What's your strategy? when basal insulin insuficient

[Amity Island]

Hi Everyone,

As some of you know, i'm struggling to get any decent advice from the DSN, could anybody give their take on the situation where you are taking (basically a very difficult insulin to adjust TRESIBA only adjust 3-4 days apart) and you need to take extra short acting insulin to make up for the shortfall? The DAFNE guide isn't much help because it states clearly on page 20 that when the DAFNE guide was developed, longer acting insulins like tresiba were not invented, and as such, they only recommend levemir twice a day.

My example.

7 a.m blood glucose 17mmol - take insulin for meal + correction of 4units
12 pm noon blood glucose still 17mmol (becasue basal is short) - take insulin for meal + correction of 4units
6 p.m blood glucose still 17mmol (becasue basal is short) - take insulin for meal + correction of 4units and by this time ketones are rising. Which requires even more correction.

You get my dilema, this would go on for days and weeks if I were to listen to DSN.

I have been taking extra insulin with my meals to avoid this problem, which the DSN said is totally wrong. Am I doing the right thing or should I just let my blood sugars get out of control and go to hospital with ketoacidocis?

Many thanks.

b.t.w I have taken your advice and asked for a change of trust, just waiting.....

 

[Ljc]

I hope you don't have to wait too long to b seen by another trust.
Sorry I can't help with you're query. Wanted to give your post a bump up.

 

[Amity Island]

I hope you don't have to wait too long to b seen by another trust.
Sorry I can't help with you're query. Wanted to give your post a bump up.

Hi, thanks very much for your reply. GP said it could take months for a referal to another trust. I have however emailed input diabetes charity, see if they can assist me, seems they are very well respected and do it all for the love of it.
b.t.w "I'll rattle if shaken" LOL

 

[Ljc]

Hi, thanks very much for your reply. GP said it could take months for a referal to another trust. I have however emailed input diabetes charity, see if they can assist me, seems they are very well respected and do it all for the love of it.
b.t.w "I'll rattle if shaken" LOL

Snap lol.
I hope Input can help you.

 

[Bloden]

So sorry to hear you've still got problems with your BGs, Amity Island. Can you change back to Lantus while you wait to change trust?

I used to get persistently high BGs (with Lantus, it was stopping working too early) in the evenings and got to the point where I seemed to be rapid insulin resistant...in that situation I'd put myself into emergency mode: hardly any carb for dinner; the usual insulin ratio and correction dose; and if I was high after an hour, I'd get on my ex bike and ex very gently, sipping water, until the bu**er started to drop.

What dose of Tresiba are you on now? You probably don't want to hear this but my transition to Tresiba was straightforward (I was on 12 of Lantus and take 9 of Tresiba). Have you read Kookycat's posts on Tresiba? She also takes less Tresiba than Lantus, at about the same percentage of difference.

I'm really frustrated for you - I was at the end of my teather with lazy Lantus and the resulting persistent highs AND my endo's lax attitude ("yeah, that happens to a lot of people"). I hope you get this sorted asap.🙂

 

[Amity Island]

So sorry to hear you've still got problems with your BGs, Amity Island. Can you change back to Lantus while you wait to change trust?

I used to get persistently high BGs (with Lantus, it was stopping working too early) in the evenings and got to the point where I seemed to be rapid insulin resistant...in that situation I'd put myself into emergency mode: hardly any carb for dinner; the usual insulin ratio and correction dose; and if I was high after an hour, I'd get on my ex bike and ex very gently, sipping water, until the bu**er started to drop.

What dose of Tresiba are you on now? You probably don't want to hear this but my transition to Tresiba was straightforward (I was on 12 of Lantus and take 9 of Tresiba). Have you read Kookycat's posts on Tresiba? She also takes less Tresiba than Lantus, at about the same percentage of difference.

I'm really frustrated for you - I was at the end of my teather with lazy Lantus and the resulting persistent highs AND my endo's lax attitude ("yeah, that happens to a lot of people"). I hope you get this sorted asap.🙂

Hi, thanks for your reply. I was on 21 units lantus. Just gone up to 22 units tresiba on Monday. The thing is besides the DSN having no idea about the insulin shortage, I'm taking 16 units of extra rapid across the day. I don't know what this means in terms of how short my long acting tresiba must be? Can it be the tresiba is not working?

 

[Bloden]

Can you start a new Tresiba pen? Maybe the insulin in the pen you're using has been compromised.

 

[Amity Island]

Can you start a new Tresiba pen? Maybe the insulin in the pen you're using has been compromised.

Hi Bloden, WOW, WOW, WOW!!! Guess what.....I did change my pen to another tresiba pen as the old one ran out and......48hrs later which was this morning, for the first time my background blood sugars are no longer rising!! I can't beleive it. I've been battling away for three weeks, and all of a sudden, change of pen and everything works as it should. I would never of thought about the insulin not working, being a bad batch. You are the first to make this suggestion and you were right. My blood sugar readings this afternoon during a fasting (no lunch) 12pm 5.3 1pm 5.5 2pm 4.7 3pm 4.5. I'll reduce my dose tomorrow as it is falling a bit. Who would of thought? This doesn't give me much confidence in TRESIBA though. At least next time this happens I will know where to look.🙂
Thanks

 

[Bloden]

Yippee!!! Oh, I'm so relieved for you, Amity Island.😛😛

Don't let your experience put you off Tresiba (difficult after 3 weeks, I know) - any insulin can be faulty. 🙂