Oh and yes, 100% basal needs are affected by exercise, stress etc. It’s absurd to say otherwise, ignores the biological systems that cause the need for basal insulin, which are also affected directly by those factors. Perhaps for some, a basal regimen happens to be flexible enough to not need adjustment for their own variability in activity levels, but that is likely the exception, rather than the norm (and I would wonder if it represents some residual insulin production or other reason for that increased flexibility).
I take Tresiba, and it is very inadequate for responding to changes in activity. It works for me, because my activity levels are mostly pretty much the same. The exception is when I travel and am usually walking constantly (vs tons of time at the computer), and inevitably, I end up with an extra day or so of adjustment on Tresiba where I’m going low constantly, but I also usually am ok with that because I just eat delicious local foods to cope until the dose change kicks in.
Oh and finally, for most people, exercise (and stress, illness, even sometimes hot weather) is a basal effect, because it isn’t short-term. I remember being in diabetes camp, where we are suddenly super active, and my whole cabin getting low at different points every night. It was rare that someone wouldn’t go low overnight, ha. Some of us, as kids some of whom were still honeymooning, would get to the point where they were taking only half a unit and still going low, and they would refuse to give them no insulin, so yeah. Significant exercise has effects on basal needs long after the exercise itself, I believe because your glycogen stores are getting depleted and/or going to your muscles, rather than raising your blood sugar, but @Eric can speak to that better than I can.
That’s the one thing i’m really loath to try. It’s just too invasive for me, and my skin is sensitive…i imagine nightmarish infusion site problems. Just having the Libre in my arm is bad enough, with skin reactions and sometimes aches throughout my arm for the full 14d, if i unluckily placed it somewhere near a ‘nerve cluster’ or something (i’ve no idea why this sometimes happens).
My endo says the same, but i thought he was just lazy/sick of my emails. Perhaps he’s right. He doesn’t seem to want to prescribe NPH or Humulin I, which I feel might be all i need as a third tool in the toolkit, injected once per night to stop these highs. Daytime volatilty i’ll just have to deal with. I think he fears hypos, which used to be a nighttime problem for me…less so now i have my CGM. in fact, i haven’t had a ‘out-of-it-until-11am’ morning once since i had my CGM, whereas i was having them every fortnight without it. So i’m not sure i understand the reticence to NPH.
I really don’t know what to do re. basal, I really like the idea of the flexibility of Levemir given my lifestyle but something has gone wrong since 23 July when i started it. My TDD chart is below, showing an almost-doubling, since Apr/May/Jun. I have lost weight (down to 61 from 65) so that puts me at (on some days) 1u /kg bodyweight. That sounds a lot for someone who exercises every day (30-40mi/wk run + 50-100mi/wk ride + 1/2 resistance sessions).
If i don’t bolus, i will rise to the mountains. I’ll be at 20mmol/l on waking, as i sometimes was before my CGM. I can’t afford that. If i bolus at 3 or 4am, it’s likely out of my system by breakfast.
Although interestingly, my CIR is typically much higher in the morning (c. 15) versus afternoon/evening, although i put that down to a ‘peak’ in the evening basal shot.
I tried shifting to both 6p and 8pm (from 11pm) - made no difference for me. Up i went.
In my case at least, agreed. (which is what i’m stuck with now)
I never realised a dinner could take so long… but they seem to in my case, unless it’s the Dawn effect. My dinners are typically low/medium carb, and fairly-high-but-not-ridiculous fat (i.e. EVOO on salad, steak/ chicken with skin/ fatty fish). Sometimes i’ll have duck legs slow cooked in a dozen plums, and 50g of jasmine rice… i’ll need to get up at least twice during the night to bolus for that. seems to take hours to process.
Very interesting. I have long-doubted their theoretical and practical efficacy… but ended up thinking i was just doing it all wrong as my endo and nurses insisted it’s the only way.
Crucially, the CIR is NOT a linear function, i.e. it might be 10 for 30g carb, but is 5 for 60g carb… not to mention the second order impacts of other variables. Practically speaking, it’s useless. Each and every meal has turned to being an eyeball guess… which inevitably, due to the law of large numbers, causes (frequent) errors. But what else can we do?
Heard back from both the nurse and my endo…
re. Rise in TDD: seemingly no worries about it, as “Levemir doses are often higher”. The scale of this rise seems egregious to me, but they seem unconcerned.
Re. the c. 6% weight loss, they suggested i see my GP, unless my control is terrible and ketones present from being high etc… this isn’t DKA, but surely it is endocrine-related? i suspect my GP will just say “hmmm, go and see your endocrinologist”…
Re. NPH: he’s keen for my swtich to Tresiba to ‘bed in’ before looking to add NPH.
If it worked so well there would be no market for the closed loop pumps being developed. I think no one really had a full understanding of what was going on until accurate CGMs came about in the last few years. Now it’s easy to prove how variable and frustrating insulin dosing actually is, but it’s also possible to dose in an entirely new and safer way using CGM data in real time.
I think most endos (except very old school) prefer pumps because it’s easier to see the data and to manage only 1 type of insulin. I’m agnostic personally, think both regimes have pros and cons and that for most people a CGM is much more important than a pump. However, in your case there may be an advantage since I think it is just too difficult for you to deal with the specific issues that you are having overnight using just NovoRapid and Levemir or Tresiba. Why not try it if you can get NHS funding? Worst case scenario you are right about the site issues and you just go back to MDI.
But what about NovoRapid & Levemir/Tresiba & NPH? Isn’t that the easier next step, vs a pump (which i don’t like the idea of anyway) ?
True. He’s offered it me on the NHS, so i could do it…i just think it’s a huge overhaul that i’m not sure i’m ready for, and that trying NPH before sleeping is potentially an easier solution to the current problem.
As i often explain to him (much to his dismissal) my diabetes goes through periodic phases. In a given phase, certain rules need to be followed, and if they can be successfully followed, things work out … and then, in 3-6mtths time, the chess set is thrown into the air and the pieces land all over the place…and i then need to figure out the new rules and try and follow them…and at the moment, they aren’t followable (due to nighttime rises) given my current tools, hence the (supposed) need for NPH. in a few months time, there’ll be another phase shift and i’ll have to recalibrate again… and all these phase shifts are in the ostensible absence of any other exogeonus changes. This has happened too many times over the last 17yrs for me to be making it up.
Not sure if this has been mentioned already on this thread, but if your basal needs are not flat - like maybe you need more during the day or night - consider using Tresiba as the base, and adding a dose of Levemir in either the morning or night to cover the higher needs for that time. At low doses, Levemir does not last very long, so this might be a good way to manage different basal needs.
So you might consider taking enough Tresiba to cover your lowest basal needs, and enough Levemir at the right time to consider the higher basal needs. The two basal insulins would stack up to meet your needs.
Sorry if this was already discussed on this thread.
Here is a very simple picture to show this as an example. Here, the Levemir is taken in the morning and only covers the higher needs during the day, and Tresiba covers the entire day at the lowest basal requirement.
Yes, if your blood sugar is high, you will lose weight! That’s the way it works.
The reason is, the carbs you eat (which get turned into glucose in your digestive tract) have nowhere to go if you don’t have enough insulin.
Your liver can take some of them, but your liver can only store about 100 grams worth of glucose. And your liver can convert some of the glucose to fat, but it does not do that as much with insufficient insulin (insulin signals the liver with various enzymes, which tell the liver what to do).
But with insufficient insulin, your body will end up losing most of that glucose through your urine. Without enough insulin, the glucose can’t get into your cells, so it ends up being peed into the toilet. (sorry for the description there )
Anyway, the short answer is that weight loss is a common and expected result of high blood glucose levels because your body does not process all of the food you eat. It gets disposed of instead of being stored or used by your body.
Interesting concept. I guess at low doses, Levermir approximates NPH, profile-wise. I can certainly try that. Obviously goes against the instructions (“don’t mix with other basals”, not to mention endo advice, but hey ho)
Is this part of an app/piece of software, to model insulin and food responses? I would love something like that, but don’t have the time or skillset to put together.
That Tresiba line looks suspiciously flat though… not sure that’s quite right? It might vary from person to person (or, knowing this area, day to day…)
Yes, fully on board with that. But I thought that needed DKA, and i don’t think i am anywhere near that. When first diagnosed 17yrs ago, i had lost 5-6kg, but was drinking gallons of water and urinating every hour or so… classic type1 symptoms. By BG was at 25+ for days on end. Whereas currently, my 30d ave BG is 6.8mmol and ‘time above 8mmol’ = 29%… okay, fairly high, but i rarely go above 12…although i do spend hours between 9 and 12mmol at night, asleep. But would this really start the process of glucose spilling into urine and the resultant weight loss? I thought it needed REALLY high BG for this processs to kick in. If so, surely people wanting to lose weight (and nefarious types wanting to make money out of people wantingt to lose weight) would take advantage of this method…? And if so…perhaps explains why i have struggled to put weight on for the vast majority of my life. But is ave BG of c. 7 really high enough to drive that?
You definitely do not need to be in DKA to lose weight from high blood sugars. Otherwise diabulimia would kill people too fast to “work.” You will however likely be spilling some amount of ketones, but possibly just trace or small amounts, but that’s often true with weight loss, even when not due to high blood sugars. Burning fat results in the byproduct of ketones, just not necessarily enough to cause the extreme imbalance of DKA.
I think you should back up here and decide what your goal is. Having had T1 for 46 years I have used all these insulins and more, for more than a decade each. So if your goal is to test out all the different insulin formulations you haven’t tried yet, then by all means, add another one to the mix, since there are certainly benefits to knowing how you react to all the different insulins. I have done this and think it is a worthwhile exercise.
But if your goal is to simplify your insulin regime and achieve better control, then I would send you in a different direction based on my experience. It would require some changes to your eating patterns - but not change the foods you eat - only when you do it. Of course these may be specific to me, and may not help you, but I can go into detail if you’re interested.
Sorry, I don’t post here that much. I don’t check in often, and when I do I find my contributions are often lost or ignored. But I have had T1 for a long time, and my last A1c was in the low 5’s, and my G6 shows a std dev of 24 mg/dl, so I thought I would mention it in case it would be useful to you.
It’s possible, as I’ve said in many posts I’ve had good experience using Regular insulin (what you might call either Humulin I or Actrapid?). I have not really tried NPH. The issue with it may be that it is not known to be consistent from injection to injection since it is a suspension. Some people say that it will peak at different times each day, may not peak at all, or may have an extreme peak one day and a slight peak the next. This is based on anecdotal comments I have read from people who have used it though, I could be mistaken. I have found Regular insulin to be extremely consistent and effective in small doses, despite its bad reputation. @Eric’s advice to add Levemir may make more sense, given how consistent Levemir is designed to be from day to day.
I was moved to levemir fron lantus to help with a dive in sugars at 3am regardless of of what I took or didn’t when going to bed at whatever sugar levels.
The idea was to give me more control over the day time,night time basal
My son who has been Type 1 a lot longer than me suggested most people over egg their basal so I reduced the intake a little and that has worked to give a better night time experience.
I have in the past had basal that simply put notched in the still increasing 45 degree line on my charts, that is to say for an hour my sugars dropped 4 units and then nearly instantly rise to where they would have been without the bolas.
Levemir gives me a roller coaster of a line on the chart rolling some 3 to 4 units every hour rather than the flat line I got with Lantus. Note the waviness is present in all traces regardless of angle (if that makes sense)
I of course have the dawn reaction and often arrive at breakfast with between 14 and 20 units present.
I was wondering if the waking rush of sugars is a possibility for the someone waking during the night to bolas a high sugar and is they are suffering the same “notch” effect as they bolas for a sharply rising excess of sugar, but are only “bolasing”(sic) for what is currently evident.