Interesting theory that could be true. At the moment I’m not eating low-carb, though. Well, some meals are low-carb, but others aren’t, and in total I’m probably eating 100-150 grams of carbs per day. This has a lot to do with it being the holidays and me being off work. Once I return to work, I’ll get back to a lower-carb diet, especially if I’m having to take 20-25 or more units to cover higher-carb meals.
One good thing is that, were it not for this thread, I would be back on my pump by now. lol. No way would I be putting up with such horrible control were it not for you all saying it should get better.
I’m wondering if splitting the dose would work better. I know you’re not supposed to have to with Tresiba, but I saw a video where Dr. Bernstein says he takes it when he wakes and before bed.
Yeah, I’m in a Dr. Bernstein community on Facebook where lots of people split it.
Today, weirdly, I’ve been running low. I mean, my CGM graph has been great, but that’s only because I’ve eaten about 100 grams of carbohydrates without insulin to prevent lows The only difference between today and other days is that I wasn’t low for very long overnight last night, since I went to bed after eating uncovered food. I’m wondering if being low overnight caused my liver to go crazy the next day.
I’m going to take 30 units tonight and we’ll see what happens.
Last night I took 30 units and had a big spike as I was going to bed. I corrected with some insulin (not enough) at 11:00 when I was on the rise and about 13 mmol/L at the time, but didn’t take any corrections aside from that as I wanted to see what happened. I have no idea what caused the spike. It’s like the 100 grams of carbs I ate throughout the day all kicked in during the evening or something.
I rose to about 18 mmol/L by midnight and then sort of levelled out. Around 1:00 I began dropping gradually to around 14 mmol/L at 3:00, then levelled out (I believe this is when the Fiasp correction likely wore off). At 4:00 I began a very steady drop from 14 mmol/L to about 6.5 mmol/L then levelled out at 7:00. At around 9:00 I dropped from 6.5 mmol/L to around 4.5 mmol/L, where I was when I woke up.
So I’m still dropping quite a bit. I feel like Tresiba from previous days could still be affecting me and I should repeat 30 units tonight before deciding what to do next.
Yeah like you mention it will take a couple days to determine if another dose reduction makes sense. How long after dinner was the late evening spike? What’d you eat?
I don’t have suggestions for you but like others say, I would use more of an efficient search algorithm method. Basically I’d make a relatively big (but reasonable) change that I anticipate may be an overshoot, and then split the difference between that and the original rate that was wrong. I think mathematically that likely results in fewer “search” steps, so to speak.
For us, we look at the total TDD and then change basal so it roughly equals half as our first pass guess – because historically Samson’s basal seems to wind up being half of his TDD no matter what. Since you’re low carb, perhaps basal would be more – the ratio doesn’t matter so much. But basically I’d use some kind of rough heuristic like that to make jumps, rather than just iterating down 1 to 2 units.
You can also use things like ISF to make ballpark guesses. For instance if you’re basal rate is set to 5 units per hour at night and you’re rising/dropping by 100 mg/DL per hour overnight and your ISF is 100, then you can make a super rough guess that maybe you need 1 unit less insulin (100 mg/DL/100 mg/DL/1 unit of insulin) to stay flat. Obviously you know these types of calculations but just throwing that out there in case you don’t do that much.
And maybe you should be logging to see if your insulin use is a continuous distribution or has 'bins." I mean maybe for you, the most reasonable way to change basal is to have three or four different basal settings depending on the time of the month or early trends – like 24 units, 30 units, 36 units, etc… rather than just tweaking up and down by small amounts.
Yesterday was more of the same. Spike around noon and early afternoon and in the evening. In range or low the rest of the day.
I took 30 units at night. I went to bed high due to the evening spike, having done my last correction at 10:00 PM. Note that I stayed home and did not have any crazy parties, so there was nothing unusual about yesterday compared to other days.
I went to bed at about 14 mmol/L. dropped to 8 mmol/L and levelled out briefly at 1:00 AM (I think this is when Fiasp wore off). Then around 2:00 AM I began a steady but gradual drop until I woke up at 2.8 mmol/L at 7:00 AM. I treated that twice, but as of now (8:15 AM) I haven’t really come up yet.
So I’m thinking 30 units is still too much. If I were to try to overshoot my target, I’d drop my dose by another five units, because as I mentioned before, if I were pumping right now I think my dose would be around 22-24 units. So 25 units may still be too much, at least for overnight.
I’d try 25… can not attribute everything that’s going on all day with food and stress and activities and all of that to basal— I get that with a pump you’d be tweaking the basal settings for those times of day but with mdi it doesn’t work that way
The nice thing about right now is I’m on hlidays (and have been since I started Tresiba). My schedule is basically the same every day and I have zero stress. It’ll be interesting to see what happens when I throw all that stuff in when work and school start up again next week.
With a pump I’d be fasting through lunch and dinner before making huge changes to basal. I’m actually likely to fast through lunch today, in fact. On a pump, you’re supposed to be able to fast through any meal without rising or falling significantly.
I’ll reduce Tresiba again tonight, probably to 25 units.
Yeah, the principles in pump therapy and multiple daily injections are exactly the same. It’s just a different way of delivering insulin, with the pump having a few extra options for delivery.
Though with MDI, the way you’d deal with it if, say I stay level or rise during the day but drop at night, is different. When I was on Lantus, I had to use Humalog and carbs to make up for peaks and valleys that would happen if I didn’t eat. On the pump, I just adjusted my basal rates during those periods up and down during those time periods to cover them. I remember the first time I fasted for 18 hours on the pump without needing to eat anything at all or take any boluses and stayed flat. I’d never been able to do that in my life, so it was almost surreal.
Hmm. Well, I’m cutting this fast off early because I’m hungry. But between 11:00 and 1:00 I rose from 5.4 to 12.8 mmol/L with no food or insulin on board (I did eat at 8:00, three hours before the rise began). Obviously I’ll have to do this again to see what would happen if I skip breakfast and then eat a late lunch. I’m curious whether this rise is a basal or protein issue.
Much the same story as previous nights. I took 25 units of Tresiba last night.
I went high yesterday around late morning, came back down during the afternoon with two corrections, went high again during the evening.
I went to bed at around 14 mmol/L but dropping from insulin on board. Came down to about 8 mmol/L by 1:00 AM, then bounced back to about 11 mmol/L, then again came down to 8 mmol/L until about 5:00 AM, at which point I began dropping until I was 2.9 mmol/L at 7:30 AM. That continued to drop despite treatment until now, when I’m currently 2.2 mmol/L.
Jen, it looks like to me you are two weeks into this experiment. This is usually the point where we have figured out the big stuff and are looking to fine tune things.
I start back at work on Monday, so my original plan was to hook my pump back up on Monday if I hadn’t dialled things in by then.
If I’m still not even close by the weekend, I may do that. At that point I’ll have given it almost three weeks. If I haven’t been able to hit something even close to a good dose after three weeks of basiclaly sitting at home and not doing much, I don’t have high hopes for being able to do it once I throw variabiles like work, school, exercise, and stress into the mix.
Plus, I think once I go back to work/school the real inconvenience of having to bolus with an injection compared to using the touch/audio bolus feature of a pump will really hit.
But I have four more pens, so I could continue if I wanted to.
My plan after this experiment is to give OmniPod a call and see if I can get a free PDM and buy some pods. I’ll be really interested in whether I can use pods with my allergies.
I’m basically exploring all options before deciding what my post-Animas move is.
