Cant get basal right!

If anyone, someone (type 1s) could please provide some guidance, suggestions here…I’d be forever grateful :blush:.

So I cannot get basal dose right. My endo insisted I try tresiba, for me it’s been absolutely horrible…I’ve tried it 4 times…literally 300s all day long. My a1c has gone up to 9s from low 6s. I’m going on pump hopefully soon, but until then…this all i know:
6 units of Levemir keeps me flat overnight but it only lasts about 16 hrs. I’ve never understood splitting the dose…I don’t need 3 units overnight I need 6 units. Thus, can’t i just add a few extra units of levemir during the day around 1pm to cover me thru afternoon evening until next night time dose. Or, am i supposed to add another 6 units in the morning…Or am I supposed to split that 6 units pm dose into 3u am + 3u pm…although that never worked either. I’m so exhausted from this, down to 93 lbs and feel awful. Thanks!!

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If 6 units keeps you flat at night, keep that.
Then start with 2 or 3 units in the morning and work up from there.

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Btw, I used to split my basal because I needed a lot more at night than I did in the day.
Just start with a smaller dose in the morning and slowly bring it up until it works for you.

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Tresiba didn’t click for me until I added a bit of NPH (which was a crazy idea at the time). Your idea to add some levemir during the day is solid. I plan doing exactly what @Hammer suggested in about a month. Building of your flat overnight, hopefully you can get that house of cards slightly higher.

MDI basal dose is based on an amount that won’t make you drop too low at any one point in the day if you don’t eat. An MDI shot really can’t cope with the too high increases during the day because of the possible too low.

So an adjustment can be made with an extra fast acting shot when you need it. When I found out I had DP when I was on shots, I gave an extra dose in the am to account for it. That is commonly what people do with DP. But it could also help with any other short period of higher numbers. And if you prefer Levemir as it seems to work better it sounds like you really need to split the dose if one shot only lasts 16 hours.

A basal test also would probably be a good idea.

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For what its worth… here is what I did. Beginning in the AM… I inject my daily dose of long acting insulin. The I don’t eat anything for like 18 hrs. to see what my glucose levels are. I now know that I need 80 to 100 units of long acting glucose as a baseline. It is amazing how consistent my BG level is when I’ve done this, so you can tweak it to be quite an accurate dose. Once I know this, I use the short acting glucose just before meals (Tresiba) using a dose based on how many carbs I am going to consume. Certainly works for me… I’m in the 75% range about 80% of the time. Could do better if I’d stop the evening snacks… :slight_smile:

I never had any luck with Tresiba either, but Levemir is pretty good once you learn to master it. Don’t worry about what your total basal dose should be and then trying to split it. You need what you need for as long as it lasts. If you need 6 units overnight, then you need 6 units. You shouldn’t have to reduce that even if you take more for during the day, as Levemir typically lasts 10-12 hours at smaller doses. Also remember it takes 1-2 hours to ramp up, and will start wearing thin in the last hour or two of an effective dose. So even if you think a dose is lasting 16 hours, you could probably get away with taking another dose at 14 hours or even earlier after the last dose. This can help with dawn phenomenon as well in the morning.

Before switching to a pump, I was taking Lantus at noon. Noon was mostly because timing was consistent, but it also facilitated higher morning doses of fast acting when my post prandial BGs ran high.