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foxl

Are you kidding me? Splitting Lev dose

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dbaratta
I did that, I went off Lantus, which I was up to taking 80 units a day, and went back on NPH. I'm fine on 50 per day. Even though back when I was first diagnosed I was on 32 NPH in the morning and 16 NPH in the evening, I now do very well with 25 am and 25 pm.

 

Ann

 

Hi Ann, when I first started on Lantus I was up to 35U in the pm and I noticed that from 16 to 35 units there was no better control in my BG numbers so I stick with 16U split dose now. I think with Lantus because it is absorbed slowly we can take more than we need without going too low during the day, but what do I know. I did gain 20 pounds from getting too much of that drug which was very disappointing, live and learn. :(

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Subby

If I overdo basal by say 5%+, I will be looking at nasty lows. No buffer zone for me.

 

There is just so much variety in our insulin experiences... it might partly be various systems interacting differently relative to type or the actual attributes that make you diabetic. But even given that, even within a group of people with similar bodily issues, there always seems to be exceptions everywhere.

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dbaratta
If I overdo basal by say 5%+, I will be looking at nasty lows. No buffer zone for me.

 

There is just so much variety in our insulin experiences... it might partly be various systems interacting differently relative to type or the actual attributes that make you diabetic. But even given that, even within a group of people with similar bodily issues, there always seems to be exceptions everywhere.

 

True. Of course my exerence with Lantus was long before I restricted my diet like it is today. Just 1 unit more of lantus can make a big difference now that I know what I can and can't eat. The over-doing of the drug was when I first started taking it.

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ant hill
If I overdo basal by say 5%+, I will be looking at nasty lows. No buffer zone for me.

 

OH DEAR Subby :(, That's walking on unstable ground as you will experience terrible lows that seems to have a bottomless pit. Meaning eat until you are so so full and still low. :mad::mad::mad::mad:

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Subby

Aww, they aren't too bad, Peter, I would call my lows from a bit too much basal "creeping lows", where you just persistently keep sliding down... rarely result in those nasty crashes you talk of, thank goodness. I do remember those ones well, especially with Lantus that just did not suit my needs...

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ant hill

OK Subby, As long you know where you are at. My biggest worry is I cannot know when I have a low until it is really low. :eek: I don't sweat or shake, I just be a dumb dildo. :(

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foxl

Well I was 125 this morning! After 6U last night 9which was my starting dose last week!). Soooooo, something up.

 

I do not think it is Somogyi effect (going low and rebounding) -- I am eating SOME more carbs, (50 total g yest) but for CRYIN' OUT LOUD!

 

And yes I am using the term "split" as Subby interprets it, to mean split dose-administration, not necessarily splitting my original dose!

 

It may be the honeymoon ending, though, or me just ... moving to a higher level? ;) Or the hot weather. Or ... or ... or ...

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Rekarb

You know I'm a bit anal with this. I'm getting this as the idea of topping the tank. I take my 10u at 10 pm and by 10 am the dosage has effectively reduced itself to about 6 or 7u. I take a small dose to bring it up so I can have something to get me to 10 pm.

 

Does this sound right?

 

Mike

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foxl
You know I'm a bit anal with this. I'm getting this as the idea of topping the tank. I take my 10u at 10 pm and by 10 am the dosage has effectively reduced itself to about 6 or 7u. I take a small dose to bring it up so I can have something to get me to 10 pm.

 

Does this sound right?

 

Mike

 

I am too, and your dosing sounds quite similar to mine!

 

6 at night, 4 at morning ...

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Subby

Mike, I don't know if this helps with the visualisation of the process, but I mocked this up for what it is worth. It's very roughly based on your situation as you have mentioned it. I think these things can be better described visually sometimes, or at least visuals can help. Then again, it might make no sense, or just be illustrating completely obvious things. Oh well, I had fun with paintbrush :)

 

Asplitscenario.png

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foxl
Mike, I don't know if this helps with the visualisation of the process, but I mocked this up for what it is worth. It's very roughly based on your situation as you have mentioned it. I think these things can be better described visually sometimes, or at least visuals can help. Then again, it might make no sense, or just be illustrating completely obvious things. Oh well, I had fun with paintbrush :)

 

Asplitscenario.png

 

NICE! :D I love a good graphic ...

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Subby

Cheers, I am particularly proud of the lime green.

 

I should add that all those lines might be doing somewhat different things, this is about 80% conceptual. (does that make it diagramatical? I don't know). The battle can only be fought in the ground: ie, find a reasonable theory based on what you do know, and carefully test it! (and be prepared to fail and adjust.)

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Rekarb
Mike, I don't know if this helps with the visualisation of the process, but I mocked this up for what it is worth. It's very roughly based on your situation as you have mentioned it. I think these things can be better described visually sometimes, or at least visuals can help. Then again, it might make no sense, or just be illustrating completely obvious things. Oh well, I had fun with paintbrush :)

 

Asplitscenario.png

I loves ya, Subby. This captures precisely what I was thinking of. Now, what I have to do is get places where the bg's are going up and down as the Levemir changes potency. Unfortunately, I'm running low on strip so I might have a bit of delay on reporting the results.

 

Mike

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anneliza
Hi Ann, when I first started on Lantus I was up to 35U in the pm and I noticed that from 16 to 35 units there was no better control in my BG numbers so I stick with 16U split dose now. I think with Lantus because it is absorbed slowly we can take more than we need without going too low during the day, but what do I know. I did gain 20 pounds from getting too much of that drug which was very disappointing, live and learn. :(

 

I found much the same thing, whether I took 60 or 90 units, it didn't really change things that much. I also gained a lot of weight on Lantus, no doubt from taking too much. Who knew. But when I stopped taking Lantus, a lot of joint and muscle aches disappeared. I googled it, and apparently some people have those side effects to Lantus. I wouldn't touch it now -- I feel 20 years younger!

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foxl

My ears are OPEN!

 

Hmmm ... interesting how much basal you could tolerate!

 

I keep reading about people going hypo from basal dosing, though ... It does make you wonder -- do some people just run continual liver dumps, and others not, or what?

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Subby
My ears are OPEN!

 

Hmmm ... interesting how much basal you could tolerate!

 

I keep reading about people going hypo from basal dosing, though ... It does make you wonder -- do some people just run continual liver dumps, and others not, or what?

 

Going low during a basal indicates excessive basal insulin at the time. This is basal testing doing its job in assessing how well the basal insulin is matching needs. If you go low, you should stop the test, adjust doses, and try again another day. Again this isn't the test failing: it's doing its job of letting you know there is a problem and to fix it to the best of your ability before you move on.

 

If people basal test and say they can't do it because they get lots of lows, they are not quite understanding what the process is about! If you keep getting lows, you need to keep reducing your dose and trying again.

 

If on a pump, you program less basal for the period, and try basal testing the period again until you get it right, then you can move on to the next period. If using long acting, you might need to factor in more ups and downs and kind of hang on for grim life and assess over the life of the shot, as you can't change basal supply from hour to hour and need to find a "best fit" dose.

 

As for liver dumps, lets say you are prone to dumps after periods of no food. Usually that shouldn't be a problem if you don't push the fasting too far. After 4 hours lead up, (and BG stability during this time and previously), you are good to start testing. You only need go for a few hours at a time if you wish. I do tend to dump quite easily after say 10 hours, and so when I test longer I tend to have small amounts of low carb foods periodically (few nuts, that kind of thing). This helps stave off dump/increased gluconeogenesis, and should be a pretty small impact on the testing results.

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foxl

Thanks Subby -- but how else would you account for people tolerating so much basal? It cannot be a dump, so much as a continual spew?

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Subby
Thanks Subby -- but how else would you account for people tolerating so much basal? It cannot be a dump, so much as a continual spew?

 

Hmm, why do some people need a lot of basal insulin, while others don't need as much? Complex question and I have nothing like a definitive answer! I think liver output could certainly be a factor (whether dump or gluconeogenesis, or whatever other similar processes there are).

Also insulin resistance.

Also degree of insulin antibodies reducing effectiveness of injected insulin to a varied amount.

Also x factor, plus y factor, topped off by z factor :)

 

Consider my silly case again: I take lantus, I need 50u. I take levemir, I need about 160u. Seems completely arbitrary - evidently my body can utilise one insulin more easily over the other. Cases like this put one big "?" over the reasons for any actual number insulin doses, for me.

 

Hang on, maybe that's not what you meant. Let me reconsider your meaning...

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Subby
My ears are OPEN!

 

Hmmm ... interesting how much basal you could tolerate!

 

I keep reading about people going hypo from basal dosing, though ... It does make you wonder -- do some people just run continual liver dumps, and others not, or what?

 

Ah sorry, I thought you said "basal testing". Got that on the brain at the moment. See, some people try basal testing, go low, and think they stuffed up or it can't work for them. That's what I thought you were referring to.

 

Thanks Subby -- but how else would you account for people tolerating so much basal? It cannot be a dump, so much as a continual spew?

 

I can still read this a few ways, so if you can be bothered, can you rephrase the question? :) Do you mean, why do some people go low on using x dose of basal insulin, while other need more? Or is this to do with that kind of big buffer zone some people seem to have?

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foxl
Ah sorry, I thought you said "basal testing". Got that on the brain at the moment. See, some people try basal testing, go low, and think they stuffed up or it can't work for them. That's what I thought you were referring to.

 

 

 

I can still read this a few ways, so if you can be bothered, can you rephrase the question? :) Do you mean, why do some people go low on using x dose of basal insulin, while other need more? Or is this to do with that kind of big buffer zone some people seem to have?

 

Yes that kind of big buffer zone -- how can you add in more and more insulin, without seeing a decrease in BG? The liver is keeping up ...

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Subby

OK, I gotcha now. I agree that sounds like a plausible enough possibility. I guess I haven't thought about this that much as I don't get much of a buffer zone myself.

 

Wasn't another theory going around that this might be a case of the difference in beta cell storage/release? So, assuming you have beta cells left, the low dose of insulin forces you to release your generated insulin, whereas as you push up to the higher dose you are more and more secreting instead of releasing it. Then at some point you reach an excessive amount of exogenous insulin and that's the real hypo time.

 

Otherwise, some weird and wacky metabolism mechanic involving insulin antibodies sent out to ward off excessive basal insulin, is about the only other kind of explanation I can imagine.

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MCS

From what I have read and what I think was happening to myself was my pancreas was sending out more glucagon, which signaled my liver to leak more glucose. 10-30u of Lantus changed nothing but my FBG in the morning and my appetite. I think it is do to the slow nature of Lantus allowing your body to catch up with it, with out going low.

 

What I noticed even more was my liver behaved itself better after I quit Lantus, maybe a lack of signal from glucagon who knows, but I do not get the big liver dumps like I did before.

 

 

 

Yes that kind of big buffer zone -- how can you add in more and more insulin, without seeing a decrease in BG? The liver is keeping up ...

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Rekarb

I keep reading about people taking Levemir and then having to reduce it. It's as if, past a certain point, the body puts up resistance to the insulin and adding more will not give you a change in bs. My problem with this is that some people go hypo while some get no real change. How do you know which type of person you are? Can you be doing just fine and then your body suddenly begins to react to the extra insulin then you go low? My only answer is to go very slow.

 

Mike

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foxl

Well, I missed my morning 3U and ... my readings were lower this afternoon and I did not feel as hungry.

 

Think I will wait for a while and take the numbers I have, for now.

 

Well, I missed my morning 3U and ... my readings were lower this afternoon and I did not feel as hungry.

 

Think I will wait for a while and take the numbers I have, for now.

 

WELL ... that was short-lived. Post prandial by THREE HOURS had a 167 :eek: yesterday ... had not seen anything like that since starting Lev.

 

So back to da drawing board ... trying 3U at 10 am instead of 8 am today. We'll see. Something seems to have changed ... :confused: gotta work with what I got.

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ant hill

You will work this out Linda as this will take some time to get used to the new insulin. You will get there Lin. :D

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