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Toying with an experiment....

@Satan's little helper I would be going high too if I wasn't actively monitoring it as closely as I am... approx. every 10-15 mins.... and being rather heavy handed with the insulin when it starts to head north.
I am surprised that I need to actually jab when I get to six rather than leaving it a bit longer because once it starts heading upwards it goes really quickly. I just had a bit of a distraction when I was on 6.1 and level and I had a bit of a protracted phone call lasting about 10-15 mins and when I came off the phone I was suddenly 8.3 and rising rapidly and now at 10.1 despite a 3 unit Fiasp injection which would normally have stopped an 9.2 in its tracks and turned it around, so once the basal isn't covered it appears to rise remarkably quickly. Much more so than I expected!
 
rebrascora said:
@Satan's little helper I would be going high too if I wasn't actively monitoring it as closely as I am... approx. every 10-15 mins.... and being rather heavy handed with the insulin when it starts to head north.
I am surprised that I need to actually jab when I get to six rather than leaving it a bit longer because once it starts heading upwards it goes really quickly. I just had a bit of a distraction when I was on 6.1 and level and I had a bit of a protracted phone call lasting about 10-15 mins and when I came off the phone I was suddenly 8.3 and rising rapidly and now at 10.1 despite a 3 unit Fiasp injection which would normally have stopped an 9.2 in its tracks and turned it around, so once the basal isn't covered it appears to rise remarkably quickly. Much more so than I expected!
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I was using Novorapid or the “actrapid?” At the time. (Fair while back.) I was testing every hour whilst there was life “stuff” needing doing. You seem to be doing better than me. I was like the proverbial “yo-yo.”
 
Satan’s little helper said:
I was using Novorapid or the “actrapid?” At the time. (Fair while back.) I was testing every hour whilst there was life “stuff” needing doing. You seem to be doing better than me. I was like the proverbial “yo-yo.”
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I do think Fiasp being faster and shorter lived is perhaps helpful in this situation, especially when you may be stacking doses to cover basal as of course a pump does, but obviously just very tiny doses stacked every few minutes rather than my situation where they may be 2, 3 or 4 hours apart.

I just had a really interesting conversation with my diabetes nurse at the GP practice (not a DSN) who is reasonably knowledgeable and knows that I have more understanding of my diabetes than she ever will, because of course I live with it every day. She rang to review my blood tests which are all good and I was explaining about my little experiment and she was a bit concerned and felt that I should run it past a DSN, before continuing. Firstly I am pretty certain that they would tell me to stop or not to do it again and secondly they are far too busy to get a call back before my experiment will be over and I very much doubt I would be able to fully explain my reasons over the telephone to someone whom I have never met before and doesn't know my lifestyle or level of understanding or how my diet works or a whole host of other stuff. I am happy to speak to my consultant about my experiment when I have analysed all the data and drawn conclusions and made decisions from those conclusions and tested those decisions to see if they are beneficial, but my annual telephone call in December has just been cancelled, so that is a way off, which again I am fine about. I am hoping I have reassured her enough not to worry. I did tell her I was taking lots of precautions to keep myself safe and watching my levels like a hawk.
 
My final tally for units of Fiasp yesterday was exactly 30 and that was too much on several occasions as JB needed to be eaten afterwards, so maybe 25 ish when I typically use about 40 with Levemir and Fiasp.

Today so far since 8am my insulin usage is standing at just 9 units of Fiasp. That 10.1 earlier responded well and settled back down and I am currently pretty stable in the low 7s, so may be time for another small top up.... say 2 units which I will inject now and we will call the current tally 11.
 
rebrascora said:
My final tally for units of Fiasp yesterday was exactly 30 and that was too much on several occasions as JB needed to be eaten afterwards, so maybe 25 ish when I typically use about 40 with Levemir and Fiasp.

Today so far since 8am my insulin usage is standing at just 9 units of Fiasp. That 10.1 earlier responded well and settled back down and I am currently pretty stable in the low 7s, so may be time for another small top up.... say 2 units which I will inject now and we will call the current tally 11.
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I understand you’re covering your basal with your Fiasp. I also appreciate you need the insulin you need & it’s serving its purpose as a bolus too.
From memory, you’re on a low carb diet? It doesn’t look to me like you struggled with the fabled “IR” some mention about the diet.
 
Satan’s little helper said:
I understand you’re covering your basal with your Fiasp. I also appreciate you need the insulin you need & it’s serving its purpose as a bolus too.
From memory, you’re on a low carb diet? It doesn’t look to me like you struggled with the fabled “IR” some mention about the diet.
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I think what I am finding quite interesting is that I need so much less insulin using just Fiasp. Perhaps it is just because I am being more focused but I always felt that my Levemir was nearly twice as powerful as Fiasp in that I would need lots and lots of corrections with Fiasp if my Levemir dose wasn't right but just 2 extra units of Levemir the next day and I would no longer need all those corrections which probably amounted to 5 or more units.

Yes, I am low carb but not desperately strict although I feel better and my diabetes is better managed when I am more strict with it. I often wonder if what people actually take for insulin resistance is protein release. I do have to inject for protein a couple of hours after a meal or if I have binged on roasted peanuts as can so easily happen. 🙄
I still use a 1+10 (Edit That should read 1:10 ratio) that I was started on at diagnosis and that mostly works pretty well for the carbs and I just correct for the protein using my Libre to guide me, rather than try to calculate it. If I eat a lot of carbs I find I need more than 1:10 but I don't calculate it, I just jab a guessed amount of insulin up front and then correct afterwards depending upon what my Libre shows me is happening. If I get it wrong I can always eat a JB or 2 to fix it, so it is no big deal. I have good hypo awareness, my Libre is really reliable and I am very confident of treating any hypos that do happen and they are usually very easily fixed and mostly I can work or exercise through them whilst my JBs work. I have a lot of nocturnal hypos and whilst I try to prevent them and this experiment is part of that, they do not cause me anxiety or panic when they happen, I just treat and go back to sleep and if I don't come up or drop lower my body will eventually wake me again. I would rather it was this way than live in fear, but I know it is a fine line between letting anxiety rule my life as I was when first diagnosed and becoming overly confident as I am perhaps now. Hopefully, if this experiment leads to a redistribution of my Levemir that works well, I will have more adjustment of my night time dose to prevent more hypos.

I feel I have improved a lot today from my experiences yesterday (so far at least 🙄) and I am tempted to take it into another day tomorrow, but if I have a bumpy ride tonight again, I will likely call it a day for now and maybe do it again in a week or so's time. I need to decide what morning Levemir dose I am going to start on if I do decide to finish the experiment tonight and no doubt I will have a couple of frustrating days until it settles down and shows me if the new dose split is going to work better for me, but I am reasonably prepared for that.

I have injected another 1.5 units at 5pm when my levels were at 6.9 and I am currently sitting pretty stable on a very nice 5.6, but 6pm was when it all kicked off yesterday, so we shall see! Hoping that 1.5 units will preempt any rise and keep me steadier at least until tea time, but I am heading out to carry some hay up the hill for GGs and then warm mash later tonight, so got another 2 miles of up and down hill to do and food to factor in although I think tonight is going to be much lower carb. Bolognaise on a bed of savoy cabbage and perhaps courgette.
 
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Well I had another bit of a wobble tonight again with a sudden spike partly because I was engrossed in something when the high alarm went off and I thought I would do it in a few minutes and then forgot until I spotted that it was 10.1 with a vertical upward arrow 20 mins later. 🙄 Of course I wasn't having that so I hit it with a sledgehammer of 4 units thinking that any extra would partly cover my evening meal. 50mins later just as I was about to have my evening meal, I was 4.4 with a vertical downward arrow, so 2 JBs went in sharpish!! Wheee! Don't you love a good rollercoaster! Thankfully I think I have stopped it and managed to jump off after the first oscillation rather than ride it to the end. Currently a nice 5.2 with an horizontal arrow and about to have an early night, but envisage a couple of corrections will be required through the night. Probably about 1am and 5am but Libre will hopefully tell me. Might set an alarm as well for those times just to be safe as they correspond to 4 hours after the last insulin.
 
The experiment continues into day 3 and much better overnight and I slept really well. Was back to sleep within minutes of jabbing each 2unit dose and as you can see from the overnight graph it produced a very reasonable undulating line. The injections were at 12.57am and 4.22am. and I woke at 7am on 4.3.
Usually I inject before I get out of bed but I decided to experiment to see what happened if I waited. No massive increase that I used to see and expected, but it started to climb a bit after my coffee and so I dosed another 1.5u at 8am, nearly 4 hours after my last dose of course) when it hit 6.1 but now 5.6. Thinking now I should perhaps have made it 2 units and kept it at that every 4 hours for my basal needs, but we will wee what happens. Haven't had breakfast yet as intend to go out and stretch legs first.

Here is yesterday's full daily graph (yes, I know I still hit the red far too many times but this is taking some getting used to) but my overnight graph is much improved....

IMG_20240928_080341286.jpgIMG_20240928_080453803.jpg
 
Yesterdays insulin tally was 26 units 8am-8am as compared to average being about 40u and I still needed several JBs so that is technically still more than I actually needed, but I did do a bit more exercise yesterday.
Still enjoying the experiment and finding it fascinating!
 
If you wanted to extend/adapt/repeat your experiment, I’d be interested in seeing exact replicas of days - ie each same day with Lev, and with just Fiasp: same routine getting up, exercise, etc, and the same meals. Not sure I explained that well, but I hope you get what I mean! Everything exactly the same barring Lev/Fiasp.
 
rebrascora said:
Yesterdays insulin tally was 26 units 8am-8am as compared to average being about 40u and I still needed several JBs so that is technically still more than I actually needed, but I did do a bit more exercise yesterday.
Still enjoying the experiment and finding it fascinating!
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I think that’s standard for any experienced injector. Get everything set up for the days ahead get to work, colleague don’t show, workload excels & your having the lows? Or maybe you don’t feel well & your hunting the highs.
 
@Inka I get your point/idea but that adds a whole new level to think about and I already really struggle to follow any sort of routine with my daily life for more than a couple of days, particularly if my mental health takes a nose dive as it can do quite frequently.

I accept that I am being quite focused with this experiment and that is likely changing my routine and diet to a certain extent, so it isn't a like for like comparison, but I think most people who go onto a pump find that they need less TDD than they did on MDI and I think I have heard it is often as much as a third less.
I think the point I am making is that I expected to need much more Fiasp because generally it is less effective at compensating when my Levemir dose is not enough. ie. If I have a few days of fighting high levels I might need more basal, I might need 3 or 4 corrections amounting to 5 or often a lot more units, but a 2 unit increase in Levemir settles it all down, so I sort of equate that to suggest 2units of Levemir is more powerful than 5+ units of Fiasp which is clearly incorrect.

i like that this experiment is really challenging the thought and preconceived ideas that I had and I hope that will really help me to manage my diabetes better long term..... and perhaps to help me give more constructive support to others. We are all biased by our own experience, so broadening my experience is hopefully tempering my bias.... and this is a very different experience to that which I expected, which I think is why I am finding it so interesting. It is totally challenging my knowledge and understanding of how my body works and how my insulin works.
 
rebrascora said:
i like that this experiment is really challenging the thought and preconceived ideas that I had and I hope that will really help me to manage my diabetes better long term..... and perhaps to help me give more constructive support to others. We are all biased by our own experience, so broadening my experience is hopefully tempering my bias.... and this is a very different experience to that which I expected, which I think is why I am finding it so interesting. It is totally challenging my knowledge and understanding of how my body works and how my insulin works.
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Nicely said. I admire your “pluck!”
 
I totally get what you’re saying about the insulins. Yes, you could call it power. It’s also the different modes of action. Fast insulin is a bit more predictable than slow, I think. Some slow is usually ‘wasted’ or unavoidably mis-targeted on MDI. Changing to a pump usually requires a reduction in TDD of around 20 to 25% roughly. My reduction was approx 25%.

It’s very interesting to read about your experiment whether you repeat it or not 🙂
 
Been busy all morning doing mild/moderate physical work outside since it was such a glorious morning, so I am just having breakfast now although I did have a couple of cups of coffee with cream earlier, so I haven't been running on an empty tank and certainly not starving or even hungry.
So, this morning since getting up my diabetes doses have been....

7.56am 6.1 level 1.5u
9.35am 6.7 sl up 1u
exercise
12.13pm 5.9 level 1.5
exercise
12.59pm 4.6 level 2JBs activity
1.57pm 5.2 level 4u for breakfast
2.09pm 4.5 level 35g carbs late breakfast

Total so far.... 8 units Fiasp.
 
Having a new idea....

Waking in the night to inject is obviously not sustainable and levels seem to go a bit haywire 6 pm onwards. Might just be me perhaps taking my eye off the ball or the addition of my evening meal clouding the issue. Wondering if perhaps I jab a small dose of Levemir at 5pm. Start small with just 4 units and see if that will tide me through the night without having to wake and jab Fiasp and then manage things with Fiasp during the day. I know I was only injecting 2.5 units of Levemir at night before this experiment started, but it is clear now that my large morning dose was quite strongly contributing to that night time dose and I was taking my evening dose at bedtime so usually about 11pm. If I take a small dose at 5pm, then it is at least providing a little insulin whilst I sleep. I will still have my high alarm set to warn me if levels are going too high, but even if it just means 1 or ideally no top ups of Fiasp during the night, that would be an improvement on the current experiment. I think this is perhaps a reasonable way to reintroduce Levemir.... and see what happens, rather than a full on return to day and night time doses. It is starting to look to me like a lot of my previous large morning Levemir dose was getting wasted somehow or not nearly as efficient as what the Fiasp is doing now.

I am also starting to wonder if there is quite a significant increase in efficiency of insulin when keeping levels in the 4-7 range and above that insulin resistance may start to make a significant difference and perhaps this is why I am using less insulin. Or maybe I should say that we are more insulin sensitive in this 4-7 range. I know I often drift along in the 7-9 range.

Interestingly, whilst I am spending quite a lot of time recording what I am doing, both on my Libre log and here and how I feel about it and what I think might be going on, and checking my log regularly and adding up doses etc, I don't feel like I am actually needing to micromanage my levels any more than I normally do, except maybe that 4-6 hours on an evening when things have gone a bit haywire the last 2 nights, but I get spells like that with my diabetes sometimes anyway, as I am sure we all do. The rest of the time, particularly the morning to early afternoon has been unbelievably easy!
I fully expected to either have to inject every hour and perhaps every 2 hours or have the consequence of a very spikey graph and particularly on a morning when I thought my liver was chucking out masses of glucose, but I absolutely haven't and in fact I may be injecting less than normal. Could the fact that I am really enjoying the experiment and looking forward to the day, mean that my liver thinks it can take a holiday. Is my low carb way of eating and perhaps being fat adapted, somehow buffering things to make it so easy or am I in some sort of honeymoon period with this experiment and it will all go horribly wrong very soon. I cannot imagine that there is any Levemir left in my system after 3 days since my last dose!
 
I wonder if there is a little bit of the impact of “being watched”.
I know if I was doing a similar experiment, I might be slightly anxious which could affect my BG.
I guess there is always this affect when we change our diabetes management which probably explains a bit of the “settling in” issues when we make a change to our insulins.
 
I don’t think there’d be any Levemir left after three days. When I take a pump break and return to my pump, I feel the presence of my slow basal insulin for 2-3 days. It’s subtle but i can feel it. After 3 days, things settle to normal.

Could you try starting on your usual 2.5 units of Lev and increase if/as needed? I do similar when I take a pump break - start on less then build up.
 
@Inka
Yes, I did consider starting on just 2 units but I am now convinced that a significant part of the morning dose was contributing to that small evening dose, so I suspect I will need more than 2.
After the physical activity I have done the last 2 days I would, under normal circumstances, have reduced my evening Levemir dose down to 0 for tonight, but obviously I need some through the night without that morning dose providing some or possibly a significant amount.
 
@helli Yes, I am sure there is an element of me being so focused on the experiment that I am being more "diligent" if you like, so that will likely be skewing the results to some extent.
The first day of the experiment, Thursday, it was wet and miserable and I was quite anxious because I had no idea how it would turn out or if I could manage to keep a lid on things, so I sat about most of the day, keeping very close tabs on my levels and documenting stuff, so I was much more sedentary than normal. The first night was pretty fraught particularly after reading @Lucyr's comments/warnings about DKA etc and because I have no experience of it, I don't know how I would handle it or if I would recognise it coming on, whereas I am very experienced and confident with hypos. I think it is probably the first time during my diagnosis that I have actually worried about it, so my sleep was poor and disturbed with lots of waking and scanning. Generally I sleep really well, even when I have hypos, so again that was different. Yesterday and today I have been much more active and I slept really well last night and the anxiety was pretty much gone. Not that I don't think DKA is very serious, but just that I feel there is negligible risk of it in my experiment now after seeing how things are panning out. I haven't injected any Levemir yet. I am not sure I am ready to move onto that next phase or if I want to collect a bit more data as things are. That said, I have commitments tomorrow and I will be amongst other people when it will be easier to get distracted and things might slip a bit although my Libre alarm should remind me.
 
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