Whqt do people do to become more confident

[Inka]

I pinch up, i only did a half unit. I had my grand daughter here so was covering the rest with pumkin carving. Which we didnt get to start until my blood sugars started rising.

Ok. Something is possibly a bit askew if your basal is dropping you so much and you’re only on tiny doses. Maybe your own insulin is kicking in before lunch? That’s a common time for it to do so. I could not inject for breakfast, spike but be back well in range by lunch during my honeymoon period, and a friend found that she’d always go low before lunch too. She actually had investigations and the conclusion was that it was her own insulin.

So, assuming that’s what’s happening, you could try not correcting a similar number before lunch and see what happens. I’d also look at your Levemir timings to see if slight moves might help. Levemir has a little peak of action around 4hrs so if you did your morning Levemir a little later, it would be peaking at lunch time. You might then be able to make use of that and lower your lunch bolus slightly.

 

[rebrascora]

@Inka, From what I understand this drop from 10.7 to 7 is occurring within the first hour after the bolus+ correction has been injected, so in my mind it is mostly the bolus insulin dropping Gill's levels. I may be be misunderstanding though!

 

[rebrascora]

Gill, can you post a screenshot of your graph, so that we can see what was going on in the run up to lunch.

 

[gillrogers]

Gill, can you post a screenshot of your graph, so that we can see what was going on in the run up to lunch.

 

[Inka]

@Inka, From what I understand this drop from 10.7 to 7 is occurring within the first hour after the bolus+ correction has been injected, so in my mind it is mostly the bolus insulin dropping Gill's levels. I may be be misunderstanding though!

Yes, I get that but I’m wondering if her own insulin is kicking in then, magnifying the drop, if you get what I mean?

 

[gillrogers]

Ok. Something is possibly a bit askew if your basal is dropping you so much and you’re only on tiny doses. Maybe your own insulin is kicking in before lunch? That’s a common time for it to do so. I could not inject for breakfast, spike but be back well in range by lunch during my honeymoon period, and a friend found that she’d always go low before lunch too. She actually had investigations and the conclusion was that it was her own insulin.

So, assuming that’s what’s happening, you could try not correcting a similar number before lunch and see what happens. I’d also look at your Levemir timings to see if slight moves might help. Levemir has a little peak of action around 4hrs so if you did your morning Levemir a little later, it would be peaking at lunch time. You might then be able to make use of that and lower your lunch bolus slightly.

I had a feeling it could be that, though hospital said that there was hardly any cells left when i did the lada test.

 

[Satan’s little helper]

I had breakfast at 7.30 and lunch at 12.45. im.pushing lunch around because this natural basal drop confuses matters terribly. But i dont want it really later than 1pm. Im on humalog for bolus and levemire split 12 hours apart.

Thanks. I was wondering if it could have been the tail on another type of bolus from your breakfast. Though I wouldn’t rule out basal.

I pinch up, i only did a half unit. I had my grand daughter here so was covering the rest with pumkin carving. Which we didnt get to start until my blood sugars started rising.

I can empathise how a low can affect the cognitive. I’ve been caught out in the middle of a project, gone back after treating & thought “I’ve had a right cowboy in here.” Don’t be to hard on yourself. I’m sure your grand daughter had a great time carving that squash. 🙂

 

[Inka]

I had a feeling it could be that, though hospital said that there was hardly any cells left when i did the lada test.

It’s a possibility - and I think it’s important to consider all possibilities because then you can hopefully find the best way to deal with things 🙂

If I were you, I’d try to remove as many variables as possible. I’d eat breakfast and lunch at the same time each day and have the same breakfast and the same lunch each day. Doing that might help you pin down what’s happening.

 

[gillrogers]

It’s a possibility - and I think it’s important to consider all possibilities because then you can hopefully find the best way to deal with things 🙂

If I were you, I’d try to remove as many variables as possible. I’d eat breakfast and lunch at the same time each day and have the same breakfast and the same lunch each day. Doing that might help you pin down what’s happening.

Hi Inka, i do that for the most anyway. Ive though about moving my basal times around but thats just going to push the problem on. If the drop starts and carrys on ivefound gaving a snack works and bolus for with my lunch later. But yesterday it seemed to stop and hold so i thpught i was ok. When it does this and ive seen it before in basal tests its clearly because my basal has dropped usually by a half unit as itll cover and deal with a half units of bolus insulin in food.

 

[gillrogers]

Thanks. I was wondering if it could have been the tail on another type of bolus from your breakfast. Though I wouldn’t rule out basal.

Well ive thought that as my breakfast bolus is 7.5 to -8.5 units. I read somewhere that insulin doses over 6 units can pool under the skin and become active later. That would explain why i had a higher than expected peak too.

 

[Satan’s little helper]

Well ive thought that as my breakfast bolus is 7.5 to -8.5 units. I read somewhere that insulin doses over 6 units can pool under the skin and become active later. That would explain why i had a higher than expected peak too.

You may have a point? I also feel larger doses of insulin should not be forced through a narrow tube at high velocity & hitting the hypodermis, either. Factoring in the timing for this action to compliment digesting the food giving you a steady rise within range, then moving back to the baseline without any other intervention is easier said than done. Looking at what your basal is doing on average first, might help demystify the occurrences.

 

[rebrascora]

From that Libre graph, your overnight basal dose looks great (obviously that is just judging by a one off graph) but it looks like you didn't prebolus far enough in advance of breakfast for your levels to spike so high. Then it looks like the breakfast bolus was still bringing you down off your breakfast spike when you injected a correction and bolus for lunch. I would have taken that into consideration. We can be more insulin resistant when our BG levels are high, so that breakfast bolus when your levels were about 9 probably sat there fighting that insulin resistance plus no doubt FOTF and then by lunchtime your Levemir had built up a bit of steam and was no doubt then helping to bring your breakfast spike down.
When do you inject your morning Levemir?
If you can get it into your system as soon as you wake up on a morning, it has more chance of dealing with DP/FOTF rather than your breakfast bolus trying to deal with that and then your Levemir peaking later and bringing you down at lunchtime. The key with Levemir is timing it so that it gives you the peak of activity when your body needs it most. Once your levels get into double figures, we all become more insulin resistant and it takes longer to bring them down.

I find injecting basal and bolus as soon as I wake up really helps keep a lid on breakfast spikes.... but obviously if you are going to go out to walk the dog before breakfast or a run, than don't inject the bolus, but the Levemir will take time to build up so injecting it as early as possible should help .

 

[Inka]

Hi Inka, i do that for the most anyway. Ive though about moving my basal times around but thats just going to push the problem on. If the drop starts and carrys on ivefound gaving a snack works and bolus for with my lunch later. But yesterday it seemed to stop and hold so i thpught i was ok. When it does this and ive seen it before in basal tests its clearly because my basal has dropped usually by a half unit as itll cover and deal with a half units of bolus insulin in food.

Yes, but if you’re lucky you can make use of the slight peak of Levemir or, at least, have it happen at a convenient time. I’d also say that Humalog has a slight kick at around 4 hours or so. I’ve noticed this - a brief but quite strong drop before lunch from my breakfast bolus.

 

[rebrascora]

I have heard other people say that too about Humalog having a kick in the tail.

 

[gillrogers]

You may have a point? I also feel larger doses of insulin should not be forced through a narrow tube at high velocity & hitting the hypodermis, either. Factoring in the timing for this action to compliment digesting the food giving you a steady rise within range, then moving back to the baseline without any other intervention is easier said than done. Looking at what your basal is doing on average first, might help demystify the occurrences.

So had my lunch, , just had the drop but much slower than yesterday. But think then i need to up my breakfast bolus as i needed the correction again. Does worry me though if i do that then when my basal decides to drop ill be in a worser situation than yesterday or am i likely to see it earlier. Then i could have the snack .

 

[rebrascora]

Can you clarify when you take your morning Levemir?

 

[Satan’s little helper]

So had my lunch, , just had the drop but much slower than yesterday. But think then i need to up my breakfast bolus as i needed the correction again. Does worry me though if i do that then when my basal decides to drop ill be in a worser situation than yesterday or am i likely to see it earlier. Then i could have the snack .

How long after breakfast did you do the correction? Could you still have bolus insulin jumping on your bolus later for lunch?
But I would personally be more focused on basal testing, just to be certain that’s not “it.”

 

[gillrogers]

From that Libre graph, your overnight basal dose looks great (obviously that is just judging by a one off graph) but it looks like you didn't prebolus far enough in advance of breakfast for your levels to spike so high. Then it looks like the breakfast bolus was still bringing you down off your breakfast spike when you injected a correction and bolus for lunch. I would have taken that into consideration. We can be more insulin resistant when our BG levels are high, so that breakfast bolus when your levels were about 9 probably sat there fighting that insulin resistance plus no doubt FOTF and then by lunchtime your Levemir had built up a bit of steam and was no doubt then helping to bring your breakfast spike down.
When do you inject your morning Levemir?
If you can get it into your system as soon as you wake up on a morning, it has more chance of dealing with DP/FOTF rather than your breakfast bolus trying to deal with that and then your Levemir peaking later and bringing you down at lunchtime. The key with Levemir is timing it so that it gives you the peak of activity when your body needs it most. Once your levels get into double figures, we all become more insulin resistant and it takes longer to bring them down.

I find injecting basal and bolus as soon as I wake up really helps keep a lid on breakfast spikes.... but obviously if you are going to go out to walk the dog before breakfast or a run, than don't inject the bolus, but the Levemir will take time to build up so injecting it as early as possible should help .

I inject my basal at 6am as it helps stop a bigger rise before breakfast. I used to do it at 7 but found it too late and gave me similar problems with lunch. Ive considered pushing it back to 5am but i have enough trouble with staying asleep as it is . I dont know

 

[gillrogers]

How long after breakfast did you do the correction? Could you still have bolus insulin jumping on your bolus later for lunch?
But I would personally be more focused on basal testing, just to be certain that’s not “it.”

As im on mdi ive veen told to leave corrections until my next meal. However i will do thrm in the eveng before bed if i need to.

Im reluctant to do basal testing again as my basal changes any way very very regularly as im sensitive to the weather, stress which i have a lot off from a suicidal daughtwr. So id do a test one day make the necessary cyanges and it would be out the window within and hour of me getting up. So i go by if lunch and dinner go wrong i need the change. What gappens at lunch is usually the telk tale on it.

 

[Satan’s little helper]

As im on mdi ive veen told to leave corrections until my next meal. However i will do thrm in the eveng before bed if i need to.

OK, that seems to explain what I can make of your graph? Do you have any more graphs? Or even daily patterns.
To your credit, I don’t see any major lows.🙂