Newbie!

[rebrascora]

@Proud to be erratic
For me reducing my bolus insulin is not really an option because I follow a low carb way of eating. I don't find I drop low very much during exercise and it is easy to top up with 10g carbs here and there as needed. If I am high when I start exercise I find it really hard work. Anything above 8 can feel like wading through treacle sometimes. What I find is that my body sucks the glucose out of my blood on a night whilst I sleep. Even without any evening Levemir this can happen if I have exercised several days in a row but if I had a regular level of Tresiba in my system I would be frightened to go to sleep.

Yes there is definitely educated guesswork in my Levemir doses and I see it as a bit of a dark art (that I am slowly developing more skill with) I am usually within 1 or 2 units of where I need to be. I rarely need more than a couple of JBs overnight and usually none. For me currently 24 units of Levemir in the morning before I get out of bed, keeps me lovely and steady during the day and anywhere between 0 and 6 units at night. 1.5 last night gave me a very minor hypo at 4am according to Libre.... it was probably low 4s if I could have been bothered to bodge a finger and double check, so I might have got away with not treating it at all but I popped a couple of JBs and woke up on 6.2 which then rose to 6.7 by the time I injected insulin and got up. Anyway, my point is that it is a pretty significant difference in basal insulin needs between day and night. I really can't see how I could manage on Tresiba. I would also say that my TIR is currently 95% for the last 7 days so my guess work can't be too shabby. I very much doubt I could manage that on Tresiba.

I find it interesting that your Endo wanted to balance your basal and bolus to a set 50/50 ratio. Human bodies vary so much from person to person, as does diet, and complex organic systems rarely do anything evenly or uniformly, I would find it disconcerting for my clinical lead to be wanting things in nice even ratios over what my results suggested I need.

Yesterday I used 7.5 units of bolus and 25.5 units of basal. I regularly skip meals so I know that my basal is holding me steady rather than propping up my bolus requirements and of course Libre shows me so very clearly what is happening when I skip those meals.

 

[trophywench]

Of course your body sucks insulin out of you when you're asleep - you may be asleep, but your body is very very busy indeed!

 

[rebrascora]

I think rebrascora also eats a low carb diet so she will have to manage insulin to protein ratios which, for me, vary hugely and need to be taken later than insulin for carbs. I am not sure if this impacts her basal.

I don't calculate protein ratios. I just use my Fiasp to do corrections about 2 hours after a meal if my levels get to 8 and start drifting upwards. These days I really don't bother too much with carb counting either because I eat so few. Unless it is an exceptionally low carb meal, or I have done lots of exercise before hand, in which case I don't bolus at all, then I have 1-2 units up front and then a correction later if need be. I basically use my Libre to work out how much insulin I need, both basal and bolus and just respond to what it tells me. It takes a lot of the work out of my diabetes and the low carb eating helps to keep a lid on my sugar addiction/comfort eating.

Plus I seem to react to high levels (for me this is anything over 8 or 9 mmol/l) by having a restless mind making it difficult to get to sleep.

I can relate to this. My deepest and most restful sleeps are when my levels are actually a bit low. Mid 3-s to 4s during the witching hours. Even when my body wakes me up to treat a hypo I still drop straight back off into a deep sleep and wake up refreshed. Even if I wake up multiple times with low levels. In fact I sometimes even wonder if my body actually wants my levels to be low at that darkest time of the night in order to rest properly. I believe it may be natural in a fit healthy non diabetic person to drop below 4 during the depths of the night. I am aware however that being diabetic, I need to preserve my hypo awareness, which so far is thankfully very good. High levels through the night (7+) and I don't sleep soundly and wake up groggy and if I hit 9-10 I will usually wake up hot and agitated and do a correction.

 

[rebrascora]

Of course your body sucks insulin out of you when you're asleep - you may be asleep, but your body is very very busy indeed!

I assume you are commenting on my post about my body sucking "glucose" out of by blood whilst I sleep Jenny?

I appreciate that the body needs insulin to function 24/7 but I can assure you that my body is a lot less busy during the night than during the day.
What I am saying is that the days that I have done a lot of physical activity, it is during the depths of the night that my levels drop the most and my insulin needs are drastically reduced. The way I see it is that my liver and muscles are replenishing their stores ready for the next day and they suck the glucose out of my blood rather than needing the insulin to push it into the cells. I may be wrong in that assessment of what happens and it is maybe just that my body becomes super sensitive to insulin but that is intuitively how I see it, because I still drop even when I just have the very tail end of my morning Levemir in my system and no evening dose.

 

[trophywench]

SO WHEN DOES EG. YOUR BRAIN MEND THE MYELIN SHEATHS ON ITS NEURONS?

 

[nonethewiser]

Thank you everyone for your replies. I completely understand that the basal and bolus have very separate jobs. I’m changing from Lantus to Tresiba, on the suggestion by my consultant. He thought it may help the high but brief peaks in bs. The unknown to me is what the profile will be. I’ve been told to begin on 12 units, having taken 8/8 units of Lantus.
A large part of my life is Masters Athletics. I’m a track and field heptathlete. Lots of adjusting of insulin! I train 5 days a week and compete in the UK and internationally.
So I’m wondering if having a more consistent amount of insulin on board, in the way of Tresiba, might be helpful and I could perhaps just inject less bolus insulin…. I use Fiasp, fast and lively!
I just need to give the Tresiba a go, obviously when I’m not competing!!!
Many thanks

Pump would be answer to your prayers, ability to decrease/increase insulin depending on daily needs, example being on active inactive days or when poorly, so much easier to adjust basal when using pump, coming here from someone who injected for 30 years.

 

[everydayupsanddowns]

Pump would be answer to your prayers, ability to decrease/increase insulin depending on daily needs, example being on active inactive days or when poorly, so much easier to adjust basal when using pump, coming here from someone who injected for 30 years.

I was wondering whether an insulin pump might help @Netball1 too.

 

[everydayupsanddowns]

SO WHEN DOES EG. YOUR BRAIN MEND THE MYELIN SHEATHS ON ITS NEURONS?

No need to shout TW

 

[rayray119]

Hi and welcome.

Can I ask which basal you are changing from and why Tresiba has been suggested/recommended?

Tresiba is a very long acting basal insulin. If you have a very regular lifestyle it may suit you but it has a very flat profile in that it releases a very steady amount of basal insulin day and night at the same rate. Unfortunately human bodies are not generally very uniform in their basal needs or indeed in most other functions. Many people need more basal insulin during the day and less at night, particularly between 2am and 5am. People also usually need less basal insulin after exercise. If you exercise occasionally rather than regularly you may need to eat more carbs with Tresiba rather than reduce your basal insulin to accommodate it.
Tresiba wouldn't be my choice of basal insulin because I have very active days and other less active ones and I personally need much more basal insulin during the day than at night, so a split dose shorter acting basal like Levemir suits my flexible lifestyle more.

You may find that you need to adjust your bolus ratios a bit as a result of the change because the Tresiba will probably release basal insulin at a different rate to your current one at different times of day, depending upon what you use now and your body's basal needs..... but then those change over time anyway. Diabetes is always a case of monitoring levels, looking for patterns and tweaking doses or ratios as needed. The goal posts rarely stay in the same place for long.

Can I ask, are you relatively newly diagnosed and have you been offered or done an intensive education course like DAFNE (Dose Adjustment For Normal Eating).... DAFNE is so much ore than the name suggests.... ie a lot more than just carb counting. If you haven't done such a course (your local equivalent may have another name) then do ask about being referred onto one as they can be incredibly helpful, not just in terms of what you learn but just spending a week with other Type 1 diabetics is incredibly illuminating and you learn so much from each other.

This is a bit of a wired one when I didn’t have the more busy days when I was on it seemed to be giving me too much in the day but the right amount of the night(expect when I had busier days)