Tresiba reductions because of recent hypos and 4's

[mum2westiesGill]

You can see my other recent bgl's on my other thread hypos and 4's

Sat 3/7
7:47am 4.2 waking - posted on group 7-day waking average thread
10:44am 5.5 breakfast
14:56pm 6.8 lunch
19:47pm 4.3 tea
23:19pm 7.4 bedtime - posted on group 7-day waking average thread

Sun 4/7
8:17am 10.5 waking - bit of a blip here because I either should've had less carbs at bedtime last night or none at all with bedtime being only just below 8mmol
9:31am 6.6 breakfast

reduced on
20/6 from 21u to 20
22/6/2021 from 20u to 19u
30/6/2021 from 19u to 18u

Do I reduce it by 1u from 18u to 17u tomorrow Monday 5/6?
My gut feeling is saying to leave it for another day.

 

[rebrascora]

I think your morning reading this morning is quite relevant to your question here seeing as it was high so I am not sure why you haven't included it.
It takes 3 days for the full effects of a Tresiba dose change to stabilize so unless you get some hypos today I would not consider reducing it again. Give this current dose time to settle and show if it has been effective enough. That would be my advice.

 

[mum2westiesGill]

I think your morning reading this morning is quite relevant to your question here seeing as it was high so I am not sure why you haven't included it.
It takes 3 days for the full effects of a Tresiba dose change to stabilize so unless you get some hypos today I would not consider reducing it again. Give this current dose time to settle and show if it has been effective enough. That would be my advice.

Thank you.

Ps have a look on my post at Sun 4/7 - I've included this morning's reading there

 

[Thebearcametoo]

I would leave it and see how you do this week. Keeping track of what your bedtime reading is and if you have any carbs then and what your waking reading is will give you and idea of whether it’s the right dose. Once you’re happy with the morning reading you can look at the rest of the day and decide if boluses need adjusting or anything.

 

[mum2westiesGill]

I would leave it and see how you do this week. Keeping track of what your bedtime reading is and if you have any carbs then and what your waking reading is will give you and idea of whether it’s the right dose. Once you’re happy with the morning reading you can look at the rest of the day and decide if boluses need adjusting or anything.

Thank @Thebearcametoo I will probably leave it a few more days to "see what the week brings". I will post a few more days bgl's on this thread. Tuesday evening through to Wednesday morning will probably be a bit of a blip because we're eating out.

Re "see what the week brings" it's what an estate agent always used to say to us when we were selling our previous house - it got very annoying when all we wanted was news of what exactly was going on with the sale ie are there any more viewers.......

 

[trophywench]

Was he an estate agent or a politician in disguise? - Boris can't ever answer a question with either Yes or No, can he? - and neither can most other politicians.

Imagine Wilfred asking him 'Please may I have an ice cream Daddy?' and him replying, 'Winfred, before considering this, we probably need to firstly consider whether you consumed all of your lunch or not and whether there is a history of this' rather than, 'No Wilfy - you can't!'

 

[mum2westiesGill]

The rest of Sun 4/7
14:59pm 7.5 lunch
19:11pm 12.4 teatime - no idea at all where this came from - I definitely did my lunchtime injection, carb count was correct
22:57pm 3 and 1/4 hours after teatime and teatime bolus - 8.9 bedtime - didn't have a bedtime snack because bgl was over 8mmol

Mon 5/7
7:11am 4.3 - maybe I should've had a bedtime snack

 

[rebrascora]

It looks like your basal needs have changed in a similar pattern to mine in that you are now needing more insulin on an afternoon/evening but less overnight and in the morning.
Tresiba doesn't give you the ability to vary your basal dose over the 24hr period so the best you can do is adjust it to keep you safe overnight which is what you have done and then do corrections in the afternoon to try to balance things or change your lunchtime ratio which is essentially the same thing in that you are counter balancing the deficit in basal insulin by using more bolus insulin.
Basically your levels are going high in the afternoon because you reduced your Tresiba but if you hadn't reduced your Tresiba then you would be hypoing through the night which is much more of a problem, so reducing the Tresiba was the right thing to do but you will probably need to accept that you will go high in the afternoon evening for a while, maybe until the seasons change.
I agree that one digestive biscuit might have been a good idea or maybe something even smaller like a cracker with some cheese

 

[mum2westiesGill]

It looks like your basal needs have changed in a similar pattern to mine in that you are now needing more insulin on an afternoon/evening but less overnight and in the morning.
Tresiba doesn't give you the ability to vary your basal dose over the 24hr period so the best you can do is adjust it to keep you safe overnight which is what you have done and then do corrections in the afternoon to try to balance things or change your lunchtime ratio which is essentially the same thing in that you are counter balancing the deficit in basal insulin by using more bolus insulin.
Basically your levels are going high in the afternoon because you reduced your Tresiba but if you hadn't reduced your Tresiba then you would be hypoing through the night which is much more of a problem, so reducing the Tresiba was the right thing to do but you will probably need to accept that you will go high in the afternoon evening for a while, maybe until the seasons change.
I agree that one digestive biscuit might have been a good idea or maybe something even smaller like a cracker with some cheese

I prefer to do corrections at lunchtime rather than changing my lunchtime ratio. If my bgl at lunchtime is over 10mmol then I do a correction - it's the same for all meals ie if my bgl is over 10mmol then I do a correction

 

[Sally71]

But if you aren’t over 10 you won’t do a correction - and you might still be needing extra insulin at lunch time because you have reduced your basal. Changing your ratio would solve that problem.

 

[mum2westiesGill]

You can see in the pic of my MySugr settings the Hyper setting is set to 10.1 so any bgls I do at mealtimes which are over 10mmol will advise a correction

 

[mum2westiesGill]

But if you aren’t over 10 you won’t do a correction - and you might still be needing extra insulin at lunch time because you have reduced your basal. Changing your ratio would solve that problem.

My ratio for all meals and all day is 1:10.

 

[Sally71]

My ratio for all meals and all day is 1:10.

It doesn’t have to be though. What I’m saying is, following on from @rebrascora’s post, if you’re going high in the afternoon because you’ve reduced your basal, then yes a correction at lunch time might help with that. But what if you haven’t yet gone high at lunch time? If you’re under 10 then you won’t be advised to do a correction so you’ll probably still go high later because of the reduced basal. If you changed your lunch time ratio to 1:9 for example that would give you a little bit more with your food which would offset the rise from the reduced basal. Just a suggestion - probably best to speak to your DSN before you change anything, and maybe wait and see what happens for a few more days first.
I also find that if you change carb ratios by more than 1 at a time the effect is far too drastic!

 

[Leadinglights]

This might sound like a silly question but what did you do when first diagnosed when presumably there was no MySugr app or Libre. Were you following a much more rigid routine and how did that work for you?

 

[mum2westiesGill]

It doesn’t have to be though. What I’m saying is, following on from @rebrascora’s post, if you’re going high in the afternoon because you’ve reduced your basal, then yes a correction at lunch time might help with that. But what if you haven’t yet gone high at lunch time? If you’re under 10 then you won’t be advised to do a correction so you’ll probably still go high later because of the reduced basal. If you changed your lunch time ratio to 1:9 for example that would give you a little bit more with your food which would offset the rise from the reduced basal. Just a suggestion - probably best to speak to your DSN before you change anything, and maybe wait and see what happens for a few more days first.
I also find that if you change carb ratios by more than 1 at a time the effect is far too drastic!

I understand what you're saying about the lunchtime ratio. I also agree about not changing them by more than 1g at a time so 1u:10g (1u for every 10g carbs) then 1u:9g (1u for every 9g) but not 1u:8g!

 

[mum2westiesGill]

This might sound like a silly question but what did you do when first diagnosed when presumably there was no MySugr app or Libre. Were you following a much more rigid routine and how did that work for you?

No question is silly - I was on set doses of insulin for humalog but it won't have been humalog then. When first introduced to carb counting it was simply eye balling the pictures in the carbs and cals book.

 

[rebrascora]

It doesn’t have to be though. What I’m saying is, following on from @rebrascora’s post, if you’re going high in the afternoon because you’ve reduced your basal, then yes a correction at lunch time might help with that. But what if you haven’t yet gone high at lunch time? If you’re under 10 then you won’t be advised to do a correction so you’ll probably still go high later because of the reduced basal. If you changed your lunch time ratio to 1:9 for example that would give you a little bit more with your food which would offset the rise from the reduced basal. Just a suggestion - probably best to speak to your DSN before you change anything, and maybe wait and see what happens for a few more days first.
I also find that if you change carb ratios by more than 1 at a time the effect is far too drastic!

The problem with just reducing your ratio by 1 is that you would be having to have the best part of 100g of carbs for lunch in order to clock up a 1unit increase which looks like it wouldn't be enough judging by yesterday's readings but I would also recommend not making any changes for a couple of days to see if there is a pattern. No point in changing it only to have to change it back again if it was a one off event.
It might be easier just to do what I used to do at breakfast time and tag a 2 unit correction onto my meal bolus because I knew that my levels were going to rise due to foot on the floor regardless of my pre breakfast reading.... Again, you need to wait and look for a pattern before adopting such a strategy, so that you can see if a regular rise is occurring and how many mmols that rise is so that you know how many units correction you are likely to need. It might be a good idea to start doing a mid afternoon reading as well to get a better idea of what is happening between lunch and evening meal, especially if you decide to do a correction dose with lunch or change your ratio.

 

[mum2westiesGill]

The problem with just reducing your ratio by 1 is that you would be having to have the best part of 100g of carbs for lunch in order to clock up a 1unit increase which looks like it wouldn't be enough judging by yesterday's readings but I would also recommend not making any changes for a couple of days to see if there is a pattern. No point in changing it only to have to change it back again if it was a one off event.
It might be easier just to do what I used to do at breakfast time and tag a 2 unit correction onto my meal bolus because I knew that my levels were going to rise due to foot on the floor regardless of my pre breakfast reading.... Again, you need to wait and look for a pattern before adopting such a strategy, so that you can see if a regular rise is occurring and how many mmols that rise is so that you know how many units correction you are likely to need. It might be a good idea to start doing a mid afternoon reading as well to get a better idea of what is happening between lunch and evening meal, especially if you decide to do a correction dose with lunch or change your ratio.

Re the mid afternoon reading would you say 2 hours or 3 hours after lunch? Don't forget I'm blood glucose testing and not sensor testing so would this extra test tell me/us anything?

 

[rebrascora]

You are right. That mid afternoon test will likely just confuse you.
The reason I suggested it is that it looks like you are starting to have a problem at this time of the day with your levels and having more data during that period can help to make more informed decisions. If it was me and I didn't have Libre I would probably do checks at 1, 2, 3 and 4hrs post meal to see what was happening over 2 or 3 days and if I was consistently seeing the same sort of rise then it would help me decide how to tackle it, but you and I are very different in our approaches to diabetes and I must remember to bear that in mind when I make suggestions

If you had already changed your ratio or added a correction then it would be a check to make sure the extra insulin wasn't too much and to keep you safe.

 

[mum2westiesGill]

You are right. That mid afternoon test will likely just confuse you.
The reason I suggested it is that it looks like you are starting to have a problem at this time of the day with your levels and having more data during that period can help to make more informed decisions. If it was me and I didn't have Libre I would probably do checks at 1, 2, 3 and 4hrs post meal to see what was happening over 2 or 3 days and if I was consistently seeing the same sort of rise then it would help me decide how to tackle it, but you and I are very different in our approaches to diabetes and I must remember to bear that in mind when I make suggestions

If you had already changed your ratio or added a correction then it would be a check to make sure the extra insulin wasn't too much and to keep you safe.

Thanks for your reply. There's nothing stopping me doing the extra checks and thanks for the suggestion.