Reply To: My Change to Basal Bolus.

[Anonymous]

As I just changed from Lanthus to Levemir and then the pump, let me offer my observations.

From the profile, Lanthus allegedly works over 24 hours with an almost perfectly flat distribution. This explanation by the manufacturer has several flaws (a load of people seem to notice it works for less than 24 hours – in my experience it was almost exactly that. I got a bloody glucouse increase after 24.15h). This means that you’ll either run into “too little insulin” stages during the day (I think typically two, during the mornings and the late afternoon – but Tims basal rate profile suggests different things) or get low blood sugars in between.

Not sure that makes sense .. let me try a plotty thing:

-01  -02 -03 -04 -05 -06 -07 -08 -09 -10 -11 -12 -13 -14 -15 -16 -17 -18 -19 -20 -21 -22 -23 -24 Time
0.5 0.5 0.5 0.5 0.5 0.5 0.5 0.5 0.5 0.5 0.5 0.5 0.5 0.5 0.5 0.5 0.5 0.5 0.5 0.5 0.5 0.5 0.5 0.5 Lanthus BR derived from 12 units/day
0.5 0.5 0.5 0.5 0.5 0.8 1.0 0.8 0.5 0.5 0.5 0.5 0.5 0.5 0.5 0.5 0.8 0.8 0.8 0.5 0.5 0.5 0.5 0.5 Something similar to my pump profile

In the times where my pump profile is higher than the Lanthus one I used to cover with bolus. Typically calculated into the food bolus. Which then means that skipping a meal on the weekends and sleeping in doesn’t work well. Unfortunately, your only other choice is to increase base Lanthus – and that would probably lead to low blood sugars all day round (or rather, in the times between 20.00 and 05.00 and between 09.00 and 17.00 in my above example).

Changing to Levemir (with a more Gauss profile) and injecting twice can help a bit. Unfortunately the time of effect is around 16 hours, and the maximum effectiveness after 8 or so – which means that (for me) injecting after getting up lead to the least effect when I needed, the biggest effect when I didn’t need it at all and then a drop in effectiveness when I needed it again. And no – I won’t get up every night at 03.00 just to inject.

Or in other words: Best pump simulation would be a not-fast-acting insulin (like Actrapid [if that still exists]) injected before you get up. Err. Yes.

I used to go for higher base rate injected on Friday night (I used 50% more) and then going to bed at a higher blood glucose – yay for snacks. Risky, though, with nighttime hypos. And then needed more food during the early afternoon (which coincided with my late breakfast, no lunch, snack-type food in the early afternoon well).