Tresiba reductions because of recent hypos and 4's

[mum2westiesGill]

A follow on of bgl's from my other posts of bgl's

Mon 5/7 continued
10:09 5.8 breakfast
14:19pm 8.0 lunchtime
19:30pm 5.2 teatime
23:14pm 5.7 bedtime

Tue 6/7
7:09am 10.7 waking - I've had two 'votes' so far on the group 7-day waking average saying it's too many carbs at bedtime

I don't know what anyone else thinks but my bgl's never seem to be consistent

 

[Amity Island]

A follow on of bgl's from my other posts of bgl's

Mon 5/7 continued
10:09 5.8 breakfast
14:19pm 8.0 lunchtime
19:30pm 5.2 teatime
23:14pm 5.7 bedtime

Tue 6/7
7:09am 10.7 waking - I've had to 'votes' so far on the group 7-day waking average saying it's too many carbs at bedtime

I don't know what anyone else thinks but my bgl's never seem to be consistent

They all seem pretty decent results @mum2westiesGill . Some diabetics do get consistent results most of the time every day, others don't and others really struggle to get results in any sort of reasonable range at all.

 

[rebrascora]

I would agree that yesterday's results are looking great Gill and it may be that you have got your Tresiba dose right now which really helps to achieve stable results.

 

[mum2westiesGill]

I would agree that yesterday's results are looking great Gill and it may be that you have got your Tresiba dose right now which really helps to achieve stable results.

Thanks for your reply.
For quite a while (longer than when the hypos and 4s started) Tresiba is the only thing I seem to alter now. I never seem to alter insulin to carb ratios like everyone else does

 

[rebrascora]

Thanks for your reply.
For quite a while (longer than when the hypos and 4s started) Tresiba is the only thing I seem to alter now. I never seem to alter insulin to carb ratios like everyone else does

Gill I can't speak for anyone else but I have never altered my carb ratios, however I alter my basal doses very frequently, sometimes more than once a week.

 

[mum2westiesGill]

Gill I can't speak for anyone else but I have never altered my carb ratios, however I alter my basal doses very frequently, sometimes more than once a week.

Thank you @rebrascora at least I'm not on my own then 🙂

 

[mum2westiesGill]

Today Tues 6/7 continued
10:10am 4.6 breakfast - under target of 5mmol - 8mmol
14:06pm 9.1 lunchtime - over target of 5mmol - 8mmol - MySugr bolus advised a 1 unit correction but I declined this because of my DSN's advice to only correct if my bgl is over 10mmol

 

[mum2westiesGill]

Tuesday 6/7 continued
19:09pm - 3.7 - hypo - didn't have any symptoms - embarrassing too because I tested when the meal arrived at the table and I had to sit there eating a mouthful (3) of jelly babies!
19:25pm - 5.0 - in target - hypo retest - test before eating meal
19:43pm - 5.0 - re-entered into MySugr app along with carbs to get bolus advice for meal - took humalog insulin for meal
23:13pm - 9.0 - over target - after my meal out

Wed 7/7
7:31pm - 4.3 - not in target but ok - I feel as though this is a bit low for my liking

 

[mum2westiesGill]

Today Wed 7/6 continued
10:13am - 8.2 - not in target but ok - breakfast 36g carbs and 3u humalog - 1u advised correction but I dismissed this because I only do corrections over 10mmol on DSN advice
14:26pm - 11.4 - over target - lunch 52g of carbs and 6u humalog plus 3u humalog correction which is what was advised
This afternoon I did a couple of extra bgl tests....
16.55pm - 8.2 - bgl not great but ok - 2 1/2 hours post lunch after bolus
17:59pm - 6.3 - bgl in target range - 3 1/2 hours post lunch after bolus

 

[mum2westiesGill]

Wed 7/7 continued
19:30pm - 5.2 in target range - before tea of chinese takeaway prawn fried rice
19:58pm - bgl re entered into MySugr app also carbs for chinese takeaway entered to get bolus advice - bolus was done after eating
21:30pm - 4.7 not great but ok. Bgl 2 hrs post tea and started to eat.
22:48pm - 5.3 bedtime test 3 hrs and 20 minutes after tea in target range but below 8mmol so had 1 bag of mini choc chip cookies 13g of carbs

 

[mum2westiesGill]

Thursday 8/7
02:01am - 10.8 not in target range - over target
7:15am - 7.6 - waking - in target range
10:03am - 10.3 - not in target range - over target - breakfast - 36g of carbs 4u humalog for carbs and 2u correction

Does anyone think I need to change my tresiba again? I'm thinking to leave it at 18u.

 

[rebrascora]

I would leave it. It looks about right so far.
Your high reading through the night was likely due to the Chinese takeaway releasing it's glucose more slowly and it is just as well that you bolused for it afterwards as you would likely have hypoed if you had bolused before eating.
I would say you are doing really well at the moment and your Tresiba is about right for now.

 

[mum2westiesGill]

I would leave it. It looks about right so far.
Your high reading through the night was likely due to the Chinese takeaway releasing it's glucose more slowly and it is just as well that you bolused for it afterwards as you would likely have hypoed if you had bolused before eating.
I would say you are doing really well at the moment and your Tresiba is about right for now.

Thank you @rebrascora and I've actually just remembered that last night when I bolused for my chinese I reduced my advised bolus by 3u because recently when I've had a takeaway or eaten out I seem to hypo later on

 

[rebrascora]

Thank you @rebrascora and I've actually just remembered that last night when I bolused for my chinese I reduced my advised bolus by 3u because recently when I've had a takeaway or eaten out I seem to hypo later on

All credit to you then for using your initiative and it was clearly the right decision because you ended up this morning in range. Well done.

That said, it suggests your Tresiba may still be too high if reducing your evening bolus by 3 units prevented a hypo.... or that your evening bolus ratio is a bit too high.

 

[mum2westiesGill]

The rest of Thursday 8/7
15:11pm - 5.8 in target range - lunchtime 55g of carbs and 5u humalog
19:07pm - 4.1 not great but ok - teatime 73g of carbs 6u humalog
23:25pm - 5.5 in target range but below 8mmol for bedtime so had a bedtime snack of 1 bag of mini cheddars 13g of carbs and no insulin

Friday 9/7
4:10am - 5.4 - in target range - during the night
7:11am - 4.4 not great but ok - waking - 18u tresiba taken
10:08am - 8.3 not great but ok - breakfast 36g of carbs 4u humalog
14:32pm - 10.0 not great but ok - lunchtime 36g of carbs 3u humalog
15:49pm - 10.7 not in target over target - not done a correction because I'm thinking that I've only eaten 1 hour ago

 

[Deleted member 25429]

If you were at 10 before eating why did you take less than your 1:10 to cover your lunch ?

 

[rebrascora]

If you were at 10 before eating why did you take less than your 1:10 to cover your lunch ?

Yes I wondered that too! You had 36g carbs at breakfast and rounded it up to 4 units of insulin which is what I would have done but at lunchtime you had the same 36g carbs and your levels were higher above target than breakfast and yet you only had 3units of insulin.... why? What was your thinking?

 

[mum2westiesGill]

3u is what the bolus adviser said at lunchtime and I just take what the bolus adviser says. Should I have rounded it up myself and taken maybe 4u at lunchtime?

A little update I've just tested again so it's now 2 hours after my lunch
17:01pm - 12.1 not in target - over target and 2u humalog correction done.

I don't usually test in-between meals so this correction in-between a meal is a first.
Because I usually only test meal to meal I wouldn’t have known to do a correction now and would my level of come back down anyway?

 

[rebrascora]

Does it not strike you as odd Gill that it recommends 4 units for 36g carbs at breakfast and 3 units for 36g carbs at lunchtime if your insulin : carb ratio is the same for breakfast and lunch and even more so when your level at lunch was higher and therefore likely to need more insulin..... Unless it is capable of learning and has seen a pattern with lower levels at tea time but I am not sure the app has that sort of capability. We will see if it was right to advise you to underdose when you test at dinner time tonight.
As you realize and have made comment on, it would be inappropriate to correct an hour or two after eating. That reading at least shows that your levels haven't spiked really badly after lunch. Did you inject the humalog before or after eating lunch?

 

[mum2westiesGill]

Does it not strike you as odd Gill that it recommends 4 units for 36g carbs at breakfast and 3 units for 36g carbs at lunchtime if your insulin : carb ratio is the same for breakfast and lunch and even more so when your level at lunch was higher and therefore likely to need more insulin..... Unless it is capable of learning and has seen a pattern with lower levels at tea time but I am not sure the app has that sort of capability. We will see if it was right to advise you to underdose when you test at dinner time tonight.
As you realize and have made comment on, it would be inappropriate to correct an hour or two after eating. That reading at least shows that your levels haven't spiked really badly after lunch. Did you inject the humalog before or after eating lunch?

I think it sees a pattern but I'm not sure. I always inject humalog immediately before eating so it was before lunch. I inject after eating if I'm eating out or having a takeaway.
Ps our replies must've crossed because in my reply just above yours I ended up doing a 2u correction.