Winter into summer consequences.

[Proud to be erratic]

I find my insulin needs change noticeably as spring starts up. No doubt those forum members with decades of insulin dependency under their belts are already on this. But for those fairly new to this D malarkey this post might flag up some explanation if tgeir BG has become wayward recently.

My basal has already needed a couple of 1/2 unit reduction tweaks. The combination of somewhat milder weather and slightly longer days is naturally encouraging me to get out and about more and the extra warmth is improving my natural insulin resistance. I would think that anyone using the steady and long profile Tresiba oulght to be at least alert to this scenario - thus get mentally prepared to check consecutive CGM overnight (fasting) graphs and adjust if a downward trend is obvious.

My bolus needs are probably also changing but those changes are less apparent.

 

[Proud to be erratic]

Whoops - apologies posted before I'd finished ....

My bolus needs are probably also changing but those trend changes are less apparent. Types of meals are altering as are snacks; the carb content is different but the net "pluses and minuses" may or may not be different day to day. I'd need to look at all of the last week or weeks in comparison to this week or next week to try and deduce a bolus changing trend, but the improved weather is certainly getting me out and about more and activity/exercise adjustment factors have noticeably got bigger, so bolus dose have become smaller.

I'm not sure how warmer weather affects those T2s on oral meds, but presumably T2s using insulin also need to be alert to an increased hypo risk.

I appreciate I live in the South, due west of London and the weather "up north" may not be so kind right now. But I did notice that way up in Lossiemouth there had been an amazing burst of fine weather earlier this month. Am I alone with already noticing this consequence of spring coming along?

 

[Robin]

I always need to lower my daytime basal by a unit (from 6 to 5) when the weather gets warmer, but I don’t know if it’s just because I tend to be more active, with all the gardening that suddenly needs doing.

 

[Proud to be erratic]

I always need to lower my daytime basal by a unit (from 6 to 5) when the weather gets warmer, but I don’t know if it’s just because I tend to be more active, with all the gardening that suddenly needs doing.

Out of curiosity @Robin, what basal and is that twice daily with only altering your daytime dose?

 

[Robin]

Out of curiosity @Robin, what basal and is that twice daily with only altering your daytime dose?

I use Levemir at the moment, and take 5-6 in the morning, and 3 at night, I sometimes lower my bedtime to 2 or 2.5 if I've been unusually active, or have had a couple of glasses of wine, but that’s normally because of those specific circumstances, and at any time of year, rather than a blanket change for the season.

 

[Standup]

I've been thinking about this as well as its my first proper summer - last year I was still recovering from surgery and not very mobile. As Roland says the warm weather and being more active means I need less insulin generally but I've also found I seem to be producing much more glucose as well. Although surgery means the liver doesn't in theory have the right connections no one seems to have told it and I'm looking at increasing my basal as my numbers are going up a lot when fasting. At the moment I'm using bolus to manage it as haven't worked out if its all the time or just certain times.

 

[djdave]

I've had to change my regime quite a bit over the last month. I had noticed a lot of lows and continually reducing basal (semglee) until last week when I stopped my basal all together!
My bolus has gone down by almost 50% (trurapi) too
I have a suspicion my pancy has a sticky throttle, both on and off
If I don't bolus I get a fairly long ramp up on BG levels and feel rough. If I have a bolused big meal spread over time my pancy ramps up insulin too (as much as partially necrotised pancy can do) and I head for a low afterwards especially if I dare to go for a walk..
This 3c malarkey can be fun to manage at times!
My thoughts go back to when I was in junior school and knew someone who was insulin dependent and had a rought time trying to balance sports and insulin... We are so lucky to have CGMs to monitor or levels in real time. I think I would be lost if I was depending on finger pricks and a GP slow to respond to changing needs!

 

[everydayupsanddowns]

My basal has already needed a couple of 1/2 unit reduction tweaks. The combination of somewhat milder weather and slightly longer days is naturally encouraging me to get out and about more and the extra warmth is improving my natural insulin resistance. I would think that anyone using the steady and long profile Tresiba oulght to be at least alert to this scenario - thus get mentally prepared to check consecutive CGM overnight (fasting) graphs and adjust if a downward trend is obvious.

My bolus needs are probably also changing but those changes are less apparent.

Thanks @Proud to be erratic - a helpful reminder.

It can certainly help me to be aware of things that might throw doses etc a little of-balance from time to time. Partly because the explanation (or possibility) helps explain some of the diabetes-randomness that can be frustrating where meals which are usually fine suddenly start misbehaving or not giving the results I’d expect.

Mostly I would find that a small tweak to my basal would usually be sufficient to get my meal/correction doses working properly again, and it was only after a few successive upward (or downward) basal tweaks that I’d need to adjust ratios. These days Deep Thought (my MM780G) is the one tasked with basal tweaking, so I don’t really have to worry about that. But it used to be a small adjustment once or twice a month!

 

[Proud to be erratic]

I've had to change my regime quite a bit over the last month. I had noticed a lot of lows and continually reducing basal (semglee) until last week when I stopped my basal all together!

I certainly realised that after c. 12 months, without CGM, my regime had changed a lot. I got Libre 2 in month 13 and the changes were even more noticeable.
Then I changed (my request) from Levermir to Tresiba because I wanted to reduce my MDI by one dose. I didn't know then that this would be as beneficial to me as it has subsequently become. So c. month 15 a further new regime - and that regime with tweaks has become my present regime.

You are not alone in pausing your basal completely. There are a few on the forum who seem to do that sometimes. But I'm also conscious that despite my having no panc'y at all, adrenaline and cortisol releases are constantly triggering glucose releases by my liver. In a different thread @everydayupsanddowns talks about when the bolus/basal ratios become too distorted (he suggests a ratio between 60:40 to 40:60 is about right); outside of that suggests one's insulin regime is possibly in need of deeper review. I'll have to hunt for that comment; I only have a smart phone, so can't keep different screens open simultaneously and hunting for something becomes challenging sometimes.

My bolus has gone down by almost 50% (trurapi) too

I think as we get better management with less/gentler peaks and troughs, hidden behind that graphical display is an improved Glycaemic Variability (GV). Better GV leads to reduced Total Daily Doses (TDD). This is not a hidden goal for me, just something I'm aware has happened and gives me a sense that this D malarkey is less turbulent 5 yrs on.

I have a suspicion my pancy has a sticky throttle, both on and off
If I don't bolus I get a fairly long ramp up on BG levels and feel rough. If I have a bolused big meal spread over time my pancy ramps up insulin too (as much as partially necrotised pancy can do) and I head for a low afterwards especially if I dare to go for a walk..

Going badly low during a walk was a regular thing for me. At that time I carried lots of JBs in little bags which gave me a fairly rapid pick-me-up; but (I now realise) was also exacerbating the roller coaster effect. So now my snacks in pockets include less JB or Haribo packets, but things like Naked bars (c.15 gms but easy to just eat half), biscuits, mini packets of cheese thins, crisps etc, etc. These mid range GI snacks provide slower release but more sustaining carbs. And I snack as I walk, it's now just my "normal". As is pockets full of different snacks, wherever I go.
Incidentally, I don't bolus for snacks for this purpose.

This 3c malarkey can be fun to manage at times!

To be fair, whilst I do beat the 3c drum a fair bit, I think this malarkey fun equally applies to anyone who is insulin dependent.

 

[everydayupsanddowns]

In a different thread @everydayupsanddowns talks about when the bolus/basal ratios become too distorted (he suggests a ratio between 60:40 to 40:60 is about right); outside of that suggests one's insulin regime is possibly in need of deeper review. I'll have to hunt for that comment;

It was something I picked up from John Walsh’s Pumping Insulin, which probably has references to research that underpins it as a rule of thumb. I’ve also heard it vaguely mentioned in diabetes conferences.

 

[Wendal]

It was something I picked up from John Walsh’s Pumping Insulin, which probably has references to research that underpins it as a rule of thumb. I’ve also heard it vaguely mentioned in diabetes conferences.

Interesting Mike as I saw the other thread and I know everyone’s situation will be different but the ratio suggested to me was more like 30:70 basal to bolus.
I started of on 2u for each meal and 2u of once a day basal and increased from there settling on my present 4:4:6 bolus and 6u basal which assuming I eat my normal meals and my normal activity keeps me OK.If I am having a very high carb meal I will adjust my bolus accordingly.
In trying to get my regime “right” one of my priorities was to get a fairly flat line overnight and found that as long as I don’t have a late snack or delayed carb load tea like Pizza then if I stick to my 6u then I will wake up within 1 of my going to bed level very much as a routine.
Thus I am reluctant to change that and happier with adjusting bolus/ exercise/ diet etc during the day as required.Which means a I have not really looked at my basal for a long time.
Yours and Roland's thoughts have encouraged me to maybe look closer/ experiment at/ with my basal levels to see if I can reduce my bolus interactions.
Appreciate that if something is working why change it but equally consider it important to review from time to time just to see if a different regime works better as our situation can change over time.

 

[Proud to be erratic]

Throughout my working life I have frequently thought that the philosophy of "if something is working why change it" is way too simplistic. General maintenance is a necessary remit to keep something working well. Sometimes that maintenance should rightly include change; upgrades for example.

As you say @Wendal, regime reviews are important and I think invariably beneficial overall. This was one of the core principles in Quality Assurance (QA) methodology. In one particular role I once had, there were moments when meeting the QA requirements was bureaucracy for "jobs worth" sake; ticling boxes. Yet sometimes there were very reassuring moments when a QA review highlighted truly dangerous and / or blatantly wasteful, inefficient practices. I left that role after 4 years, clear that the QA system we had WAS worthwhile, despite the measurable overhead cost.

Change is inevitable and everything is changing all of the time. The challenge is in minimising the inconvenience of reviews and working as much as possible into daily practices. Reviews can become stressful!

 

[Pam123]

I am finding my BG is lower plus a few unexpected low alarms.

 

[Proud to be erratic]

I am finding my BG is lower plus a few unexpected low alarms.

I know far too little about the complexities of T2, so this is just speculation on my part. But I guess the somewhat milder weather and longer days is having a similar effect on your natural insulin resistance, @Pam123 and thus your insulin (home grown or injected) goes a bit further. Hence your trend towards lowering BG.

 

[Flower]

I find the longer days & warming weather do require a reduction overall of my basal insulin. I leave my bolus ratios as they are.
Reductions of 0.1 units here and there make a big difference to me. The last few weeks I’ve been dropping into hypo territory so decided it was time to switch to ‘Summer’ basal profile on my pump. I haven’t tweaked it from last year so I’ll see how it goes…

In the years pre blood glucose testing, cgm etc I was completely unaware of the impact warmer weather had on my insulin requirements. It’s interesting to see what is uncovered with access to tech & round the clock data.

 

[everydayupsanddowns]

In the years pre blood glucose testing, cgm etc I was completely unaware of the impact warmer weather had on my insulin requirements. It’s interesting to see what is uncovered with access to tech & round the clock data.

Too true @Flower

Reminds me of my first couple of years of forum-inhabiting, when I was suddenly learning all sorts of new possibilities for diabetes management, and had started systematically checking both pre- and post-meals, and writing everything down for the first time in a lot of years. Out of the chaos, patterns gradually emerged, especially as I started keeping notes.

All of a sudden, lots of my ‘diabetes randomness’ wasn’t random at all. And I was able to gradually change my approaches to things, and see my diabetes behave a little better. Well some of the time anyway!