of a human being, and left over from when humans evolved. It's also autonomous - like blinking. You can't stop it - but what you can do is find out if you're making it worse, or even life threatening, by injecting too much insulin.
Levemir doesn't have a large peak in its activity unlike eg Lantus, which builds to quite a high peak after 4/5 hours post jab, but what it can be is be a bit too high from start to finish. I always needed far more in the am than I did in the pm. It was fallacy to believe that meant I didn't need much during the night, even though that's how it looked at the time. In fact - I need just as much, so the extra dose 2, simply propped up what was left of the morning one. That's individual for me and not necessarily the case with anyone else at all. So - we all have to ascertain for ourselves what's right for us. And the only way to do it is ....... test test test of course. PITA, yes, but Oh how we can gloat when we get it right and know we have!
So if you meet a Type 1 with a self satisfied smirk on their face, tell em to enjoy it while it lasts ,,,,,
Everyone on earth has their lowest BG of the 24hrs in the early hours of the morning, so you're normal. But - are you going hypo a lot of nights or don't you actually sink quite that low? - you need to find out by setting an alarm and waking yourself up deliberately to test. Then everybody's BG starts increasing, naturally. This is literally everybody - not only people with diabetes. It's a characteristic of a human being, and left over from when humans evolved. It's also autonomous - like blinking. You can't stop it - but what you can do is find out if you're making it worse, or even life threatening, by injecting too much insulin.
Levemir doesn't have a large peak in its activity unlike eg Lantus, which builds to quite a high peak after 4/5 hours post jab, but what it can be is be a bit too high from start to finish. I always needed far more in the am than I did in the pm. It was fallacy to believe that meant I didn't need much during the night, even though that's how it looked at the time. In fact - I need just as much, so the extra dose 2, simply propped up what was left of the morning one. That's individual for me and not necessarily the case with anyone else at all. So - we all have to ascertain for ourselves what's right for us. And the only way to do it is ....... test test test of course. PITA, yes, but Oh how we can gloat when we get it right and know we have!
So if you meet a Type 1 with a self satisfied smirk on their face, tell em to enjoy it while it lasts ,,,,,
nonethewiser
Well-Known Member
- Relationship to Diabetes
- Type 1
Like OP struggled with getting basal finely balanced on MDI, plus with lots of corrections injections sites took fair hammering.
Consultant at time was pro pump so suggested pump, took to it in no time & struggles with basal was thing of the past, have had far less hypos hypers since making switch & never regretted it.
Although there will be some peeps who don't take to pumping guess is they are far & few between.
- Relationship to Diabetes
- Type 1
- Pronouns
- He/Him
Welcome to the forum @Marky7
Yep! It IS hard work in the beginning, but for my money it is definitely worth it.
I note you say you had fixed doses and fixed meals on Mixed, but that you rarely or never checked your levels. Do you know what your HbA1c was like during that time?
It will take a bit of time to get used to the new system, but it is time very well spent - and the flexibility of basal:bolus should allow you much more freedom to eat (or not eat) what you when you want 🙂
In addition to the BERTIE course (which has an excellent reputation) you might find Gary Scheiner’s Think Like a Pancreas a helpful, informative and entertaining read.
Yep! It IS hard work in the beginning, but for my money it is definitely worth it.
I note you say you had fixed doses and fixed meals on Mixed, but that you rarely or never checked your levels. Do you know what your HbA1c was like during that time?
It will take a bit of time to get used to the new system, but it is time very well spent - and the flexibility of basal:bolus should allow you much more freedom to eat (or not eat) what you when you want 🙂
In addition to the BERTIE course (which has an excellent reputation) you might find Gary Scheiner’s Think Like a Pancreas a helpful, informative and entertaining read.
- Status