Reducing basal insulin

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stackingcups

stackingcups

Well-Known Member
Relationship to Diabetes
Type 3c
Hi. I'm on Tresiba, 38 units every evening. My waking reading was 4.7 today which is the lowest I've ever had. Do you think I need to reduce my basal rather than wait for a hypo to happen?

When you reduce is it just be 2 units every 5 days like when you go up?
 
I would not be making any changes based on one day's experience. When there are so many things that can affect our levels, you need to look for trends. It may be that you did more exercise than usual yesterday or had a drink last night or had a particularly relaxing (stress-free) day with a good night's sleep.
If you find your levels are falling every night for about a week, you could reduce your basal. The usual advice is to reduce it by no more than 10% each time and Tresiba takes 3 or 4 days for you to notice the affect.
As always, keep your hypo treatment close to you at all times including a batch next to the bed.
 
Thanks for this. It's been going down every day for a few days now bit by bit. Will keep watching.
 
What level do you go to bed on and do you have Libre to see what is happening overnight?

One tactic you can employ is to push your bedtime reading a little higher with a small 5 or 10g snack and see if that improves things. If you are already going to bed with quite a high number (8-10) and repeatedly waking up with lower numbers in the 4s then a basal reduction would be the thing to do.
If you don't have Libre then it might be a good idea to set an alarm and test at 3am to see what your levels are doing then, especially with a long acting basal like Tresiba as it may be dipping you into the red during the deepest hours of sleep.

If you do decide to opt for a basal reduction, with you not hypoing but just having slightly lower readings, I would only reduce it a minimal amount. Maybe even just 1 unit and see how you go. If you were hypoing then definitely 2 units. We are all different.
I have to tweak my basal doses all the time but thankfully my Levemir allows that as any adjustments take full effect during the course of the dose rather than Tresiba needing days to get the full effect.
 
I don't have a libre, no.

It was 5.4 when I went to bed last night. I'm on a strict low cal low fat diet so I'm hesitant to add in snacks though I could probably manage a glass of milk.
 
How much insulin you need is related to body weight (in paediatric medicine, they always used to weigh the child to work out a dose of any medication, probably still do) So if you’re losing weight, it’s not surprising that your insulin needs will reduce.
 
stackingcups said:
I don't have a libre, no.

It was 5.4 when I went to bed last night. I'm on a strict low cal low fat diet so I'm hesitant to add in snacks though I could probably manage a glass of milk.
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You need to consider the drop rather than just your waking level. If you were 5.4 when you went to bed and woke at 4.7, that is a very small drop (0.7) overnight and wouldn't be enough to justify a change in basal for me.
I agree with @rebrascora that you may want to consider raising your bedtime level. Avoiding hypos is more important than a struct low cal low fat diet so recommend a small snack to raise your levels before bed - you probably only need 5g carbs.
 
If you are going to bed in the 5s and waking up in the 4s then yes I would definitely be reducing your dose. That doesn't allow any wriggle room for the Tresiba dropping your levels through the night.
 
Robin said:
How much insulin you need is related to body weight (in paediatric medicine, they always used to weigh the child to work out a dose of any medication, probably still do) So if you’re losing weight, it’s not surprising that your insulin needs will reduce.
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Ah this is a good point I've lost 9lbs this week.
 
helli said:
You need to consider the drop rather than just your waking level. If you were 5.4 when you went to bed and woke at 4.7, that is a very small drop (0.7) overnight and wouldn't be enough to justify a change in basal for me.
I agree with @rebrascora that you may want to consider raising your bedtime level. Avoiding hypos is more important than a struct low cal low fat diet so recommend a small snack to raise your levels before bed - you probably only need 5g carbs.
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@helli You are maybe not considering that your basal rate is likely reduced through the night on your pump but Tresiba is releasing the same amount of insulin day and night and whilst that looks like a drop of just 0.7 it could be dropping 2 or 3 points in the depths of the night and then coming back up.

It would be a good idea to test in the night as I think you may well be dropping low with sailing that close to the wind with your night time levels but you could just decrease the dose and see how you go. I am a firm believer in experimenting because you learn lots from it and there is no significant hardship in reducing your dose for a few days and see what happens.
 
Tested just now 2 hours after dinner and it's 4.7. Having a low cal hot chocolate made with milk. (Just under 15g carbs) to see if it brings it up before bed.

Will reduce the Tresiba tonight.
 
stackingcups said:
Thanks for this. It's been going down every day for a few days now bit by bit. Will keep watching.
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Has the very slight drop coincided with a change in the weather? I've noticed my levels have dropped a bit due to the colder weather.
 
stackingcups said:
Hmm it has, but its also at the same time I've started a strict diet and lost 9lbs.
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Ah then the weight loss would be a major factor in insulin reduction. Well done on the weight loss 🙂
 
5.6 before bed. Was due to stop taking my dapagliflozin in 3 or 4 days, so I've just stopped that now instead. Figured that might be quicker to respond than the Tresiba. (have lowered that by 2 units)

Have also emailed the dietician to see about perhaps adding a few more carbs to my day if needed
 
Let us know how you get on. You are doing fab with the weight loss!
 
stackingcups said:
I don't have a libre, no.

It was 5.4 when I went to bed last night. I'm on a strict low cal low fat diet so I'm hesitant to add in snacks though I could probably manage a glass of milk.
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I can't remember if you take Creon or not? As you are 3c I wonder if milk would be a good idea if not taking any?
 
I don't take Creon, but I don't seem to have any issues with what I eat at the moment thankfully.
 
Spoke to my DN today, as well as my dietician.

Dietician has given me advice for keeping levels up without compromising my diet.

DN said she would like me nearer 7 on a morning (which surprised me) and would like me at 8-9 before bed. So I know what I'm aiming for at least. She agreed to my stopping my dapagliflozin and said I could actually reduced by 4-6 units at the moment, so I'm going to take 4 more off today in addition to the 2 yesterday.

Feeling more confident
 
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