I keep adjusting my basal down, one unit at a time, and as of yet, I haven't seen any increase in BG over extended periods of fasting. At some point I should see that, right? I wonder if its more subtle than I would have expected. I dropped from 35 to 32 units of Lantus and intend to keep dropping until I see some indication that I have dropped too far. At some point, I would expect to start seeing roller coaster behavior, on either end of the spectrum - basal too high, or basal too low. I don't know where all the roller coaster behavior went. Its like the system changed fundamentally, somehow.
None, zero, zip, nada, rien?
Have you had less frequent lows?
!Si, Senor! Decreased lows. So, I guess I'm setting up the Lantus on the low end, instead of the high end of the spectrum, now. I was expecting to have to do a lot of corrections via bolus, by this point. I'm surprised about how large 'the range' of Lantus I can work with is. Note: I've never done basal adjustments my whole life, maybe a unit here, or a unit there. But, I've largely been at the same Lantus dose for ten years.
I still have a very minor increase in BG after waking, but that occurred at 35 units as well as 32 units, about 50 points, most recently. Although, I think there was a longer time interval, after waking, when I saw the 50 point jump at 35 units. It seems to have shortened at 32 units. Kinda makes me think I was roller coaster-ing because my Lantus was set too high on the spectrum of whats appropriate. If that's true, I would expect to see similar behavior start to develop when I reach the low end of an appropriate basal dose.
So you are in fact seeing higher BGs, just not higher than your target range, except for your Dawn Phenomenon. Sounds like progress.
FWIW, I have periodic changes in my basals.
Yes, have eliminated the places where it used to trend low.
What surprises me, is that I don't see it peaking high out of range, anywhere. Doc was right, maybe. I'll have to get her a coffee mug shaped like a trophy.
I did this about 10 years ago. Dropped my basals gradually from a daily 28U of Lantus (1 shot before bedtime) down to 20U without any big changes. Dropped it down to 18U and my BGs remained fine until after dinner (around 7 pm) when they jumped up to as high as 24 (430) 2 hours later even if I only ate 30 g of carbs (and bolussed correctly). Increased my basal back to 20 U and the problem went away.
At the time I thought it was just me being peculiar, but apparently it is called glycemic instability and is not uncommon. Taking too much basal can also destabilize your stability.
Keep dropping your basal gradually until you hit the roller-coaster, then go back up a couple of units.
I see. I guess that's why your supposed to eliminate system lows first. That makes sense. I think I was having difficulty detecting subtle patterns of lows that occurred 5pm through 5am. I was just so happy to have recovered from morning highs, lows seemed insignificant. Thanks guys. I was lost. I was moving down a bad path without seeing it. Lost song
In the past 6 months I have gone from 28u Lantus per night to 21u per night, and now a split dose of 10u/night and 10u/morning. I was definitely waaay overdoing it before, but like you I am wondering how I will be sure when I have gone too low with it. I need to do more fasting tests with my days off I think
I'm on a much smaller dose, but I have noticed a difference by changing my dose just 1 unit. At 7U per night, I have almost no dawn phenomenon, but often battle stubborn lows in the afternoon. At 6U per night, I have a noticeable dawn phenomenon (lowest point at night is in the 80s, wake up around 120-130) but no afternoon lows.
I am probably still honeymooning (5 months past diagnosis of type 1/LADA) but I have also noticed that my Dexcom graph drops fairly quickly after I go to sleep, reaching my lowest point around 2 am. This occurs whether or not I have insulin on board.
I am really looking forward to getting a pump, as I'm hoping I can get the best of both worlds with those 6U/7U Lantus doses--no dawn phenomenon and no afternoon lows. :D
Thanks for the feedback, everybody. Dropped from Lantus = 35 to 29 and then I saw the true nature of the night time lows. Last night I dropped 100 points overnight, bumped it back up to BG = 200, and it dropped to 60 by morning. Going 'all in' tonight and dropped to Lantus = 26. I thinks that's the bottom of the well...
Well, Mike, I never found the absolute bottom of the well before my day time sugars self destructed. But, I think you recommended, in a post somewhere, that I consider splitting the Lantus. Thank you, thank you, thank you, Mike. I'd never heard of splitting a Lantus dose. Thanks a bunch for your suggestion! I've been agonizing over these numbers for months so I know damn well what both basal dosages should be. The missing link was to split the shot into two. I don't understand just why that works, but I just know its gonna.
Let us know how it goes - wishing you the best in your next step of the marathon.