Thanks for the responses everyone. I am actually needing a lot LESS insulin. my pump basal was about 14 and I seem to only be needing about 8 units of lantus in the PM to last me all day. its bizzarre.
I worry about weight gain...as I feel like the pump was a good device for helping me achieve weight loss for some reason.
I took one shot of Lantus per day, in the mornings, for two years. Then my overnight numbers kept climbing despite increasing the dose, so I split it for about a month and a half, but it seemed like the morning dose was doing nothing, so I dropped it. I took Lantus once per day at bedtime only for more than five years.
I just recently started pumping (I wish I was still on Lantus).
i'm on levemir, i've tried, it seems, every combination but can't seem to get it to work; 1 dose lasts too long, causing me lows in the middle of the night combined with the second dose, the other dose not enough..ugh! sometimes it seems after my dose - basal injection my blood sugars go high within a few hours, always high at around 12AM, don't know why? i can't seem to figure this out. i'm gonna try this a few more days and then switch to 1 dose lantus - pm and see if that works. lantus is about 2 x's stronger then levemir, so i've been told.
i've posted many discussions on this..but how does one know if there basal is correct? it supposed to keep up 'flat' but what does that mean? can someone explain this? does it mean we find the correct dose(s) which keep us in range 80 - 120 or whatever and that's where we're supposed to stay fasting and overnight? if you all go to bed at say 120, does that mean you wake up to a good number? Does a drop concern you if you still wake up to a good number? I'm so confused about this..ugh! THANKS!
Hi Sarah, I usually judge my basal being correct if when I skip a meal (and also didn’t take a bolus for over 4 hrs) I don’t go too high or low and it just sits where it is. I believe mornings aren’t good to judge basal due to the dawn phenomenon. I split my Lantus lunch and bedtime, but only because I exercise some evenings and wanted more to cover the highs after the exercise. It’s all very tricky though!
OK, thanks. but where is it supposed to sit, that fasting - between meals blood sugars, that's what I don't understand...if it sits at 150 is that OK? How do we ever get a fasting between 80 - 120? What do you wake up at and go to bed at? I AGAIN - STILL do not understand how this is supposed to work..ugh? If I go to bed at 170 with no meal prior (fasting) but, say, wake up at a good fasting blood sugar of 80, is that a correct basal dose? If i sit at 150's all day, steady, I'm steady at this number but it's still too high, don't I need more basal to bring it down? I took 6 units one night and did drop nearly 100 points but I woke up at a good number. It was too much of a drop so, if I was to split the dose wouldn't I split that 6 units at night and not add another 6 units for an AM dose on top of that. I don't know WHY my ENDO keeps saying I need to add another AM dose? I just can't get this right. I'm going to try again with one PM single dose i think cause every time I add more my blood sugars seem to go up and somehow fight with my bolus. I've never had this problem until I started doing all this splitting stuff..ugh! THANKS!
The goal, for me, is to remain in target range as much of the time as possible. No, if I went to bed at 170 (and didn't correct) and woke up at 80, that would make me nervous. Because if I went to bed at a better number (say 120) and dropped the same amount I would obviously be in trouble. If I am 170 at bedtime I correct to target and hope then that my basal will keep me in range of that target. Frankly, though, on MDI I found this pretty hit and miss. I would always say, "it doesn't work that way for me" when people talked about going to bed at a number and waking up close to that same number. It didn't work for me because MDI basal is not that exact a science. With a correctly set pump basal dose I can expect that more often than not I will be reasonably in range. "Steady?" Not perfectly, no, not for me. But if I am in range when I go to bed (or correct a high to be in range) I hope to wake up also "in range" and more often than not this will occur. I don't have DP, though, and know this complicates issues, but the goal remains the same.
Ok I think i understand - personally, I consider nighttime and daytime two different issues. I aim to keep my daytime steady around 90-100 (regardless if I skip meals or not). As I mentioned skipping a lunch or dinner meal usually tells me if I’m ok and will base my basal to cater this.
Night time is a different beast altogether (this is because my evening schedules and meals can vary dramatically so it’s more important I have continuity during daytime). You may find that an ideal ‘daytime’ basal will drop you during the night in my experience so I would have to eat something before bed to avoid a low.
If you don’t want to eat before bed then experiment with night basal, either gradually starting with less insulin working your way up over a few nights or set your alarm for every few hours (you’ll get a rubbish sleep but worth it to see the numbers). As I said though, a ‘perfect’ night basal might leave you higher (or lower) during the day though. FYI splitting didn’t help me with this issue. Also if you do suffer from dawn phenomenon, adjusting your basal to accommodate this can be like chaising your tail. I usually wake in the night/early morning and take a small bolus if I’m a little high.
I Just read your message again. Don’t skip dinner altogether because you need something to eat at some point in the evening otherwise you may drop during the night (then your liver will dump glucogen and then go high) and that won’t be a true basal reading. Do your fasting earlier in the day as I said. Work out your basal that way. Monitor yourself during the night to make sure you don’t drop, maybe eat something. Confused? Me too. All the books and advice I got helped but still had to work it out on my own because you’ll eventually have your own little system that works for you.
I used to take 16 units in one dose but it would wear off. Now I'm 8 and 8 every 12 hours. I think that 4 units in 12 hours might not be enough to give you good control. Does it?
oh geez, zoe...i still don't understand this. if 6 units drop me that much overnight, why would my endo keep saying to stay with that and add another AM dose too. i didn't even take a PM dose overnight last week, only took 6 units in the AM and still dropped to 80 during the middle of the night. i frickin hate levemir..ugh! i'm going to try one dose at bedtime because i think it might last me all day too, it has to be better then this. i can't wake up to any good number, ever or go to bed at a good number, or..if i do, it seems a few hours after my levemir shot my blood sugars actually go UP! i'm not sure how to go from two doses to one, guess i'll try 6.5 tonight, i'm high right now anyway, not correct and watch my CGM during the night and not take anything in the morning tomorrow and see how I do through out the day. i think I'll probably need around 7 - 8 units total. Who knows at this point.
I would go with your instincts, Sarah, but please, please remember that one day or one night of too much drop or whatever is not a pattern. You need to resist your urge to keep changing things based on one day or one number because that is how you get yourself on a roller coaster and then get frustrated.
I was having some lows so i am currently just taking the 8units at 7 pm. things are working well!
i know but last night i was 143 before bed, hadn't bolused or eaten anything since 6pm. didn't correct, took 6.5 units levemir at 10pm and by 12:30am I'm woken up with a screaming CGM arrow rising straight up and I'm 199 going up to 200. WTH? Does levemir do nothing? It seems when I take my shot, 2 or so hours later I'm higher.
When I was on shots a number of years ago, I always took my entire daily dose at bedtime. I'm not sure if the protocols have changed for shot administration, but it always worked perfectly fine for me. If you doctor suggested this method, then I would go with what he/she wants. The doctor typically knows best. :)
I wouldn't worry about weight gain if you are following a low carbohydrate diet (although, I'm not sure how many carbs you are eating) and using less insulin. Using a lot of insulin can cause you to gain weight, so if you are using less insulin than you were on the pump, then it stands to reason that you wouldn't gain any weight. Ultimately it depends on your calorie intake and exercise. If eating a lower carbohydrate diet works for you to maintain your weight, then go for it. From your picture, you certainly look in shape! I hope you're not trying to lose weight!
hi andrea, hope things are still going well for you...i think i'm gonna end up similar to you. i took 7.5 units last night of levemir, woke up to 88...wow! which is feeling low, ugh, for me. gonna just see how it lasts throughout the day and not take anymore in AM; always a work in progress. thanks for posting this discussion! :)
In my opinion nothing beats personal experience. I used Levemir for some years and now I am on Lantus. With Levemir I used two shots every 12 hours. This is the recommended application pattern and my numbers have been good. But the risk of lows at night was always present and it was quite challenging to adjust to days with different levels of physical activities. Thus I asked my Endo for Lantus.
With Lantus I switched 1:1 in dosage and pattern using two shots every 12 hours. First this went fine but with time I found out that I suffered from something like a chaotic oscillation. Looking at the numbers my endo came to the conclusion that the lower the dosage of the Lantus is the less reliable is its duration for me. This means that on some days the shot in the morning last for 22 hours and this combines nicely with the shot in the evening resulting in nice basal coverage. However sometimes and with more and more regularity the shots did not last 22 but only less than 16 hours. This brought up some disturbing irregularities in my numbers. My endo recommended to use the Lantus with only one shot late in the evening (10 units). This has its own challenges that I needed to address properly. First I usually have now a gap in coverage before the next shot. This gap is compensated by some I:C tweaking for supper (+20%). Since I eat supper quite regularly this is not that problematic for me. The nice side effect is that the gap in coverage is reaching into the night as well. This fits quite nicely to my high sensitivity to basal insulin around 3 AM. As a result I still have to eat something to prevent going low at night but it is just some dark chocolate (my reward for the day). With Lantus additional carbs are a little bit harder to handle as I have experienced with the food around Christmas. But the more important effect is that the number of lows has been reduced. I am still fine-tuning and in some months I will reevaluate my Lantus usage. Perhaps I can then try Degludec that is in the approval process for the German market. I am still looking for the one basal insulin that will keep me steady at night. I suppose this is work in progress...
How does one tell if basal shot is not lasting long enough or simply isn't enough basal? say one takes 8u levemir or lantus at bedtime. hypothetically, it only lasts about 18 hours, then does one split that 8 u PM dose into a 4u AM and 4u PM dose or add an additional AM dose to that PM 8u dose? not sure why splitting a dose would make it last longer, aren't smaller basal injections more prone to burning out faster - shorter duration compared to 1 larger basal dose...stronger, longer duration? thanks!
Well, to test if it's right you fast. Skip a meal, no exercise or anything just normal day etc, and it "should" keep levels flat with no swings up or down in bg level. If it's moving one way or the other, it's too much or too little. This is how a pump is more controllable as in a morning you could need a higher basal than in the afternoon which isn't able to be altered with a long acting insulin. Overnight is yes fasting, but you are asleep and a drop from going to bed to waking is still a drop and without cgm data isn't enough information really to work off which is why fasting through the day is usually more reliable source for data to work off.
Not enough basal and when fasting you will find you bg levels will increase. Same for not lasting but that more displays in that when fasting your levels remain a nice steady level for the skipped meals, but later on begins to tail off higher in level, thus showing the insulin isn't function as desired and is causing the levels to rise. Lots of monitoring is the key though, as lack of monitoring and you can get all kinds of anomaly's like rebounds where you've gone low and your liver has decided to help out and you've gone high, although from personal experience I tended more to originally get those during sleep.