[Injecto]

You know, I've been having trouble with my basals I think. I recently started splitting my basals to two injections a day. One at night (10:00pm) and one at lunch (12:00pm). Basically I've gone down now from 18 units/day with one injection at night to 15/day with an 8 at night, and 7 at lunch. I've been a little bit more even, but I find that I still barely need to bolus in the morning. I can eat a 54 carb breakfast at 7:30am and not bolus at all and I'll be about 10.4mmol by 9:30am, but by 10:45am I'll have gone hypo, almost every morning. It's very frustrating. But this is less of a problem in the afternoon, and almost non-existent at night. I swear my basal needs are very different by time of day, where mornings I'm terribly sensitive, but with the pen I can't vary the basal much more other than just decreasing or increasing the injection volume. Any ideas are greatly appreciated.

[Cyborg]

Have you considered a pump?

[duck]

Originally Posted by Injecto

You know, I've been having trouble with my basals I think. I recently started splitting my basals to two injections a day. One at night (10:00pm) and one at lunch (12:00pm). Basically I've gone down now from 18 units/day with one injection at night to 15/day with an 8 at night, and 7 at lunch. I've been a little bit more even, but I find that I still barely need to bolus in the morning. I can eat a 54 carb breakfast at 7:30am and not bolus at all and I'll be about 10.4mmol by 9:30am, but by 10:45am I'll have gone hypo, almost every morning. It's very frustrating. But this is less of a problem in the afternoon, and almost non-existent at night. I swear my basal needs are very different by time of day, where mornings I'm terribly sensitive, but with the pen I can't vary the basal much more other than just decreasing or increasing the injection volume. Any ideas are greatly appreciated.

Some assumptions: Your basal insulin lasts only 20 hours. You always take your shots at Noon (15U) and 10PM(8U). Based on these:

Your total basal per hour is 1.15 from 8PM until 7AM.
Your total basal per hour is .4 U from 8AM til Noon.
Your totla basal per hour is .75 from 4PM til 8PM.

How are your sugars, reallll early, like 5AM through 7AM, without eating? If they are fine, I'd consider taking your Noon shot at 10 AM, that way it would be done providing basal at 6AM...So you'd have only .4 units (from the previous day at 8PM) working from 6AM til your next basal bolus at 10AM. We can tweak, move the rates as needed. What do you think?

[Geoff]

Hi Injecto,

This is very interesting. I am experiencing almost the same problem as your self. Back in September 2006 I was taking 18 units of lantus one time at around 22:15. My Endo looked at my bs charts, and although I was having very good bs control, av 5.6mmol/lt he suggested that I was taking too much basal dose, and that I should try to reduce it to at least 14 units. So I started reducing 1 unit every week, got to 14 units and found that my av fasting bs reading was 5.6, so I kept going downwards until I reached 9 units per day still managing an early morning reading of no higher than 5.9mmol/lt. the only problem was that I seamed to run out of basal at about 20 hr’s, and was unlike most people who’s bs goes higher in the evening, my was going lower as I was using more nova rapid to cover my carbs for my evening meal.

I have now started going back up and am on 14 units, split into 9 units at 22:15, and 5 units at 10:15 I tried like you first at 22:00 and 12:00, but found I was going high ( 7.1 mmol/lt) at around 20:00, so I moved it back to 10:15am, and increased the dose to 6 units at this time and 8 units at 22:15pm. This seams to be more stable, but I am still having problems getting my bolus to carb ratio right, at breakfast it is 1:50, mid-day 1:25 and for my evening meal at 17:30 it is 1:12.

Sorry for rambling on a bit but I was thinking of asking my endo if I could try Levemir for my basal dose as I have read that it’s profile is better suited to split dosage, but seeing that you are on it right now I wonder if I will get an improvement over using Lantus?

[Stuboy]

My basal's are changing at the moment, i think i owe that to the honeymoon. I used to take 10u at 9pm, and found my evening meals were causing highs even with a bolus. I split my lantus and was taking 6u 9am and 6u 9pm. it's been changing since then and im currently taking 5u 10pm and 7u 10am. It works well for me right now... thinking of dropping my morning lantus though as im just starting to run at a constant low (consistant). I run in the 4's during the day lately, which is a bit close to a hypo for my comfort, i'd rather be in 5's.

[Injecto]

Originally Posted by duck

Some assumptions: Your basal insulin lasts only 20 hours. You always take your shots at Noon (15U) and 10PM(8U). Based on these:

Your total basal per hour is 1.15 from 8PM until 7AM.
Your total basal per hour is .4 U from 8AM til Noon.
Your totla basal per hour is .75 from 4PM til 8PM.

How are your sugars, reallll early, like 5AM through 7AM, without eating? If they are fine, I'd consider taking your Noon shot at 10 AM, that way it would be done providing basal at 6AM...So you'd have only .4 units (from the previous day at 8PM) working from 6AM til your next basal bolus at 10AM. We can tweak, move the rates as needed. What do you think?

Hey Duck, thanks. I take 7U at Noon with 8 at 10PM. Can you teach me how you did your calcs? This is very interesting indeed. As for my BGs, I test every morning around 6:30am, when I normally get up, and I am always between 5.2 and 6.2 (in the last 22 days I've only had two readings above 6.0 ).

[Injecto]

Originally Posted by Cyborg

Have you considered a pump?

Absolutely, I hope to be on a pump by the end of January/early February. It all depends on when I hear back from insurance (the quote went out on Dec 27). I'm just waiting now.

[Injecto]

Originally Posted by Geoff

Sorry for rambling on a bit but I was thinking of asking my endo if I could try Levemir for my basal dose as I have read that it’s profile is better suited to split dosage, but seeing that you are on it right now I wonder if I will get an improvement over using Lantus?

No worries on rambling, I do it all the time, and that's what we are all here for, help and support. I have a hard time putting my faith in the flat "profile" of any insulin, but then again I've had no experience with any other insulins so perhaps it is "flatter" than others from the past. Some old timers here may have much more experience in the matter.

Originally Posted by Stuboy

I run in the 4's during the day lately, which is a bit close to a hypo for my comfort, i'd rather be in 5's.

I hear ya completely. Being in the 4's is a little scary for me. I like the 5's better, like 5.6-5.8.

[Gangrel]

Originally Posted by Injecto

No worries on rambling, I do it all the time, and that's what we are all here for, help and support. I have a hard time putting my faith in the flat "profile" of any insulin, but then again I've had no experience with any other insulins so perhaps it is "flatter" than others from the past. Some old timers here may have much more experience in the matter.

Trust me. I'm an old timer about to finally switch to Levemir over NPH, and I am as excited as a kid in a candy store.

The 'peaks' of NPH are nothing but a pain in the

Even if Levemir/Lantus aren't perfectly flat, they are certainly flatter then the NPH curve....

[duck]

Originally Posted by Injecto

Hey Duck, thanks. I take 7U at Noon with 8 at 10PM. Can you teach me how you did your calcs? This is very interesting indeed. As for my BGs, I test every morning around 6:30am, when I normally get up, and I am always between 5.2 and 6.2 (in the last 22 days I've only had two readings above 6.0 ).

I just make a spreadsheet with time across the top on the horizontal axis, and then I divide the bolus amounts by 20 (it seems most people here report Levemir and Lantus to stop at about 20 hours), and I plug that amount in for the next twenty hours. Then I do the same for shot #2. So, if you are taking 7U at Noon and 8 at 10PM, we get:

.75U from Noon til 5PM
.75 U from 10PM til 7AM
.4 U from 8AM til Noon
.35 U from 6PM til 10PM

I'd still consider taking the Noon shot at 10AM. But double-check my math, if you will.

[Injecto]

duck, I'm sorry I didn't get back to you earlier but I've been working on my basal rates non-stop since the last post and I am very thankful for your help. I made up a spreadsheet, similar to what you suggested, and I've been looking at several different combinations of what I can do. Right now I'm trying 9U at 12PM (it's just a convenient time to inject for now), and 6U at 10PM. I've skipped breakfast today (I'm still having a coffee, no sugar) and going to see what happens. Recall, my big problem is that I go hypo in the mornings, without taking any bolus at breakfast (eat at 7:30AM), and it's measured cereal (Oatmeal Crisp) and skim milk (total breakfast carbs 53g). But I will still spike at 2hrs post meal (between 9.5 and 11.5), and then eventually go hypo at around 11:00AM. If I do bolus (with 1U), I will hit around 8.0 at 2hrs post meal but I will be hypo by around 10:00AM. (I do have trouble in the afternoons too, but I figure one problem at a time right now).

So far:

Last Night:

10:00PM = 6.0 (Activity: Sleep)

Today:

6:40AM = 5.6 (Activity: Shower, get kids ready)

8:10AM = 6.2 (Activity: Get kids to school, drive to work)

10:00AM = 6.9 (Activity: Sitting at desk working)

11:00AM = 6.4 (Activity: Still sitting at desk working)

12:00PM = 5.4 (Activity: Still sitting at desk working, but I took my 12:00PM Basal of Levemir, 9U).

1:20PM = 4.3 (Activity: I had gone out for a walk before this test)
I think I'm starting to drop now, I might have to eat soon. We'll see.

And here's a copy of my basal sheet:

[belyro]

Injecto, this might be a slight aside, but Oatmeal Crisp is one of those cereals that I rarely eat. It just gives me waaaay too much of a spike. It sucks, because it's my favourite one, but it just doesn't seem to work for me. I'm better off with Special K or Cheerios.

Just a thought.

[duck]

Your spreadsheet looks better than mine! LOL

Your numbers look real good today too so far...I am curious to see the rest.

[Injecto]

I quit fasting after 15.5 hours and being too close to 3.9 for my comfort without eating (at 4.3) I ate 13g of carbs (low fat Breton wheat crackers).

1:20PM = 4.3 (Activity: I had gone out for a walk before this test, ate 13g Carbs after test)

2:00PM = 4.7 (Activity: Sitting at desk working. Ate another 13g Carbs)

3:00PM = 6.1 (Activity: Again, still sitting at desk working.)


I'm still not going to eat much or take a bolus until dinner, which will probably be around 6:00PM. Actually, this test is kind of cool, it tests my will power over hunger, it faces some of my fears of not eating and going hypo (though I still have to try it when I'm really active, yikes!), and it brings me closer to understanding what the heck my body is doing to me now.

Originally Posted by belyro

Injecto, this might be a slight aside, but Oatmeal Crisp is one of those cereals that I rarely eat. It just gives me waaaay too much of a spike. It sucks, because it's my favourite one, but it just doesn't seem to work for me. I'm better off with Special K or Cheerios.

Just a thought.

My big problem is I don't like cereal because it gets too soggy for me, but I found that Oatmeal Crisp stays "crisp" for long enough. I'm picky with cereal I guess.

[Injecto]

Well, it's 4:00PM and I'm at 6.0