I’m brand new to the forum and to diabetes. I’m type 1, and my nurse/endo and I are currently trying to figure out my insulin levels. Trouble is, I feel like the endo recommends numbers that are lower than I feel comfortable right now. My lantus is at 10 units, but my blood glucose waking is 135 — still, it seems to dip to the 80s in the afternoons regularly — although it shoots up to 250 or so after meals (this with an I:C ratio of 1:10)… Its all so confusing, and I’m really worried about getting a low (still haven’t had one but i’ve read they’re horrible). Will upping the lantus make the late afternoon low even lower? In other words, if insulin lowers my waking glucose by 20 mg/dL, does that mean it’ll lower my daily low by 20 points as well?
I know this post is a bit confused, but so am I! I’ve had a tension headache ever since I’ve been diagnosed.
Most lows aren’t horrible at all - just annoying. Your first few will feel like a big deal but once you’re used to them it’s just an excuse to have something yummy to eat lol (Well ok this may not be true for everyone but it’s all good for me). I’m not fussed about lows - but then I test regularly and have never ever had a serious one. I AM fussed about highs - hate them!
If you mean that you go down 20mg/dl overnight - when compared to a before bed test - then yes it’s likely it happens in the daytime too.
It does take a while to find your correct dosage rates, so breath deep and just make sure you test lots & record everything so you can see where the problem times are.
I have my BASAL down prety good. I set it using the following method.
First, had to start with a good FBS level, IN RANGE. Then tested often heading toward lunch time no food or exercise. If my BS level stayed about the same then I knew it was good, if my BS was heading UP, my BASAL was low, and if my BS level was diving, my BASAL was high. Adjustments were made only 1-2units at a time. When I was first moved from NPH to Lantus for my BASAL, it was an even unit for unit move, however it was way too high and still on the spike and dive roller-coaster. More recently I was told to change the split so I take less in the AM for a lower BASAL rate during the night when Lantus is more active. , I started out 50% AM and 50% PM or half in the morning and half at night for a more even BASAL. I take the same total, jsut 2 units more at night for my daytime BASAL rate.
BOLUS is best figured AFTER a good stable BASAL rate is found. I was started with a 1:15, insulin:carb ratio but after getting my BASAL rate set properly I foudn the 1:15 not enough insulin. I found my BASAL rate to be better at 1:10 or 1 unit of humalog per 10 grams of carbs. That brings me right back near where I was before the meal, not much above or below my starting point. You can not really tell this without having a STABLE BASAL to begin with.
BASICLY what I did was use the same proceedure a pumper would do to get properly set up with an insulin pump, only done with shots and it’s GREAT to feel normal again for the first time in nearly 3 decades. I no longer need to eat in 4 hrs or take a dive or panic for a meal or take glucose tabs to tie me over.
DAWN effect, if you go low during the night, your liver will dump glucose as your bodies self defense against going hypo and cause HIGH FASTING blood sugars. That is WHY I am on an uneven AM/PM split instead of half and half.
LAUNTUS is NOT completely level, it does not peak as much as say N/NPH though.
The drug companies would like us to believe that our basal needs are steady throughout the day. Most diabetic professionals cling to this belief. Any pumper who has basal tested and anyone who’s paid close attention to their sugars on MDI knows this is not true. We all have hills and valleys.
Some general truths:
we all experience dawn phenomenons (DP).
we all tend to need less insulin in the afternoons
the midlle of the night – midnight to 5am – is a critical period because you tend to be sleeping and unaware
we tend to need more insulin in the evenings in the evenings
our needs are unique, like a fingerprint.
ideally our basal doses should keep our sugars level throughout the day and night (easy with a pump).
The most important thing is to discover YOUR basal profile.
I recommend people shoot for good fasting numbers as long as they don’t go low in the night. If you go low, you’ll have to try other ways to get that fasting number down
For afternoon drops I recommend adding uncovered carbs to your lunch. Simply always eat 10 or 20 grams to keep you level for the afternoon. Any carbs on top if this you bolus for.
For evening rises I recommend adding a fixed bolus to keep you flat. You can do this for untreated DPs too, but it tends to be a little late.
Great post Power pumper. Thanks. I doubt any of us could have laid it out on the line better than that.
Laura you need your morning fasting blood sugars down. If you worry about going low, just keep testing. Lows aren’t bad, they are definitely something that you can handle. If you are lower than you want to be or are feeling like you need to eat, do it. Once you learn how your body reacts to doses, it will get easier. I shoot Lantus in the mornings and before bed. Usually all of us cycle higher during the night and need something to help us through the night. I really like getting up in the mornings with my blood sugar under 100 One morning I got up at 62 so I just got my breakfast a little faster,. I wasn’t feeling bad, but pulled back my night time dose by 2 units for that night. I shoot lantus in the morning and my Humalog as well right after breakfast. As long as you eat on a regular schedule and shoot or pump on a regular schedule you shoiuld be fine. Correct any time you need to with any food intake or insulin. Remember to log. That is one of the most important steps you can take to help you figure out how much of anything you need to do. I look on having diabetes as having a second chance to take better care of myself. I don’t wish this disease on any one. But since it is here, I am deeply grateful for having all the people here on Tu diatbetes who care and for having someone like Power Pumper to explain the true ins and outs. Please keep coming back and let us know how you are doing.
Usually all of us cycle higher during the night and need something to help us through the night. I
I’ll disagree on this point. I don’t know if there are stats on this, but many do drop. In another forum poll we did the largest number of respondents actually did drop. I do know that teens tend to rise, and it tends to drop more and more as we age.
Take a read through the following link. It has some scenarios for this very problem. Exercise Book
Wow, that’s super reassuring. Probably the scariest part about finding out about diabetes is the idea of lows, and its nice to hear someone say they’re not the end of the world (even if I already know its true). Thanks!
Power pumper, this link probably describes the basal insulin calculation process better than anything I’ve read. Its really clear, and why does every other site draw the lantus action curve as if its a perfect plateau? Anyway, this is going on the list of essential diabetes reference. Thanks!
Thanks to everyone generally for the comments! Its been really reassuring!
Thanks, Saundra. I asked the doctor when I first got diagnosed if it was possible to prick your fingers too much. She said no, but I think I may prove them wrong. I am OBSESSIVE. I pricked myself 6 times in a row a few days ago in order try to figure the standard error of measurement of my glucometer (its huge!). Point being, I am definitely monitoring. Anyway, thanks for the advice and reassurance. Its nice to get feedback from people and feel like I’m (more or less) doing the right thing.
Just to emphasize PowerPumper’s point that we all are unique!
I have problems with lows when most people have the dawn phenomenon. I require much less insulin between 4am and 10am. In the afternoons, I require extra insulin. So I’m exactly 12 hours off of the usual patterns!
But we were able to figure this out by frequent testing (you have found the key Laura!). This was the main reason I went on the pump-- we could not get normal levels during the rest of the day without waking up low almost everyday! Now I am very thankful for the pump
Your example really hits home. Usually when the doctor says “everyone is different” it means, “you’re different”, but with glucose/insulin management it seems to really be true!
Laura,
It sounds like you are on the right track. I am so glad you are a part of our community/family now. It really helps to get feedback. Although I am extremely fortunate in that my doctor has been really wonderful, my very best teacher has been my experienced son. He has helped tremendously to know what to ask my doctor for, and to talk to in the wee hours of the morning when things were not going too well. I think most of us need help in the beginning to learn what our bodies need. I hope you keep on coming back to let us know how you are doing. And i hope you have someone around who makes you laugh. My son calls me to tell me jokes and leaves them on my computer. He also comes over a couple of times each month to watch my workout and has me laughing until the tears run. He tells me that is the best medicine I can use. Don’t get discouraged It sounds like you are being really attentive.
I hate to break this to you, but the standard error of measurement is mandated by the FDA to be included in the package inserts. You will find it based on a much larger statistical sample, too! One thing your educator(s) may have failed to disclose, but is very important is to always wash your hand/finger off before testing. Believe it or not, you can pick up tiny particles of carbohydrates in the grooves of your fingerprints, and that can throw your test off. You may wash you hands, use an alcohol swab, or one of the hand sanitizers which will remove any residues on your fingers before testing.
I suspect (I really don’t know) all studies show that liver glucose release is pretty steady throughout the day. What they (drug cimpanies and doctors) fail to acknowledge is that our insulin resistance fluctuates , in many cases quite significantly. At least I have found this to be true for me. My basal patters are very correlated with my I:Cs
