High Numbers-Basal?

Hi all and Happy New Year!

Around a week ago I experienced some unusually high numbers which were primarily bedtime, fasting and my dinner post prandial. Since my Lantus was on its 21st day the first thing I decided to do was start a new one. But I have been noticing my dinner pp and my bedtime have been a bit higher than I like (nothing like this) for awhile so I read over the threads and decided to try splitting my Lantus which I’d been taking at bedtime (10 units) into bedtime and morning, in case it wasn’t lasting the full 24 hours. Long story short after I started the new Lantus the numbers came down from the extreme highs (a 190 and a 280!) but continue to run high. Thinking maybe that as a LADA I am finally experiencing end of insulin production (I’ve been diagnosed 2.5 years), I have been gradually increasing the dose and as of today am at 7 morning and 6 bedtime, not very much I know, but 13 is a significant percent over 10.

My post prandials are generally ok; except when I’ve been high before the meal (I try and add an extra correction unit). It’s my fasting, before meals and bedtime. Last night my bedtime was 177 and my fasting 174. The fasting is highly unusual for me prior to this week. I had normally run under 100 and was concerned because I’d been seeing some numbers between 100 and 120.

So my question is should I just assume my basal needs are increasing and keep increasing by a unit morning and night until it gets under control? The other possibility is that the new box of insulin I opened is not potent. (It wasn’t still frozen when it arrived). I could call Medco and ask for a replacement. But that seems like it would be a coincidence that this rise in numbers started with a pen from the previous box! Oh yeah and I’m not sick, though I do feel like I’ve been fighting a cold. (I have a weird immune system where I can feel that way for weeks before it goes away or I just succumb. But I’ve never seen any rise in numbers like this even when I actually HAD a cold.)
Thanks in advance for any thoughts!

Since it’s your fasting & before meals (unless you’re not covering carbs from the previous meal adequately), increasing basal will help. You can test basal by not eating & seeing how level BG is.

Be aware that several high numbers may not be significant. It’s trends that you want to observe.

Good to raise or lower doses by 1 unit & keep it at that dose for 3-4 days to get a better idea of effectiveness.

Insulin shouldn’t be frozen.

It’s possible that the insulin isn’t potent if both vials have the same lot number, but more likely that your basal needs have increased. Have your bolus needs increased also?

Hi Zoe, I know impending sickness can cause a rise in BG, even if you’re fighting something, and not actually sick. Also, you mentioned about your insulin “wasn’t still frozen when it arrived”… maybe I don’t know about this, but I thought it was important for insulin to be shipped cool, but not frozen. When I’ve accidentally left my insulin in the car overnight, and it froze, I had to replace it because its effectiveness would not be as potent. But maybe there’s something that I don’t know about? Well, perhaps that’s true, there’s lots I don’t know about! lol I find that diabetes, and my body’s reaction to it is like trying to hit a moving target, and I’m a lousy marksman (markswoman/person?). As you have the LADA variety, I might expect that with your body’s production of insulin lessening over time, your body’s response to insulin might be changing too.

Thanks you two. I miscommunicated one thing: I knew the insulin itself wasn’t meant to be frozen. I meant that I’d noticed that the packing material was no longer frozen and wasn’t even that cold. But I think you are right, Gerri, that it is more likely an increase in basal needs. I hadn’t thought that my bolus needs had increased; I do small numbers so it isn’t all that noticeable unless the pp is above target, but now that I look back over my log I see that there is a gradual increase not so much in my insulin needed to cover carbs, but in what that I:C ratio does, if that makes sense. In other words, what would have before lowered me after eating, now raises me a bit. I was kind of wondering why my basal needs would increase but not my bolus, but it’s just that bolus changes are more visible because it’s a fixed amount. So thanks for that question. Yeah, “moving target” is a good reminder, Jamie (cute kitty, my lula loves to snuggle too). I get secure when my numbers work out day after day…until they don’t!

Zoe, your bolus needs have increased as well. Both need adjusting. Nothing is ever a fixed amount, unfortunately.

Hi Zoe,

Gerri is right about insulin needs changing all the time. It’s very good that you are keeping a close eye on what is happening with your dosages too. It may sound like you are at the physician’s office but are you exercising as you were prior to feeling like you were catching something? Sometimes checking your sugar right after exercise is not good as your levels are higher after exercise for about 30 minutes, then a dramatic drop sometimes happens. You may want to consider asking your physician about using Novolog or Humalog (NovoRapid) or Apidra which are all very fast acting and fast vacating insulins for carbs and illnesses. Just a few thoughts from my end. Good Luck! Don’t worry about increasing your insulin though because if your body needs it, it will ask for it in not so subtle ways (High PP’s).

Thanks guys, great input. One more typo, Gerri…I need to proofread my posts! I meant “it’s easier to notice basal increases because it is a fixed amount, unlike bolus which changes with carbs and time of day”. But good point, that what I’m seeing is that isn’t truly fixed either! I do use Apidra, Catherine, for my bolus. Yep, I think that is just what my body is doing, saying “more insulin please”. I think one of the big things I get from this board is to remind myself that the simplest answer is often correct (I tend to make things too complicated!)

It’s not unusual when you are taking control of your own diabetes. My doc doesn’t like it when I see him and I have made dramatic changes to exercise or insulin without consultation. I told him when I began seeing him that I need him for infections and routine bloodwork, not for control because I do that for myself and if I need help I will call. Your body is yours and no one else’s. You control what goes into it and what you do with it. So…you are learning a very important lesson in that diabetes changes everyday and so do meds, exercise, food, and research. Keep doing everything the way you are by making very small changes and logging them to find out what your body is telling you. Don’t hesitate to ask for help!

Thanks, Catherine. Actually I tend to be on the opposite extreme. When I returned to the U.S. I found a doctor, gave him my history with diabetes and the list of meds I needed him to prescribe. My niece was concerned that I wasn’t seeing an endo and reminded me to “let the doctor do his job, Zoe”(the girl knows me!), but really there isn’t much I need him to do! It’s an interesting condition we have where the people who manage their diabetes well seem to recognize that it’s a 24/7 self-help project with PRN support from others, sometimes doctors and more often sites like this! I will actually need to remember to let my doctor know the changes I’ve made to my doses!

So in the 10 days since my numbers had started to climb, I’ve gradually increased my basal dose from 10 to 13 or 14 and split it into two doses. I’m still working on a slight change to my I:C ratios. I found it was hard to determine the bolus until I got the basal straight because when my numbers were high before my meals I was adding in an extra unit correction. I’m fine-tuning, but my numbers are pretty much back down into the range I want them. With my c-peptide tests of .38 and .74 a few months ago (Yes, it went up-maybe lab variation), I’m probably pretty close to empty now. But as a LADA I know I need to keep alert for spurts down the road so I don’t go hypo. Interesting process! Thanks again for your input and Happy New Year!