I did 22 units again tonight. We’ll see what happens overnight.
Today I fasted through breakfast and lunch. I rose by about 2 mmol/L during that time, so ended up high but the rise was very, very gradual so it was pretty steady. I bolused a single unit for a snack I had in the early afternoon (sugar-free latte with almond milk and a single “Larabar bite”), but I had eaten 17 grams of carbs ('course I didn’t look this up till I started rising), so gave a 2.5 unit correction (that correction was given within 30 minutes of eating). That didn’t bring me down into range, so I did an additional 2 unit correction when I got home. As of dinner, I was still high (8.7 mmol/L), so I bolused 4 units for dinner (which was a salad - lettuce, chicken, egg, cucumber, homemade dressing), which was quite an aggressive bolus for me (on the pump I may have bolused 1.5 to 2 units for this plus the correction). For some reason around dinner I began skyrocketing and ended up at 18 mmol/L currently.
I’m not going to bother correcting at this point as I want to be high going to bed, anyway, so I can drop overnight without ending up low. But it seems clear to me that I’m going to have to take a huge amount of insulin to cover food, and also probably take additional insulin if I skip a meal or in between meals as needed, especially at dinner as I don’t think there’s been a night I haven’t seen a huge spike. I’ve been using an 1:8 to 1:10 food ratio up until now, but I’m going to start using 1:6 tomorrow and see if that yeilds better results (my usual ratios are 1:14 to 1:16 under normal circumstances and 1:8 when hormones hit). I’ve been using a 1:2 correction ratio for this past week, but I’ll change that to 1:1 (usual ratios are 1:3 under normal circumstances and 1:1.5 when hormones hit). I’ll skip a few more meals to see what happens, but if I continue to see a rise, I’ll start doing a bolus if I skip a meal to prevent a rise from happening. Hopefully those changes will give me better results during the day.
If I end up using like a 1:1 correction ratio and 1:6 carb ratio, I wonder what will happen when hormones hit. I think I’d end up with crazy low ratios like 1:0.5 for corrections and 1:2 for carbs… It’ll be interesting if I continue this experiment another couple of weeks to see.
Well, I think this initial dose-finding was supposed to be easier than it’s proving to be. So I have no reason to make me think the other half of the quation will be any easier. Hence why I’m starting now… (Also because spending so many hours high just feels terrible!)
3)Separate rule 1 and rule 2 by at least 8 uninterrupted hours.
Those ideals are what you’re working toward. Super frustrating at first but seems like you’ve made as much progress in the past 2 days as in the first 2 weeks
I think most of my progress is just because I’ve been doing more aggressive corrections, going to bed high so that I don’t drop low overnight, and (today at least) barely ate anything until the evening. Yesterday was easy, I think, because I had the extra Tresiba in my system (probably somewhat today, too). Tomorrow I think I’ll be back on the normal track, and hopefully being really aggressive with boluses will keep me in range and I won’t drop so much overnight.
I went to bed at HIGH with insulin on board. At around midnight I came back down into view with a very steady drop. But then, rather than just continuing to drop at varous rates the whole night, at 2:00 AM, when I was around 11 mmol/L, I turned right back araound and rose steadily until by 4:00 AM I was back to HIGH, where I’ve levelled out for the past hour.
I’m up early and tested, and my meter says 16.4 mmol/L, so that’s off from the CGM, but regardless I think the trend of coming down and bouncing back up is correct (and clearly there’s been no massive drop, even if the trend is wrong). I’ll probably see if I can restrain myself from correcting for another hour or two just to see what happens over the next couple hours.
Why not skip a few steps and just look at how much you have been taking total during the day (basal + bolus) to bring yourself down from highs for foods and corrections and then just jump straight to those much more aggressive ratios, with glucose tabs ready if you go low?
For instance, did you use 75 units yesterday and 22 of them were from basal? Then the remaining 55 were bolus, and you ate, say 110 grams of carbs. So use a carb ratio of 110/55 = 2. Something like that. It may be a huge overshoot but it seems likely a faster way to get to the right ratios, IMO. STicking with your old ratios as a jumping off point doesn’t make much sense as you know for sure that they’re insufficient and you’re taking a different basal.
So, an update. I didn’t correct and I did end up dropping - from 16.4 to 6.9 by the time I woke up (which was late, at 10:00 AM). So that’s a drop of nearly 10 mmol/L (180 mg/dl). Though Usually on weekdays I wouldn’t be sleeping in so late, so if I’d woken up at say 7:00, I don’t think I would have seen such a major drop, though I would have seen some.
So I think tonight I’ll stick with the same 22 units, but not go to bed so high and not have any food/insulin on board so that I can see what’s happening. I find it hard to believe that I’m having so much fluctuation with just Tresiba affecting things.
I haven’t tried 23 units yet. I went from 25 to 22.
I like your idea. Unfortunately the past few days so far (with the accidental dose) haven’t been very reflective of insulin needs, I don’t think. But I’ll see how 1:6 goes today and if I’m still needing tweaking, I’ll use the data from today to implement your suggestion.
How feasible would it be to get in range with no bolus on board before going to bed? That would make analyzing what’s going on much easier to interpret… would it be possible to get there?
That’s what I’m going to try to do tonight. The problem is I’ve been having massive spikes every evening, so I always end up either correcting or just staying high. Tonight I’m going to try a 1:6 ratio at dinner or maybe even more aggressive (we’ll see how the rest of the day goes with that ratio).
The other issue is that I got sick of these 5- to 9-hour lows that were happening. I suspect those might still happen if I go to bed in range. So I don’t know. I might try for a mild high. I still haven’t seen a night without a significant drop during the hours before I get up.
It’ll be interesting to see if your IC ratios need to be completely reconsidered, after we get the tresiba dosage figured out… it’s an entirely different regimen than it is with pumping where the only difference in the insulin is the way we mentally conceptualize it…
When I was on Lantus versus the pump we used the same principles and guidelines. It wasn’t that different. Of course, everything is just a guideline, so there’s always individual variation. I’m sure that my ratios may change again, I don’t expect 1:6 to be my final set ratio. At this point I just need to find a way to not run high all day every day if I want this to continue into next week. (I also wouldn’t be surprised if next week causes everything to go out the window and we basically have to start from scratch again…)
On the pump we’re advised to get overnight blood sugars flat before moving onto the day. Then we’re advised to fast through meals to get our daytime basal set (obviously this step isn’t that useful with Tresiba because you can’t adjust it further). Then work out meal boluses, then correction boluses, then figure out exercise.
Were you taught some different sequence of events for MDI with Tresiba versus other basals? These steps were pretty similar to me for both Lantus and pumping, and I’d think Tresiba would be the same as well…