Should I try a different basal?

[Robin]

People who read the 'What's your morning reading' thread will know that I bang on about my Dawn Phenomenon with unfailing regularity. (Sorry!) I've tried everything I can think of to sort it out, and have been resigned to the fact that it happens, and provided I bung some Novorapid in as soon as I wake up, my levels aren't too shabby. I've tried upping my Lantus, but I tend to hypo between 1am and 3am, even if I eat a bedtime snack. ( carby, proteiny, fatty, I've tried them all)

The most effective way I've (sort of) tamed it, is concentrating on my Lantus overnight, and busking it through the day when it doesn't quite fit.. Taking it at 6pm or later gives me a dip just after I've gone to bed, taking it at breakfast leaves a gap just when I need a boost. At the moment I take it at 1pm, which covers night time, just about lasts til late morning, and gives me a gap after lunch while it gets going, which I try and cover ( not always successfully) with bolus. I only need 7 units of Lantus a day, so splitting it isn't really an option, as the smaller the dose, the more unstable it becomes.

The one thing I haven't tried is experimenting with a different basal, so I wondered if I could pick everyone's brains as to the ins and outs of swapping to Levemir. ( Levemir seems an obvious choice because of its flexibility. Something else I find limiting with Lantus, I tend to have an irregular exercise pattern. I'm thinking Tresiba wouldn't help with that aspect).

The problem is, would I just be jumping from frying pan, if not into the fire, then just to another frying pan. I've found myself overthinking the problem, and ending up going round in circles.

I don't think a pump is an option, because I don't fit the criteria, and I don't think I want one enough to kick up the sort of fuss I'd need in order to be considered. ( Last HbA1c was 47)

I may ask to try a swap when I go for my annual review, in October, but I know it'll send the nurse into a panic, so I'd like to have thought it through myself before then.

So any insights welcome!

 

[Radders]

I had awful problems with Lantus and did manage to get some better control with Levermir. I would say it's worth a shot: what do you have to lose?

 

[Robin]

I had awful problems with Lantus and did manage to get some better control with Levermir. I would say it's worth a shot: what do you have to lose?

Nothing....apart from my sanity trying to explain to my lovely but unclued up nurse!
Interesting to hear you found Levemir a bit better.

 

[Copepod]

Just one other option to throw in to the mix - I find that twice daily Humalin I suits my very irregular activity pattern. It's an old medium acting insulin (and much cheaper than others - so your nurse should like that!), but I've found it's worked for me, since diagnosis about 20 years ago, initially just once every24 hiurs, but twice a day for over 15 years.

 

[Radders]

Nothing....apart from my sanity trying to explain to my lovely but unclued up nurse!
Interesting to hear you found Levemir a bit better.

I did tweak the split quite a lot, and wasn't quite "there" with it before I finally got approved for the pump, but I did have fewer hypos with it. I think my problem with Lantus was to do with it pooling under the skin and then deciding to start working whenever it felt like it! Levermir was better for that. My doses were similar to yours if I recall correctly.

 

[everydayupsanddowns]

I understand your frustration. The only way I could stop Lantus giving me hypos overnight was to take it at breakfast, which was OK for me as my Dawn Phenomenon only really happens when my feet hit the floor (or FHTF Phenomenon as I like to call it).

Just meant I had to delay breakfast for a good while to allow the Novorapid and Lantus to start working.

Even since switching to a pump and with a hefty basal pattern increase just before I expect to rise I still need to leave 30 mins after bolusing before I eat.

If I hadn't gone for a pump, Levemir was my next choice. Hope it suits you well.

 

[everydayupsanddowns]

Incidentally, I'd be surprised if you didn't qualify for a pump with the effort you are putting in. And with your HbA1c where it is I suspect you have to keep an eye on hypoglycaemia and bear it in mind pretty much all the time with at least a part of your brain. Which means that you qualify for pump therapy under the 'hypoglycemia' criteria.

 

[Robin]

Thanks for that input, MIke, yes, I worked out the ideal time for my Lantus would be 4am!

 

[Robin]

Just one other option to throw in to the mix - I find that twice daily Humalin I suits my very irregular activity pattern. It's an old medium acting insulin (and much cheaper than others - so your nurse should like that!), but I've found it's worked for me, since diagnosis about 20 years ago, initially just once every24 hiurs, but twice a day for over 15 years.

Thank you, I hadn't considered older basals. Just because something's newer doesn't mean it's necessarily better, on an individual basis.

 

[Pumper_Sue]

As Copepod says try an older basal as it has a few peaks and troughs so should sort your DP. I would suspect as you have DP and Levemir is a flattish basal it wont solve your problem.

If you want a pump the you are entitled to one due to your DP.

 

[HOBIE]

Good luck sorting Robin 🙂

 

[SB2015]

When on MDI I got very frustrated with the inflexibility of Lantus. The switch to Levemir enabled me to split the basal insulin and let me adjust morning insulin without impacting on nighttime insulin. It got even better once I realised I was supposed to take both at a specific time, rather than just 'when I went to bed' and ' when I got up'. These were very variable, and it made a lot of difference once I settled this. I also found for exercise I could happily reduce the morning dose for a days walk and then return to do normal nighttime one. A big improvement in Hba 1c, but nowhere as much as when I went to the pump. But then your readings are fabulous already.

 

[khskel]

Only ever been on levemir but I like the way you can split it e.g take a small amount at night to cope with a peak at about 02:00 and then adjust my morning dose according to what I'm going to be doing.

 

[New-journey]

It seems a excellent question to be asking and not a clue here but hope you get the right solution for you.
It made me laugh that you have to explain to your nurse as she is lovely but clueless! Also it's a bit sad as you do deserve to have someone who has the information you need. Thank god for this forum!

 

[Robin]

I also found for exercise I could happily reduce the morning dose for a days walk and then return to do normal nighttime one

This is one of the advantages I can see for me.

 

[Robin]

It seems a excellent question to be asking and not a clue here but hope you get the right solution for you.
It made me laugh that you have to explain to your nurse as she is lovely but clueless! Also it's a bit sad as you do deserve to have someone who has the information you need. Thank god for this forum!

My poor nurse is also the Asthma Clinic, the Travel clinic, the flu jab clinic...oh yes, and she did my last smear test. She has to know a bit about an awful lot of subjects. Last time I saw her, she said, 'I like seeing you, I always learn something!' I'm not sure it's really meant to be that way round!

 

[New-journey]

My poor nurse is also the Asthma Clinic, the Travel clinic, the flu jab clinic...oh yes, and she did my last smear test. She has to know a bit about an awful lot of subjects. Last time I saw her, she said, 'I like seeing you, I always learn something!' I'm not sure it's really meant to be that way round!

Oh Gosh, No that's not how it is meant to be. That's so many subjects.
I spend all my time with mine in counselling mode, listening to her, acknowledging her fears and supporting in her in feeling better!

 

[SB2015]

My poor nurse is also the Asthma Clinic, the Travel clinic, the flu jab clinic...oh yes, and she did my last smear test. She has to know a bit about an awful lot of subjects. Last time I saw her, she said, 'I like seeing you, I always learn something!' I'm not sure it's really meant to be that way round!

Does this mean you have no access to the specialist nurses at the hospital? How would you ever find out about recent developments as the Practice nurse has no chance of keeping up to date with everything.

 

[Robin]

Does this mean you have no access to the specialist nurses at the hospital? How would you ever find out about recent developments as the Practice nurse has no chance of keeping up to date with everything.

It means I haven't had access for the last five years, and have been relying on this forum! But I went to a DUK group meeting earlier this year, for a new group that was set up, and they'd arranged for all sorts of experts to come out from the main Oxford hospital and speak. The thing that came out at the meeting,( because a lot of people made exactly your point) was that all surgery nurses can ring up a specialist DSN at the hospital, at any time, and can refer a patient directly to them if necessary.
I'm not sure my surgery nurse knows that, so I will be telling her!

 

[Lisa66]

What would happen if you phoned the specialist nurses directly? I'm fairly certain you can do that locally to me.....but one of the things that stands out from the forum is how areas can differ.

I've always gone to the hospital clinics, from children's then automatically moved onto the adult clinic. However 4 or 5 years ago when the clinic at local hospital closed I got sent back to gp, was all a bit vague. When I asked the gp they said I could see them as they had a specialist nurse...specialist she isn't. I explained that "with respect" I would prefer to see the experts (I said it very nicely) as they have all the up to date information etc, gp was fine and I got referred back again straight away. So it's definitely worth asking.

I'm with you in the frustrations of trying to sort basal. After donkeys years toddling along very nicely on Levemir I started getting a few 3am-5am hypos or waking up in the 3s, but then it seemed to be running out in the evening. I tried splitting the dose, didn't really seem to work for me, but maybe I should have persevered and played around a bit more. I'm now a few weeks into trying Tresiba, not convinced either way yet, however it does have a lovely flat line and have not had a nighttime low since starting.

Hope you get some good advice and can find something that works for you.🙂