Not much new to report. HIgh most of the day yesterday. Low for nine hours non-stop overnight.
I’ve now officially gone through two tubs of glucose tablets plus two tubes in the past week and need to pick up some new ones.
I did 35 units last night, but I think I’m going to drop that by two units tonight. These lows are getting ridiculous, not to mention literally exhausting. I’ve been napping for three to five hours during the day because I don’t sleep at night, I just eat glucose tablets non-stop.
Yesterday I skipped lunch (because I was sleeping) and basically just continued running high even with a correction on board. But I was already high after eating breakfast…which was just eggs and some veggie sausage, about 4 grams of carbs total.
At the moment I’m still running low, so maybe today I’ll just run low all day.
I haven’t skipped a meal for the purposes of basal testing yet because, in order to do a valid basal test, you’re supposed to start the test in range with no insulin or food on board. I haven’t had an opportunity to start breakfast or any other meal in range and with no food or insulin on board yet. But as soon as I wake up in range, I’ll skip breakfast and other meals and see what happens.
I agree that it’s clear your using too much… I don’t know if it just took longer for you for the tresiba to stabilize or what. once u get to the right dose for overnight I think the basal testing will be key
I took another 35 units last night because I don’t want to change doses too fast.
I had a similar pattern yesterday and overnight as previously. Spike after dinner, back in range for early afternoon. Then I ate a late lunch, which was admittedly high-carb, took enough insulin to cover 200 grams of carbs (I didn’t eat this much, but I just wanted to be aggressive so as to not spike), and then went to bed. When I woke up I found my Dexcom had been reading HIGH for the past two hours!! I did an IM correction, but it took another hour before readings started appearing again.
I went low several times before bed, likely because I’d over-corrected for that crazy high. I purposefully ate a 40 gram snack with no bolus before bed because I did not want to spend another night up treating lows non-stop. So I spiked to 14 mmol/L around 1:00 AM before I began my usual gradual drop and woke up at 3 mmol/L at 9:00 AM. So, at the moment it seems to me that if I go to bed in range I spend the entire night low, if I go to bed high (or spiking from food on board) I drop a good 6-11 mmol/L (100-200 mg/dl) overnight.
Tonight I’ll take 34 units, but I can’t help but wonder if my daytime highs (which are largely corresponding to when my pump had its highest basal rate) will be even worse with a lower dose. I can’t remember ever covering a meal with 25 units of insulin, much less doing so and still ending up with off-the-charts high readings.
From the mdi guru perspective, it would appear to me that you’re taking significantly too much basal and… once the basal is set right it’ll become much much easier to troubleshoot what’s going on with meals, but at this point it seems clear to me that outside of food your bg is consistently and substantially trending downward. I also don’t think 1u is anywhere near enough of an adjustment (if it were me)… 1 excess unit of basal stretched out over 40+ hours is not dropping you 100-200 overnight… that’s just not mathematically reasonable
I would tend to agree with this—I would only bother doing that small of an adjustment if I felt like it was almost right and just needed a very minor tweak.
I guess I’m just hesitant because I don’t want things to shoot off in the other direction. lol. Especially during the day when I’m running so high so consistently despite correcting all day. And also because I’ve seen people reiterate again and again that you shouldn’t adjust too quickly or by too much at once… I’m nervous I’m going to adjust downwards and then just be dealing with the opposite problem and have to adjust upwards again.
During the years I spent on Lantus, the protocol was to raise or lower by one or two units (depending on how high/low one was running) and then wait two to three days to see the result before making further changes.
What protocols do you guys use for changing by more than one or two units at a time and/or not waiting two or three days before adjusting again?
If you stick with this until the dust settles, your daytime high trends will be addressed more through bolus… the night time downward trends deserve the most consideration for basal adjustment…
I don’t think I should give specific dosing advice but your second idea is closer to what I’d be doing if I were you
This is true, but I’m already taking 20-25 units for high-carb meals and feel like that’s ridiculous and still spiking insanely high. It’s just crazy. I really don’t want to take even more. It’ll be really interesting to see what happens fasting during the day once I’m not dropping at night.
Well how much bolus you need just kind of is what it is… not really doing yourself any favors by trying to circumvent that by taking too much basal instead…
So do you have a protocol that you use for adjusting basal?
If I were on the pump right now I suspect I’d be taking around 24 units for basal. But two weeks ago I was taking around 36 units. So, when the next phase of “Geez, I suddenly need 50% more basal!” hits, I wonder if I should just do it in one go? Like 24 > 36 units or whatever over a couple of nights. I’m just thinking of this now because the fact that I know my doses will need to go back up again in a couple of week is partly why I’m dragging my feet making major reductions.
I was planning to make my work start date the cut-off date for this experiment, but I’m thinking now I should let it run longer.
I don’t have a real formal method that I could really explain… if I start seeing downward trends outside of food, I adjust downward, if I start seeing upward trends outside of food I take more…
It’s key to mentally separate out what’s happening at night because or basal and what’s happening during the day which is at least somewhat due to food…
Yeah, I’m just trying to think ahead so I have somewhat of a plan.
And it just seems really counter-intuitive to lower my basal when I’m spending 2/3rds of my 24-hour period high, even though I’m dropping or the other 1/3rd… In my mind the daytime issues could be food, but they could also be related to basal… I’ll have to wait until I’m staying level overnight and can fast to find out.
Personally, if things feel really off, I usually adjust by several units (2-3; but historically my daily basal doses have been between 16-24 units, so maybe I’d have done more with a higher dose), with the expectation of basal dosing being a process that tends to look like a wave tapering down around what eventually settles out as the dose. So I’m not opposed to risking overshooting a correct a little bit, since then I still get useful info. So in theory you know 35 is too much—if you adjusted to 32 say, and it was too little, now you know your next step should be either 33 or 34. Or even getting a lower bound of 30 would be a start. Of course, this gets screwed up once you factor in variable hormone levels and activity, so it’s not nearly as simple as that sounds. But it’s all why I think it takes a while to establish the right dose, it just hopefully should be moving in a direction of smaller and smaller levels of tinkering as you go.
In thinking about this more, one thing I’ve started to wonder is whether eating low carb could mean that you end up with more liver glycogen production during the day, since you aren’t getting carbs from food and need blood glucose from somewhere. I could imagine it might result in higher basal needs during the day. I usually don’t eat ketogenic levels of low carbs, but when I do, I find that while my blood sugars are very flat, I also sometimes have higher daytime insulin resistance, like my body can just absorb some extra units scattered around throughout the day as it goes… I have no idea if that’s at all accurate, but I wonder. Would be another reason why perhaps you might need a variable basal setup.
I was seeing this too when I first tried Tresiba - insanely high spikes after dinner no matter how much bolus I took. Ive never seen this happen with Levemir or on the pump, so don’t know what to make of it and it’s why I stopped the first time.