I typically have about 5 units of novorapid in the morning with 30 units of the NPH. Novorapid depends a bit, according to my blood sugars usually never more than 7-8.
I have none during lunch
My night time dosage is significantly lower as it’s not uncommon for me to drop over night. Fortunately it’s a case of me just waking up and having a couple jelly beans and going back to sleep.
I have somewhere between 0-5 units of novorapid, usually none and of the NPH, 5-15, I even had no insulin at all last week on one evening (and still woke up with low BG).
For comparison I’ve been an autoimmune T1 since around 1972 and, when on MDI, I take 6IU of Lantus morning and evening and bolus an amount dependent entirely on what I eat, but it tends to end up at least 12IU. Here’s my 90 day history basal vs bolus, I sometimes use basal rates to cover carbs (these figures come from a pump):
Average daily basal: 17.6IU
Average daily bolus: 23.6IU
Average total carbs: 136.7g
I exercise moderately; not athletic, 1/2mile 100m of ascent every day or there abouts with additional spot exercise many days.
Basal usage is a choice, but higher basals need to be covered by continuous available carbs. It’s a choice because the basal lets us put on weight.
Newly diagnosed T1s and LADA both need to be careful. I don’t know your situation but complete loss of beta cells can take many years, or just a month or so… Certainly things can change so that’s a reason for talking to an endo and asking wtf is going on; C-peptide tests can detect insulin production, IMO they are important for all diabetics until the point where they return zero. Any insulin production massively complicates everything, though believe me it’s much better than zero.
i felt very similar energy issues in the 1980’s when nph was my only option and anywhere from 2-6 hours later nph will peak depending on breakfast… i prefer tresiba(approved in au in 2018), but it looks like austrailian pharmacy companies don’t want to pay for it, so maybe obtaining levemir, splitting the levemir dose with experimental 35/65, 50/50, etc every 12 hours…a cgm with a pump is preferred, but can be costly. the knowledgeable endocrinologists/nurse practitioners usually tell me to aim for 6-7.1 mmol before activities, because you’ll usually drop if your basal is correct, and that sounds like what is happening…i also recommend trying a cgm, maybe a libre2 on the back of your arm with flexfit over it, or an arm sleeve, or shin guard sleeve, and aim for 6mmol prior to the game…sounds like lower bg levels are causing the fatigue which makes sense
I might look into Levemir as an alternative. I know it sounds like I’m describing low BG, and the symptoms certainly are very similar. However, as I have previously stated, it is definitely not low blood sugar. These symptoms will occur regardless of BG levels. I am convinced it is a reaction to the insulin I am taking, a theory which was pretty well confirmed during my last game, when I skipped the NPH and only used the novorapid to cover breakfast. I have had a couple of weeks off because I’ve been away but will test this again in my next game.
everyone knows cgms are a little delayed, as interstitial is a little slower than blood, but the directional arrows are why they are popular… novorapid only is similar to an insulin pump…so it is better in terms of predicted levels based on your insulin on board, however, if you have trouble obtaining levemir, you could try to test on your arm, then finger to see which direction your glucose is headed… probably the closest to a cgm
I am interested in hearing if you are able to get rid of this symptom if you start a different basal. NPH is totally different than any of the other basal insulins, so this is a very interesting thing to hear about.
It will take some experimentation to get a different basal tuned correctly. None of the other readily available basals like Levemir, Lantus (Basaglar), or Tresiba have the same pharmacokinetics as NPH. They aren’t even close!
I don’t really understand why you’re taking such an aggressive tone?
I know full well that a CGM will monitor BG more effectively. Personally, I don’t think I need one. I know when my blood sugar is dropping, even without the regular testing I do. I also know when it’s up. This isn’t some sort of boast, it just is. This feeling I get, while similar to low BG, is different.
If I test before a game, and two more times in the 80 minutes of game time, and then after… and my BGL is sitting between 7.0-10.5 mmo/l for the entire game… I don’t see how this can be the cause of my problem.
I will work a 8 hr day and then head to training for 2 hours. Sometimes I might have a low before or during training, which are easily identified and remedied before they become an issue. My energy levels aren’t an issue after the initial slump following insulin. Fortunately I am only injecting twice a day. By lunchtime and all the way through to dinner, I am feeling great. Even when the hypos come, I bounce back very quickly, with little impact to energy.
I’m not trying to be closeminded. It just doesn’t feel like a BG issue. Especially when I skipped my NPH insulin as an experiment before my last game, and felt significantly better, even though I over compensated with the novorapid and ended up having to correct a low at half time.