What signs do you look for to adjust your basal dose?

I already posted once a long saga about maybe needing to adjust my Lantus downwards now that I am more active. I’ve lowered it by 2 units (from 18 to 16) but I’m still having a lot of between-meal lows. I’m guessing I need to lower it some more but this is starting to seem like a big change! I’m afraid to be getting confused the effects of insulin with the effects of my exercise/glycogen uptake or some other equally confusing issue (such as maybe Novolog peaks much later for me and that’s causing my lows? do I need to maybe switch to a different insulin altogether?)

fwiw I’m planning to ask for a consult with a diabetes nurse next week :slight_smile:

So I’m wondering, those of you who don’t have pumps, what do you look for that tells you you need to change your basal dose? How do you personally figure out that that’s where the problem is?

I think that I generally used my fasting blood glucose as my indicator (before i started on the pump). Can you find a pattern in WHEN the lows occur? If they always occur around the same time of day, then you might be able to prevent them by adjusting WHEN you take the insulin injection.

Lantus is most active in the first 6 hours and many people report that it is only active for 20 hours.

Do you take your Lantus once a day or as a split dose?

Hope that you are able to find a solution to prevent the lows!!!

Lantus insulin dose should be adjusted according to your fasting blood glucose levels. If you are consistently more active, you may also need to adjust your insulin to carbohydrate ratios or your sensitivity factor if you are going low between meals ie: after fast acting insulin. I agree that keeping good logs will help you and the diabetes educator to see what is going on and what is having the greatest effect so that you may determine just what needs to be adjusted.

typically your morning fasting numbers are used to set basal dosages, but this is faulty for many. About a third of us have roller-coaster basal patterns. Flat insulins like Lantus just don’t work well.

In my case, if I set my dose to make my normal when i woke, I’d hypo every night. I crash hard between midnight and 4am then have a DP from hell. I then drop from midday to supper and have a long high rise in the evenings. The only way I’ve been able to control it is by pumping. But MDIers can do things. You can add supplimental doses of NPH, Regular, or a rapid acting to cover gaps.

The question remains “How do I know what my needs are?” The answer is remarkably simple. Test your sugars without eating food. Basal test! You don’t need to test 24 hours of the day at once, but they should all be covered. Skip breakfast one day, skip lnch the next. Build a 24 hour profile. It’s not easy. But once you gain that knowledge of your behavior, you can then plan a strategy of attack. Knowledge is power!

Google “Basal Testing for MDI”

I agree with Kristin, I use my fasting blood sugar to determinehow much lantus I needed. I bottomed out a few times but once I figured it out I was good to go.

Once a day, 11 p.m. I’m not seeing any trouble with it running out. The lows are happening all throughout the day, usually 30-60 minutes before a meal (i.e. several hours since I last ate/bolused). Thanks, I hope so too! :slight_smile:

That’s some good information about the 2hrs/4hrs! I’d never heard it put quite like that before but it makes perfect sense (I was kind of intuitively thinking it anyway). It’s good to know that at least for some people Lantus needs can fluctuate so much, makes me worry a little less about myself. Thank you!

The thing is, the lows are happening long after my bolus insulin should have peaked. In fact if I ease up on my I:C ratios I end up with big spikes. It’s going: bolus, food, post-meal spike (2hrs), then within the next 2hrs after that I go from spiked to low. That’s why my feeling is it’s a basal issue and maybe I actually need to tighten my I:C ratios for the spikes…I’m just scared to do it right now because of all the lows.

I’ll start keeping better logs too. I usually do a pretty detailed log but I have been slacking off lately, working on getting other good habits established in my life. But if I’m going to be consulting a diabetes nurse I’ll need something to show!

Thanks SO much for this info…it’s so obvious I’m laughing at myself for not having thought of it sooner. I think I’m going to do some basal testing starting next week (don’t want to do it over the weekend because my routine is not the same) but I can’t wait! I think just having some clear, solid knowledge of what’s going on in my body is going to make this SO much easier.

Why oh why did I not know about this sooner? :smiley:

That’s a good idea. I think the hardest thing is going to be skipping my workouts for a couple of days, I’ve really gotten hooked!

Thanks for the reassurance…you’re right, when you take into account all the factors that change as we get active and lose weight, 2 units may not be much at all.

I prefer to do basal testing by just skipping ONE meal.

If I eat carb free, I actually see that the protein raises my blood sugar because I eat a lot more protein than usual. I usually skip one meal which lets me test the basal rate for 6-8 hours a time. And i rotate which meal I skip. Just make sure that you do not start the basal test until 5-6 hours after your last bolus!

I love the exchange of ideas… I’ve learned so much here too :slight_smile: