The traditional approach would have you give a bolus shortly before eating to cover the meal, and not use the basal for that purpose. If the basal is right, you’ll stay about steady even if you don’t eat, which gives flexibility: if you want to eat, take the bolus, if you don’t want to eat, don’t take the bolus, and either way the BG should be fine. Of course in real life we always have small corrections as the BG wanders off, but we don’t want the basal dose forcibly driving the BG out of range.
Before I had a pump, I set it up the same way: very gradual drop overnight and during the day, but nothing that would make the CGM alert me that I need to fix something—I didn’t want to be awakened at night or pulled off of some task during the day just to fix the BG. I mean, it happens, but I tried to tune the dosing to minimize it.
So then it sounds to me like I’m on the right track with my basal for the time being, will continue to keep this split dose and if all continues to go well - I should be able to introduce the bolus shortly thereafter.
Others have given great advice here. Just a small data point:. I had a lot of nighttime lows on 1x/day Lantus, which improved a bit when I went to 2x/day. I’ve found Levemir 2x/day to be better yet in my case, more consistent overnight.
The NPH has it’s peak at about 6 hours. Using graphical analysis the trailing edge of the evening dosage is just about right but it depends on the time of the injection. I must also not to catch the trailing edge of my evening meal basal Humalog. The Humalog lasts for about 6 hours after my evening meal injection so you can see that with careful placement it will last until the NPH as long as there is about 3 to 4 hours before my evening NPH. I know I drive my endo crazy with these graphical analysis. She does however agree that it does work.
Another fact is that it is very easy and fast to correct for a low BG level but takes a lot longer to reduce a high value. I have found that the pure Mattinelli Apple Juice gives the fastest rise, much better than juice made from a concentrate. I must be very careful to only take a few ounces to make any correction.
53yrs wth T1D, I’ve seen it all,!
I don’t think it’s a good idea to get into the habit of eating to accommodate/ anticipate your insulin trends. That’s how I would gain 5lbs and more without even enjoying it!!
I also took lantus back in the day but in the morning.
Now on tandem X2. Dexcom 6. A1C is less than 6.7 constantly.
Very little physical reaction to a 40 and lower BS.
I never really understood 10pm dosing, this was back pre CGM, and too many nights of syrup poured into my ears by a frantic husband trying to revive me.
Lantus in the morning made more sense to me and I believe that it worked well, although no CGM confirmation.
Any thoughts on the rational to this treatment plan other than that’s how the trials were done back in the day.
@Necroplasm
While the basal may be a little bit on the high side right now, you are also (I think) doing very low carb at the moment. Over time, once you begin to increase your carb intake, having a little bit higher basal will probably match that better.
And there are those who say that food intake does not make a difference with how much basal you need. But in reality, if everything else were the same, eating more carbs would require more basal than a very low carb diet.
The reason is, when you eat more carbs, your liver glycogen is generally topped off much more than it is with low carb. So your liver “spends” more of its glycogen (stored carbs).
Just like the local bar is going to be more crowded on payday. People have more money to spend.
Hadn’t heard this explanation before. Do you have a general approach towards carbs? I’ve done somewhat the opposite in that I’ve had a lot of protein, some fat, and plenty of veggies while taking as little insulin as possible (37-45 units of humalog per day). Carbs are generally taken if and when the blood sugar trends down.
Athletically, I’ve focused mostly on strength training with some bicycling and hiking but am transitioning back into sailing and looking to lose 10 lbs. Overall, my calorie counts have been low but my muscle and fat weight have been rather high relative to insulin amounts and calories.
There have been times when the BG has gone way up after not many carbs. Could this be due to a lack of carbs in the system?
It could also, imo, be due to the exercising! However, it depends on when you’re requiring your bolus honestly. Find the trend, find the culprit is what I’ve been learning.
Then again, our pancreases are all rebellious teenagers starting puberty, so who knows.
Heard my Dexcom alert this morning… NoooooOoOoOoOOoOooo! I was doing so well.
3 factors come into play:
Hormonal imbalances joyyyyyyy
I ate 2-3 hours earlier than I normally do
My dinner had hardly any carbs, in fact I’m pretty sure the only carbs were black beans (and so my healthy 154mg/dl turned into 138mg/dl before bedtime)
I’m seeing a trend with that last factor. My fasting yesterday was 78, and so I can only imagine that with a higher rise in nighttime glucose, my basal taper would’ve left me around 77 instead of the 57mg/dl I woke up to. A more moderately carbed dinner is in order for today and I will troubleshoot to see if that changes things with my dreaded lantus.
Big shout-out to @Chris for coming through for me in a big way with those extra sensors, I will be setting up my new one later today. Also shocked to see there are some really cute adhesive overlays in the box! What?! Thank you so much! I will most definitely be using the blue koala.
If you extend the sensors you will want the adhesive overlays to keep the sensor adhered. The very rare blue camo koala that battles diabetes is an especially potent example.
HI Necroplasm, I am Type 1 and have been on Lantus for a short period. The trouble I had with Lantus was that it stayed active in my system for 28 hours. This caused me to get lo0w BG for about 4 hours after injection. I had a hell of a time proving this to my endo, but with a little time using the Freestyle Libre CGM I was able to prove my theory. T^He solution was to switch to using Levemir twice a day instead of the Lantus once per day. It did give me much better control. I also use Novolog before meals, but if you are only on Lantus, you may not have to worry about that.
Keep in mind that you will need atleast one additional injection per day, so if your endo decides to try this with you, make sure they up the prescription for needle caps too.
This isn’t the first time someone has suggest Levemir might be better. It’s something I can delve into with my Endo at my next appointment. I’m not sure the split dose is the best choice for me, but it’s working a lot better than the single nighttime dose was. So I’ll take it for the time being.
One might choose Levemir rather than Lantus if the required daytime basal is significantly different from the overnight basal, because Levemir lasts about a half day, whereas Lantus lasts about a whole day.
Levemir can be a little bit tricky, because the amount you take determines how long it lasts. Eric has posts about that.
But in some cases, if you are taking a certain amount per kilogram of body weight, and the duration lands in either the 8 hour zone (for very small amounts) or 12 hours (when taking a little more), those time-frames can fit nicely into the day.
Like if it is 12 hours duration and you take it twice a day, you can have either more or less basal in the day or night.
Or if it is 8 hours duration and you take it 3x a day, you can have really nice granular basal amounts, very much like a pump gives you.
It gets a bit more blurry and less useful when you start getting into the 14-18 hour range. At that point, you might as well take Lantus.
To me, the challenge with Lantus is when it only lasts 18 or 20 hours. In which case you might have to go 2x, like Necro is doing. And you have some areas of more and some with less. For me, getting to see it on the graph is very helpful.
For the time being, it sounds like the 2x with Lantus is working pretty well for Nec.
