snicker. Thanks for the laugh Dave.
Whatever you do, please don't compare yourself to others. I have a friend who, at one point, was about 50 pounds lighter than me, and yet was taking about 3 times as much basal. We had both been T1 for at least 25 years at that point. There is no "average" or "right" dose. Just what works for you.
Hi Pancreas, I'm pretty much nocturnal so I don't usually sleep before the 2 am dose, although on one occasion I did and I woke up in time to take it. I also try not to have my evening dose too close to the evening so it won't drop me too low overnight.. I have tried various time changes but so far this works for me and lets me sleep a little earlier. I have a weird work schedule which changes and I don't teach morning classes anymore. So it mostly works out ok for me.
It really takes time and patience to get past the learning curve on a pump and get the numbers fine-tuned. Start somewhere, usually about a 25% reduction from long-acting doses, divided evenly, then keep careful records of blood sugars, then,after about 3 days based on highs or lows, slowly tweak the appropriate time zones (2 hours before the problem time), then wait another 3 days, before making more changes, etc.
But once the numbers are tuned in, it works much better than shots for variable basal needs and for DP (I don't have DP, but had a couple months where it looked like I did and can't imagine accomodating that with shots. Oh, when I was on shots, I took Levemir in two equal doses bedtime and morning, and I believe it was 16 units. It worked better than Lantus had and better than one shot, but not perfect by any means.
Most people get DKA at diagnosis, when they have been running very high without knowing it. Frequent testing ensures that high numbers that put you at risk for DKA won't go on in a prolonged way. I don't worry about DKA, but then being LADA I never experienced it so don't have the anxiety I know is understandable if you've been through something like that.
I do 10 units of lantus every night at 10pm. Works pretty well for me though sometimes I wake up pretty low in the morning, and at first I'd go kinda high at night but now not as much? I tend to eat pretty late though and bolus for it. I also tend to stay up until like 2 or 3am and I eat a 15-25 carb snack (depending on if my sugar is lower or not) before I go to bed (which I'd do regardless of if I went to bed at 11:00pm or 3am) . I did have my first hypo , first thing in the morning, that was no fun, but at the same time that's never happened before and I typically wake up 75-110 mg/dL which is fine and dandy for me.
i know, i know...zoe. but 'where' to start, again, the question. I'm redoing - restarting a new levemir dose again (today) 7u am 7u pm, will stay on that 3 days and see if that's a good place to start with pump, less 20 - 25%. highs for three days straight, IDK, it feels like torture, seriously...and then the fear of late night lows too when on pump. I'm not so worried about DKA on pump, I have my Dex but I just end up taking a shot anyway because if basal is incorrect, i can correct all i want but they just climb and very difficult to get down on pump.
looks like you were just diagnosed in July (sorry you had to join our T1 club..ugh). 10u lantus/levemir seems like the 'starting' point for most newly diagnosed. some lower or higher depending on where they are when diagnosed and how much insulin their body is still producing. geez, i'd give anything (ha!) to wake up to any type of normal number these days.
To be honest Zoe, I doubt I have the patience for a pump from what you describe and I would be very likely to make a big blunder on it even if the other issues weren't a problem for me. I have read here that many type 1 have never been through dka which surprised me. But as soon as my former dvm mentioned to me that her type 1 friend went into dka 3x with 3 different hospital stays and pumps I thought, no I will not do a pump unless there is no other alternative. I have also read similar stories here so people do go to dka from pump malabsorption. I had severe acidosis, it was very bad and I was in the icu for 4 days. I can't even describe what happened to me there, multiple mistakes and serious complications such as my dvt which they released me with. I went back for 4 more days and I was on warfarin for 6 months and have permanent damaged from that. I'm not risking another dka. If it happens due to being sick that is another story but I try to avoid that as best I can too.
Sounds like you feel strongly, meee, and based on your experience, a pump would cause you a lot of anxiety. I think having multiple bouts of DKA is not typical and not caused by a pump, but other factors such as illness or insufficient testing, or even eating disorders. I think sometimes those of us who are so happy with our pumps (though of course they have their own issues to deal with) get a tad evangelical at times. I'd say the majority of people who try pumps love them, but they are not right for everyone for many reasons. I feel that way about CGM's; I have absolutely zero interest in them and get tired of hearing people say they are the greatest thing since sliced bread. Heck, even when I could eat bread, I thought unsliced was better! (A propos of absolutely nothing!)
Ellie, that sounds just horrible. so sorry you had to go through that. Well, it looks like, although a lot of work, you're doing well on MDI and rockin' a good (great) A1C...you go girl!
Zoe, I think you're right about the pumps, my nurse said most everyone loves them and stays on them, she only had to take one person off because they were abusing it badly. it does take patience (which I lack sometimes and just want to get my #'s down). funny comment about the 'bread'...i'll take unsliced, too. HA!
I was diagnosed in June...but despite that didn't get on insulin until September since I was unlucky to be mistyped as 2 because of my age at the time (22) ...that's a long story Iv'e probably told like 5000 times on here already and I don't shut up about it but yeah. I haven't had any really abnormal numbers since really starting insulin, like I was put on lantus alone at first but it didn't take too long to figure I needed mealtime insulin too. I've only had like 2 or 3 200's since starting mealtime insulin which is like entirely less than I had before . Like for the past 2-3 weeks? I've not gone above 180 at all ,which makes makes me really happy.
My 30 day average is 23.625U of basal, or 53%, still a little hotter than 50/50.
I use:
12M-3:00AM .8U
3AM- 7= 1.1U
then every top of the hour is .8U/ hour and every :30 is .775U/ hour to rig a .7875 which seems to work very well, although the new sensor doesn't seem to be so I'm not confident in the data, other than that most of the meter readings are cool, even if the sensor isn't.
I use about 24u a day,
lol.. I know what you mean about that.. it seems like people think because it works perfectly for them that is all we need to do and things will be just fine and dandy but that isn't always the case.. when I read about all the infusion set problems, absorption problems, irritations etc. I think who the heck would want to deal with that and having to change it all every three days as well as tubes and things attached to you?
I actually would like a non invasive one if it didn't beep too loudly… this woman's dka's were all caused by pump problems though and this article seems to say there are more cases of dka in pump users than in mdi users.. but I can't find very many statistics about this…
http://www.ncbi.nlm.nih.gov/pubmed/16774616
Causes of DKA
The sudden start of Type 1 diabetes is only one cause of DKA.
Common infections like pneumonia or urinary tract infections can be a cause of DKA. Infection raises the level of "stress" hormones, such as cortisol and epinephrine, which raise the glucose levels in the blood.
When someone is noncompliant (doesn't do the things necessary to control blood glucose) or can't afford their insulin or other medications they can also be at risk for DKA.
Insulin pump failure can lead to DKA. If a person is unaware that their pump has stopped administering insulin, blood glucose levels can rise quickly.
Kids who are going through adolescence can experience endocrine changes that can alter glucose levels and insulin effectiveness.
I miss bread, any kind, lol...
omg… it was… thanks Sarah :) I am quite happy with my a1c as I thought it was going to be higher last time… it is a ton of work for sure
Mine rises when I get up, too, if breakfast is delayed by more than about an hour. Yesterday I was 5.6 (100 mg/dl) when I woke up and was 9.8 (176 mg/dl) two hours later when I got to work and had breakfast. Usually if I don't eat breakfast it's three hours between when I wake up and get to work and eat, and usually by then I've gone to 11-13 (200-250 mg/dl). If I know I'm not going to eat I bolus 2-3 units and that seems to work, but days like yesterday I'm rushing so much that I forget to do even that. (My own fault, I should make morning preparations the night before!)
The weird thing is that if I sleep in, or if I eat breakfast as soon as I get up, I don't need any extra insulin beyond the rise in my basal rate.
daily basal = 7.75 units. Profile:
4:30pm-12:30am: .3u
12:30-2:30: .35u
2:30-8am: .5u
8am-12pm: .25u
12-4:30pm: .2u
I do extended bolus after every meal and at other random times if im grazing or snacking(like in the evening) so my basal would probably be a bit higher if I was on mdi and didn't have the extended bolus feature available to me.
My basal has actually gone up quite a bit since my dx 2 1/2 yrs ago. I was all the way down at 3 or 4. my c-peptide test this past week came in at .1 and basically confirmed my honeymoon is over so hopefully my basal will be steady now for the most part.
I'm really surprised how most people here have such low basal rates of around 10 units or even less! My basal rate totals 28-32 units (depending on where in my cycle I am) at the moment, partly because I am overweight and not exercising lately. But even six or seven years ago when I was near a perfect weight, ate probably around 100g of carbs per day, and exercised every day my basal rate was 18-22 units at its lowest.
I know everyone is different and we can't compare insulin needs - I'm just surprised at all the low numbers!
10.7 units on a pump, somewhere between 40 and 50% of tdd. I eat a ton of carbs compared to most people here.
I never understood why CDEs and dieticians tell diabetics they should eat a snack between meals. I too was told that I should eat a snack and it should be covered by the basal, even a 10-15carb granola bar! Umm, no, basal should cover your body's insulin needs and nothing else, so technically even 1g of carbs would require a bolus to maintain flat bgs.
Maybe its an issue with precision, I can see where mdi doesn't allow for that precise of basaling and a snack may be required at times to prevent drifting low, but w/ the pumps that doesn't seem like it should be an issue.