timing of basal dose??

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tracey w

tracey w

Well-Known Member
Relationship to Diabetes
Type 1
Hi,

Does it matter what time you take the basal dose in the evening? My dsn said it should not matter so long as around same time.

i take mine around 11.15 before I go to bed, however cant seem to get morning readings down to a good level? Have been increasing and now on 14 units, was 11.4 before bed but was 13.7 this am??? Yesterday had night hypo, and again was 3.5 when waking?? Averaging around 9-11, any ideas welcome.:confused:
 
i take my basal dose at 7pm as i thought that would give me some flexibility on when i go to bed and would probably translate into something sensible when i went abroad

basal insulins are fairly flat but i've found that they have a small peak a couple of hours in which i think if i took it just before bed would play havic with my readings, taking it slightly earlier allows it to stabilise before bed but it's a case of what suits you... it could just be that the night hypo was caused by taking excess fast acting insulin but it takes a wee while to get the basal dosage right, think it took me a couple of months after switching - if you change the dose i'd recommend sticking with it for a couple of nights to make sure a one off isn't counted as fact
 
Hi Tacey,
Have you tried splitting your dose? There are not many people that can get good control on just 1 basal injection.
 
I take my basal dose (humulin I) just before I go to bed - I don't tend to worry too much about taking it at the same time. What insulins are you taking? As previously mentioned it may have something to do with your fast acting. When you had the night hypo, what was your reading before bed? I would also agree that if you change the dose then give it 3 days to give you a better idea of what is happening.
 
I take mine at around 10:15 pm, but I've been having problems with night hypos since I improved my control and got my bedtime BG below double figures. I never wake up high though. Last night I went to bed at 7.1, woke up at 3 am to take a reading and it was 3.0. I had some jelly babies and a cereal bar then woke up this morning at 3.3.

I'm going to reduce my lantus by one unit to see if that helps things. If not, I'm going to try taking my lantus in the morning instead of the evening. If neither of those works, I'm going to try splitting the dose!

They always say that you should discuss any changes with your healthcare team - I had my 6-monthly review the other day and tried to talk the options through with the consultant, but his response was, 'Yeah, whatever, it's trial and error...' - very helpful NOT!😡
 
Hi Tracey

Your basal dose doesn't actually last 24 hours so if you're high in the evening ie 11.4 before bed it could be that your basal has run out. And if you keep increasing it, that could be causing the night hypos which, if untreated, ie you don't wake up and eat something, could be the reason why you are high in the morning.

I split my dose so take half before bed and half with my breakfast. The reason I did it was I do a lot of running and started to find that if I went for a run after work, my blood sugar actually shot up! It was cos my basal had run out. Exercise can actually make your BS go up if you have run out of insulin, its something to do with adrenaline! Anyway, have gone slightly off topic here but splitting your dose might work for you. I would speak to your doctor about it.

Swarbs x
 
Swarbs79 said:
Hi Tracey

Your basal dose doesn't actually last 24 hours so if you're high in the evening ie 11.4 before bed it could be that your basal has run out. And if you keep increasing it, that could be causing the night hypos which, if untreated, ie you don't wake up and eat something, could be the reason why you are high in the morning.
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I think this is what was happening to me - my basal was running out, leaving me high before bed. I countered this by increasing my bolus insulin with my evening meal. My doctor said that lantus (my basal) can last anything from 18-24 hours.

Swarbs79 said:
...I would speak to your doctor about it.
Swarbs x
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Or not, if he's anything like mine!🙂
 
my basal only last between 10 and 12 hours so i was told to adjust my bolus accordingly. however at the min i have really bad swings even when i stick to stated doses so im at a loss. most dn will tell you to adjust by 2 units at a time however i have found some people this doesnt work for and they just need to split it. with regards to running i find if i exercise my sugars go down first but the they rocket really high lol.
 
The only thing to remember is when you split a basal dose that doesn't last the full 24 hours, instead of having 1 gap of insulin coverage you'll have 2 smaller ones of reduced coverage. This may or may not be noticeable.

I have thought about splitting my basal dose the would not be able to be consistent with the morning dose.
 
Northerner said:
I think this is what was happening to me - my basal was running out, leaving me high before bed. I countered this by increasing my bolus insulin with my evening meal. My doctor said that lantus (my basal) can last anything from 18-24 hours.



Or not, if he's anything like mine!🙂
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thanks everyone, really helpfull.

I suspect this is whats happening with me, my bedtime readings are quite high, I suspect the humulin I is dealing with, peaking during the night, maybe Im going low and not waking and they are high in the mornings?? but running out after around 20 hours Increasing would make things worse in this case. I have also recently increased my exercise which could account for higher evening readings??

what I dont understand is how splitting could work better, I understand a lower dose may e needed but if its lasting around 20 hours then arnt you doubling up somewhat. sorry if this sounds stupid.


also on a different aspect of this lovely condition. I have just gone hypo 3.3 but my reading was 13.9 just over an hour ago when I would have given anything for a biscuit with my coffee, but didnt? Honestly, dont think will ever get this. Is it normal to drop by approx 10 in this time??:confused:


thanks for all the help though, will try contact my team tomorrow re splitting my humulin I
 
didn't realise you were on humalin i, this insulin is an imtermediate insulin only last 12-20 hours anyway. it's an insulin that should be in 2 doses and isn't marketed as being a once daily basal insulin.
 
sofaraway said:
didn't realise you were on humalin i, this insulin is an imtermediate insulin only last 12-20 hours anyway. it's an insulin that should be in 2 doses and isn't marketed as being a once daily basal insulin.
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wow, thank you so much. why didnt my dsn tell me that? perhaps they dont even know this. actually am really quite annoyed now as Ive been trying really hard with this for almost 5 weeks now and Ive been doing it wrong havent I. It really does make you loose trust in them doesnt it?

I think I will ask to speak with somebody else regarding this tomorrow. In your opinion do you think I have been taking too much (14 units) and going low overnight? I know I need to speak with the team but you are so knowledgable, thanks.
 
splitting insulin should in theory give you the long lasting basal over the time period it is ment to work over as you split you dose. with regards to the drop in sugars i have been having some problems myself with this sort of thing so all i would say is contact your dn and see what she has to say about it. with regards to your specific insulin i would defo contact your team to check this out.
 
Humalin I

I was on Humalin I single daily dose for about 7 years, before finally finding a hospital I could trust (so put off by hospital where I was diagnosed, that I avoided any hospital for years, although I also moved around a lot) and mentioning occasion early morning low blood glucose episodes - and he suggested splitting the dose, taking half morning (approx 0700 to 0800), half evening (approx 2230 to 2300), which I've been doing for about 6 years now, with good results. I also like the added flexibility regarding activity levels, as I sometimes find myself hiking / orienteering / shifting numerous heavy kit boxes and bikes etc at all times of the day and night, due to adventure racing.
 
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Copepod said:
I was on Humalin I single daily dose for about 7 years, before finally finding a hospital I could trust (so put off by hospital where I was diagnosed, that I avoided any hospital for years, although I also moved around a lot) and mentioning occasion early morning low blood glucose episodes - and he suggested splitting the dose, taking half morning (approx 0700 to 0800), half evening (approx 2230 to 2300), which I've been doing for about 6 years now, with good results. I also like the added flexibility regarding activity levels, as I sometimes find myself hiking / orienteering / shifting numerous heavy kit boxes and bikes etc at all times of the day and night, due to adventure racing.
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Hi, when you mention flexibility, do you mean that you change your basal doses or do thay stay mainly the same?

thanks again!
 
Yes Tracey, flexibility means changing the basal dose, particularly in anticipation of an active period or after an unpredicted episode, or if unwell eg with a cold cold. Generally 16 each time, down to 12 if very active, up to 18 if ill.
 
Copepod said:
Yes Tracey, flexibility means changing the basal dose, particularly in anticipation of an active period or after an unpredicted episode, or if unwell eg with a cold cold. Generally 16 each time, down to 12 if very active, up to 18 if ill.
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thanks that helps a lot. I think my hypo the other night was due to my increase in exercise around tea time! I was told by the doctors about reducing insulin pre exercise and took this to mean fast acting. Infact Im sure thats what they meant.??

do you also reduce fast acting insulin pre or post exercise. ? As well as basal. I did reduce fast acting after the exercise but generally dont the meal before as I dont always know what, or how much exercise I will be doing, I usually have a snack pre exercise in this case.
 
tracey w said:
thanks everyone, really helpfull.

I suspect this is whats happening with me, my bedtime readings are quite high, I suspect the humulin I is dealing with, peaking during the night, maybe Im going low and not waking and they are high in the mornings?? but running out after around 20 hours Increasing would make things worse in this case. I have also recently increased my exercise which could account for higher evening readings??

what I dont understand is how splitting could work better, I understand a lower dose may e needed but if its lasting around 20 hours then arnt you doubling up somewhat. sorry if this sounds stupid.


also on a different aspect of this lovely condition. I have just gone hypo 3.3 but my reading was 13.9 just over an hour ago when I would have given anything for a biscuit with my coffee, but didnt? Honestly, dont think will ever get this. Is it normal to drop by approx 10 in this time??:confused:


thanks for all the help though, will try contact my team tomorrow re splitting my humulin I
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I'm no expert, being new and all, but they told me if I squeezed to get the blood drop after the prick there's a big risk of not getting "whole" blood and then you get really funny readings. (They only told me after I'd got the really funny readings and phoned them) Also, what's all this about basal not lasting ? The blurb said it kicks in after about two hours and then lasts 20 - 26 hours (Lantus). I believed that till now, is it really not true? What time then does one take the basal? Is the dose different for each one of us or is there a common(ish) sort of number? (Mine's 24)
 
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