Yoyoing bolus ratio and basal

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gillrogers said:
Blooming surgery just rung to tell me theyve cancelked my appointment and cant say when theyll remake it for!! i give up!
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Sorry about the frustration you're having
 
Doc rang me this evening. Shes pretty sure its the Levemir thats giving me the problems especial with that peak. So she suggest i change to a slower flatter long term. Nakes sense to me as i only went on it because of working bars in the evenings at weekends and found that 5 hours on my feet at night was causing me problems during the night even after having something to eat when i got in. Im not doing that now and I have been on the same basal at night and day on and off. Im going to run it by my dbn tomorrow but i do think it makes sense. So feeling a bit yappier now. She was so apolgetic for letting me fowny yesterday.
 
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gillrogers said:
Doc rang me this evening. Shes pretty sure its the Levemir thats giving me the problems especial with that peak. So she suggest i change to a slower flatter long term. Nakes sense to me as i only went on it because of working bars in the evenings at weekends and found that 5 hours on my feet at night was causing me problems during the night even after having something to eat when i got in. Im not doing that now and I have been on the same basal at night and day on and off. Im going to run it by my dbn tomorrow but i do think it makes sense. So feeling a bit yappier now. She was so apolgetic for letting me fowny yesterday.
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hope you get on with the other insulin
 
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Hope whatever they move you to works out better for you. Let us know how you get on. Really pleased that you got the call back even if it was a day late and that you are feeling like you have some hope of a solution in sight.
 
rebrascora said:
Hope whatever they move you to works out better for you. Let us know how you get on. Really pleased that you got the call back even if it was a day late and that you are feeling like you have some hope of a solution in sight.
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Thanks Barbera. Funilly enough my hubby said a few weeks ago that he didnt think i was on the right medication. But onky as far as the reason why i was on it isnt there now and it never occurred to me that it may be the case. And with a bit of luck i wont find myself having to change my evening bolus so much depending on the night time basal that im on.
 
Oh dear it’s tresiba she thinks will be better with. I think I’ll be just putting the problem else where and if anything making it worse with a 2-3 day delay in effect.
 
It had to be either Tresiba or Toujeo and they are both the same in that respect. That is the whole purpose of a long acting insulin. They are not designed to be changed regularly. You set the dose for optimum overnight levels and then make up any shortfall by adjusting your bolus ratios through the day.
 
I wonder if there is some temporary advantage in the longer acting basal insulin - you will be "forced" to stick with the same dose for longer to learn what is happening. Changing so often as you do has meant that you have not been able to identify trends and learn what you body needs.
 
helli said:
I wonder if there is some temporary advantage in the longer acting basal insulin - you will be "forced" to stick with the same dose for longer to learn what is happening. Changing so often as you do has meant that you have not been able to identify trends and learn what you body needs.
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Yes I’ve been wondering that but it does worry me when my basal can drop on a daily basis which seems regular especially when the weather changes. That would mean making changes to bolus at mealtimes . I think it’s going to confuse the hell out of me even more . Going to see what my dbn says this afternoon.
 
gillrogers said:
Oh dear it’s tresiba she thinks will be better with. I think I’ll be just putting the problem else where and if anything making it worse with a 2-3 day delay in effect.
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I guessed it would be. They’re obsessed with Tresiba being ‘easier’ but for many people it’s not. They’re also obsessed with long-lasting basals. Think about that new basal recently that they said would last a week. To me, that sounds hideous not an improvement. Newer isn’t always better. Many of these new insulins aren’t actually step forwards. They’re just a chance to advertise longer/quicker/whatever and keep on making money.

Don’t be pushed into changing @gillrogers if you don’t want to. Often their suggestions are generic not aimed at the individual.
 
I have to say that whilst I am not a fan of long acting basals, I do agree with @helli, that giving Gill a break from adjusting one of the parameters, may help her to stabilize a bit.

I hope you don't mind me saying this but you are just a bit too keen to tinker with things and you are making too many adjustments. I never adjusted my basal at all until after my DAFNE course and then it was very slow and cautious. I know that it is anxiety causing you to adjust things all the time rather than looking at a weeks worth of data and making one well thought out decision. You latch onto ideas like atmospheric pressure being a factor when in truth this may only have a tiny impact on a very small number of people. Not saying you are not one of them but it will not be significant enough to warrant adjusting anything and because you have been adjusting things too much, you really have no way of knowing what is doing what. It is really not something which should be a consideration for you as there are many, many more factors that have a bigger impact, your anxiety being a major one, which I know is really difficult to tackle and like me, you need help with it. I am lucky in that my anxiety doesn't involve my diabetes, but it certainly affects many other aspects of life and I have recently sought help with it and I think you should too if you haven't already.
 
rebrascora said:
I have to say that whilst I am not a fan of long acting basals, I do agree with @helli, that giving Gill a break from adjusting one of the parameters, may help her to stabilize a bit.

I hope you don't mind me saying this but you are just a bit too keen to tinker with things and you are making too many adjustments. I never adjusted my basal at all until after my DAFNE course and then it was very slow and cautious. I know that it is anxiety causing you to adjust things all the time rather than looking at a weeks worth of data and making one well thought out decision. You latch onto ideas like atmospheric pressure being a factor when in truth this may only have a tiny impact on a very small number of people. Not saying you are not one of them but it will not be significant enough to warrant adjusting anything and because you have been adjusting things too much, you really have no way of knowing what is doing what. It is really not something which should be a consideration for you as there are many, many more factors that have a bigger impact, your anxiety being a major one, which I know is really difficult to tackle and like me, you need help with it. I am lucky in that my anxiety doesn't involve my diabetes, but it certainly affects many other aspects of life and I have recently sought help with it and I think you should too if you haven't already.
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I know you're so right. But when i go to the dbn nurses and they say do this and do that and experinent its so confusing. There are patterns though without a doubt but i think i get given advice from the dbns and they forget ive not been type 1 all my life , just tge last two or 3? And im trying to cram a lifetimes worth of experience into those 3 years and its not working. Doesnt help when db nirses take over a week to respond now and I end upbeing left to try and sort these things on my own.
 
Inka said:
I guessed it would be. They’re obsessed with Tresiba being ‘easier’ but for many people it’s not. They’re also obsessed with long-lasting basals. Think about that new basal recently that they said would last a week. To me, that sounds hideous not an improvement. Newer isn’t always better. Many of these new insulins aren’t actually step forwards. They’re just a chance to advertise longer/quicker/whatever and keep on making money.

Don’t be pushed into changing @gillrogers if you don’t want to. Often their suggestions are generic not aimed at the individual.
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I want to change but i am worried about this delay in changes with it. It seems like i might be swapping one problem for a bigger problem. ‍♀️
 
Just one of my odd thoughts, do they use tresiba in pumps?
 
gillrogers said:
Had a week of starting a drop 20 to 30 minutes after dinner. Sorted with a glucose tab, expected a high spike but didnt get one and just levelled off. Every day! But each day i reduced my bolus by half and each day it happened again.
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If you are going low within 2 hours of eating then it's your bolus that needs changing..
 
They don't use basal insulin at all in pumps. The pump only uses fast acting (bolus) insulin and it delivers tiny amounts of it throughout the day and night to balance the glucose from your liver. You (or your nurse) set up a profile for every hour of the day and night for your basal needs and then you tell it when and how much to deliver for meals. It means that when you are dropping fast you can suspend your basal profile so there isn't all the basal insulin you inject on a morning or evening or both, releasing it throughout the day and night, but just a tiny trickle of fast acting insulin every few minutes providing that basal cover. So if you are going to exercise, you can suspend the basal an hour or so before hand and that should prevent you having a hypo during the exercise. You can have more for however many hours in the morning you need to cover DP/FOTF but less or none after lunch if you have problems dropping low in the afternoon. You can set up different basal profiles for work days and weekends or different times of the month. This makes it sound really good and it is, but it is also more complicated because you can adjust so many more things. The closed loop systems do a lot of this adjusting for you, but you have to know how to use it in manual mode because technology can fail and will usually do so at the least convenient time.
 
rebrascora said:
I have to say that whilst I am not a fan of long acting basals, I do agree with @helli, that giving Gill a break from adjusting one of the parameters, may help her to stabilize a bit.

I hope you don't mind me saying this but you are just a bit too keen to tinker with things and you are making too many adjustments. I never adjusted my basal at all until after my DAFNE course and then it was very slow and cautious. I know that it is anxiety causing you to adjust things all the time rather than looking at a weeks worth of data and making one well thought out decision. You latch onto ideas like atmospheric pressure being a factor when in truth this may only have a tiny impact on a very small number of people. Not saying you are not one of them but it will not be significant enough to warrant adjusting anything and because you have been adjusting things too much, you really have no way of knowing what is doing what. It is really not something which should be a consideration for you as there are many, many more factors that have a bigger impact, your anxiety being a major one, which I know is really difficult to tackle and like me, you need help with it. I am lucky in that my anxiety doesn't involve my diabetes, but it certainly affects many other aspects of life and I have recently sought help with it and I think you should too if you haven't already.
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Meant to say Barbera, yes i have sought help. Im hoping it will work ad its not the type of help i definitely know that works with ne as i cant afford it. Im receptive to hypnotherapy . What im trying now is something like cbt or dbt that will target my catastrophising and hopefully rewire me to think properly.
 
gillrogers said:
I want to change but i am worried about this delay in changes with it. It seems like i might be swapping one problem for a bigger problem. ‍♀️
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I think, like Barbara, that you’re changing things too much too frequently. That’s your root problem. Once you can deal with that better, I think you’d find the Levemir a better fit.

I see the point about Tresiba giving you less opportunity to change, but I don’t think it will necessarily reduce your anxiety. The simplest ‘don’t have to think too much’ is a fixed dose regime where you eat to the insulin. That might mean you’d be less tempted to fiddle with your doses. Unless there’s an additional medical problem having an effect, it would be unusual to have to do so many changes.
 
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