Should I adjust my basal? (long post)

Hi all, new here! I’m a T1 :slight_smile: I apologize in advance, this will be a bit long as there is kind of a lot I think I have to explain.

I’m working on losing weight, which means eating less and exercising more. I read labels and count carbs and calories. I use a nutrient tracker and try to eat balanced, 1500-1800 kcals/day. I use an “intensive” (4+ times/day) monitoring regimen, on Lantus and Novolog with a correction formula and an I:C ratio. In other words I’m pretty hands-on and well-informed.

I’ve already noticed I can get by on smaller boluses now that I’m more active (and I do have a formula to adjust my insulin for exercise also). But suddenly I’m starting to have a lot of lows again, which is unsettling and also screws up my weight loss because I have to keep eating more! I prefer being proactive with my insulin rather than adding in extra snacks, but I’m kind of stumped what to do.

So here’s the pattern I’ve been seeing, and I just wanted some second opinions on this. I know I need to consult my dr. as well but it will take me a while to get an appointment.

Monday and Tuesday, I changed my exercise time from just before lunch to just after breakfast, and ended up going low overnight Monday and Tuesday night. Wednesday I switched back to just before lunch, but still had a low. Thursday (yesterday) I took the day off, didn’t go low but had a HUGE drop between bedtime and morning.

I have already had issues with exercise in the past, and done a little digging about glycogen response, and after thinking about it more, I suspect what happened Monday and Tuesday was that since I had a long wait between exercise and eating, my blood sugar got robbed for glycogen replenishment later that night. Wednesday I’m guessing it’s because I was still within that 48-hour period of Tuesday’s workout. But on Thursday? I’m stumped.

My first instinct was to change my Lantus dose, but I’ve had some bad experiences with that in the past. And these drops are sooo big I’m not sure Lantus could be doing it (when I am less active I generally do well on my current dosing of both insulins, so I don’t think I’m having underlying problems that way - it’s related to the activity increase). Like I have seen it go from 10, 12, or even 15mmol/L at bedtime - which I know is really too high - to 2 or 3 by 2 a.m. without my taking any correction insulin. Supper insulin is long gone at that point…the only thing still working is the Lantus. Can Lantus do that much??

The other thing that’s happening, that ties into this, is that I’m having some decent after-meal spikes. This is normal for me in that it happens no matter how active I am. I know I don’t spike as bad if I wait 15 minutes between injection and meal so I can moderate that somewhat. Ordinarily I would want to adjust my I:C ratios, but what I keep seeing is that I will spike up at my 2h post-meal, but then by the next meal I will be low or almost low again!

As an example: Woke up at 8mmol/L this morning. Did my workout, it went up to 9. I’m not too worried about that - one my blood sugars are in flux right now with all the changes in routine and two I just finished a workout that included resistance work. Took my adjusted insulin for breakfast. Two hours later, 16 (!). But by lunchtime, down to 3. When I am less active I don’t go quite so high or so low but I will still see a spike and then a really big drop long after my bolus insulin should be on its way out.

There will be times that I “feel low” but my reading is still normal…but a half hour later it’s low for real. I think I can feel it not just when it’s low but when it’s starting to drop so fast. At least I still have good sensitivity, thank god!

I am so confused and frustrated and tired of this roller coaster. I have been exercising every weekday for the past month or so and have not been this unstable until now, so I feel like it has a lot to do with my changing the timing of my workout (last time this happened it was because I was going for long walks after supper so I think timing is really important for me). But it feels like every time I try to tighten down my blood sugars or be more active this happens. I know the body is not a petri dish but it’s like banging my head on the wall!

So what do I do? Do you think I just unbalanced myself with the schedule change and it will settle out after a weekend off exercising? Should I be looking at decreasing my basal and increasing my bolus? Have any of you experienced anything like this - what worked for you? I just want to understand what’s happening in my body (as much as possible that is) so that I can adjust whatever I need to adjust.

Hi,
I think it would be helpful to know your doses and when you take your Lantus.

Maria

Sure! Sorry :slight_smile:

I take 18 Lantus at 11 at night. I know some people have issues with nighttime Lantus - I have done morning dose and split dose and didn’t have really good results but I could always try again.

My correction formula is (BG-6)/1.2 I:C ratios: at breakfast 1:4, lunch 1:10, supper 1:9. (when I’m not exercising regularly all those numbers come down by one: 1:3, 1:9, 1:8) For exercise I subtract one unit of insulin for every hour of moderate exercise or 30 minutes of more intense that I’ve just done or am about to do.

This is complicated …The way I read your ratios : breakfast : 1 unit of insulin for 4 grams of carbs when you exercise etc. . I wonder if your carb ratios are correct, esp. your breakfast , hence you crashing at lunch time …I have a sense and I could be totally off , that most of us require a higher ratio at breakfast , and lower for other meals unless you do shift work ?? You bolussing and having insulin on board may be a concern here as well .
Can you contact a Diabetes center /nurse in your area before you can see your Doc ?
May need to do more finger pokes, as in 2 hours after meal bolussing and during the night .
I hope you get this sortered out …

You read my ratios right. One unit per 4g at breakfast :slight_smile: It IS a lot but I’m told this is very normal as due to the way your hormones work when you sleep, almost everyone is insulin resistant in the mornings (even nondiabetics). My endo said I have a pretty standard “curve,” in that I need the most at breakfast, the least at lunch, and a little bit more again at supper.

I’m reasonably sure I have the right ratio for me, from trial and error. When I have taken less insulin in the mornings, I end up with a bigger spike and a bit higher at lunch. Otherwise I would have thought the same as you - too much at breakfast bringing me low at lunch. But the thing is, too, that the insulin I take is supposed to peak 1.5-2 hours after taking it and then be out of the system by 3-5 hours. Whereas, at 2 hours out, I am having a spike, and between 2 and 4-5 hours out I drop low.

Hmm…is it possible that my body doesn’t metabolize rapid-acting insulin…well, rapidly?

When I was crashing at night I lowered my basal. My dr told me to try lowering it by 1 U every 3 days - that the body needs about 3 days to settle into any changes. Is your doctor/dietician not helping you with your dosing? Please take my advice with a grain of salt because I’m kind of new to this myself (only 2 years).

I also find that in the summer, when I’m much more active, I need less basal than in the winter. The warmth might have something to do with it too. If I weight train in the evening sometimes I have to worry about going low overnight. I know some people eat a small (tiny) snack before they go to bed to keep this from happening. But again please consider that I’m a relative newbie.

Best wishes and do keep us informed.
Maria

I understand what you are saying …my pump nurse always said that I am different …your story proves it again and I apologize for giving you possibly wrong ideas .
I cannot recall reading : are you delivering breakfast bolus possibly 15 minutes prior to eating ??..for me eating slowly helps too .I may end up drinking my milk about 1 hour after starting breakfast .
I went to the fourth edition of Pumping Insulin ( I am a pumper ) and John Walsh talks about basal and bolus ratios . On page 52 he talks about ( for type 1 ) basal insulin delivery to make up 40 - 65 percent of the TDD ( total insulin per day ) …are these numbers making sense ? Correction bolusses should not make up over 8 percent of your TDD , page 156 .
And by the way …have you considered pump therapy ??
I agree with Maria, I need more insulin during winter , however I am as active in summer as winter .
What does your BG test show at 3 am ??..are you maybe rebounding ??
Let no one person tell me , that diabetes is not complicated …ps are you aware of the Canadian disability tax credit for type one’s , if qualified ??