to bleed or not to bleed

[rebrascora]

Ha ha, just realised where i got the 12 hrs from - i had a daphne follow up and i remember that for 5 days i had the daphne dsns telling me it was 12 hours!
Still, this has been v useful as may go onto levemir in future

Have you actually seen the 3D graph we are referring to.... It really is quite neat! Will try and find it if you haven't seen it....

 

[Tdm]

Have you actually seen the 3D graph we are referring to.... It really is quite neat! Will try and find it if you haven't seen it....

It would be v useful is i was going on levemir, will deffo want to see it then...i do try to give correct asdvice but with DSNs saying it was 12 hours, didn't think to question...will perhaps just stick to commenting on my person experience in future.
At mo only need 3 units basal a day so levemir flexibilty likely lost on me...

 

[Celtic38]

Thanks for your help I'm on 4 injections a day 3 Novo rapid 24 -28 units and 1 Levemir at night 44 units thats just gone up by 2 units .

Do you find that 4 insulin injections in the Day are enough, i don't becasue you have to account for correction Insulin dose's so i Inject at least 6-8 times a day Insuline then once at Night with my Tresiba i used to use Lantus for my Night pen Insulin. Everyone is different through hope you are ok.

 

[Proud to be erratic]

Do you find that 4 insulin injections in the Day are enough, i don't becasue you have to account for correction Insulin dose's so i Inject at least 6-8 times a day Insuline then once at Night with my Tresiba i used to use Lantus for my Night pen Insulin. Everyone is different through hope you are ok.

@Celtic38, in my 1st year after diagnosis my injection routine was mostly 2x Levermir basal and 3x NovoRapid bolus daily - as directed by my DSN. My HbA1cs were in the low 40s, but I had way too much time hypo and in retrospect I now know my DSN was a lovely person but not helping me at all well with my D! 2020 was a rotten year generally. Major surgery, chemo and a constant roller coaster from deep hypos to silly hypers and back - most days.

At the start of my 2nd year I moved to Tresiba, 1x daily basal and I started taking more bolus injections for extra corrections; I also got Libre 2 then and my general visibility was (of course) massively improved. My BG stability also steadily improved.

During my 3rd year (2022) I had 4 hospitalizations for various reasons and there were inevitable BG increases associated with the problems that put me in hospital. Partly out of boredom I was micromanaging my BG and might make 6 bolus doses daily - pretty well every time I was disturbed for my 4 hrly BP and BG checks, while in hospital. My Time in Range (TIR) was terrific and my HbA1c also vg. My stress (distress) and frustration with the amount of time I was allowing to manage my D was a big concern for me and my wife was accordingly concerned.

This last year, my fourth, I deliberately pulled back from the micromanagement and I've mainly only taken corrections with my meal boluses; only sometimes I've needed one extra correction bolus. My TIR has slipped a bit, all from too much time high, but still >70% and I'm broadly content with that. During a DAFNE course in Nov '22 we were heavily encouraged to only correct with meal boluses, thus only 3 x daily bolus doses including corrections, 4 if an extra meal/snack needed a bolus; this also influenced my reduced D management time.

On balance, @Celtic38, I suspect that you are over-correcting if you need 6-8 bolus doses daily. Since your NovoRapid will normally last 4 hours it does look as though you are actually stacking bolus on top of bolus already on board.

I'm a huge fan of Tresiba - it has been great for me and I've optimised my Tresiba dose to keep me very stable at night; so in practice I sleep for 6-8 hrs daily, leaving 18-16 hrs awake and needing my D managing. So even with 4 bolus doses per day that is still putting me at risk of taking a correction while I have insulin already on board. When I need that extra correction, I usually know (roughly) why I've got into that higher BG state. Looking back at my insulin record for this month I've averaged just a fraction more than 3x bolus daily, with many days just a big breakfast and then dinner; I often snack during the afternoon and those snacks are because I'm particularly active and I'm gently fending off a drift below 5.5.

My CGM is the Dexcom G7 and this allows me to have my Alert for low at 6.0 - which keeps me safe and far enough away from low 4s. [G7 has an upper limit for low at 8.3, which might arguably be excessive but is way superior to the low limit allowed by Libre 2]. What is your low alert setting @Celtic 38?