My Change to Basal Bolus.

[Anonymous]

Hi All,

Been lurking for a while and it’s now time to post and ask some noddy questions!

I recently ditched my Novomix 30 as I was starting to use it 3 or 4 times a day and figured that it was time to take the plunge and move to the good old Basal Bolus malarkey which has left me with a question. I have been a good boy and listened to my DSN and take my lovly Lantus before bed and am slowly sussing out the correct dosage (Bolusing is ok at the moment). The problem I have found is that if I test when I wake and am ok but don’t eat (usually as it the weekend and I can’t be bothered getting up) I find that my Blood Sugars go up by about 1 point an hour e.g 5.6 @0700 and then 8 or 9 at 1000. I thought that the Lantus should cover this or is this a good old liver dump making my life more interesting?

Any help, advice, mickey taking welcome.

My Pancreas only decided to leave me 3 years ago so I’m still learning.

[Tim]

That not a noddy question at all, you’re going to have to try harder than that to demonstrate incurable ignorance & stupidity! 🙂 This could be a liver dump of some sort, I used to struggle all the damned time with exactly this when I was on Lantus. You’ll be thrilled to hear that I never really found a solution for it.

Since being on the pump I’ve discovered that my basal needs are all over the place (I’ve copied & pasted them below) and I never would have been able to get them right with Lantus.

Reading that back, I realise my input is essentially “get a pump”, hopefully someone else can be much more helpful! 🙂

Time > units of insulin per hour

00:00:00 1.8
01:00:00 2
02:00:00 2
03:00:00 2
04:00:00 2
05:00:00 1.5
06:00:00 1.5
07:00:00 1.5
08:00:00 1.5
09:00:00 1.5
10:00:00 0.7
11:00:00 0.7
12:00:00 0.7
13:00:00 0.7
14:00:00 0.4
15:00:00 0.2
16:00:00 0.2
17:00:00 0.2
18:00:00 0.4
19:00:00 0.8
20:00:00 0.8
21:00:00 0.8
22:00:00 0.8
23:00:00 1

[Annette A]

First: disclaimer – I’m also a pump user and my basals move about as much as @Tim’s. And I now see why I could never get ‘good’ control on MDI – there’s no way Lantus could match my rollercoaster needs.
What you describe does sound a bit like the dawn phenomenon I used to get – it only really happened if I didn’t get on with my day – so I guess the breakfast insulin/food hid it most days. I found that giving my Lantus in the morning helped – I only used it once per day (so as to reduce the night time hypo problem) but lots of people find that having it in two doses (morning/evening) works well for them so as to give differing amounts to cover night/day- something to ask your DSN about, I think.

[Tim]

I swapped between splitting Lantus and not splitting Lantus every six months or so. I found it didn’t make much difference either way – but I know people swear by it, so it’s worth a punt.

[Anonymous]

Cheers Folks,

I figure my lovely Liver is doing its thing really well as it’s working out that Ive not eaten in the morning and chucking bucket loads of glucose into my system in the misapprehension that I actually have some Beta cells left that work. Guess something still works eh?

I’ve only been on B/B for a few weeks so I reckon I shouldn’t get too upset at weird readings – I had the Novomix down pat but got ticked off at too many Hypo’s and having to be totally regimented in my eating times hence the change to something allegedly more manageable.

Currently bunging 26u Lantus into my Gluteus(not so)Maximus before bed and am going from there, will see if an increase is needed as I go.

Hilarious thing is – I haven’t seen my DSN since diagnosis in 2010, should have seen her face when she realised I’d been missed off the system but was doing ok thank you very much on my own! Me 1 – Churchill Hospital Oxford 0. She did mention a pump but after looking at 3 years of record cards fiured that my control was ok and I probably wouldn’t qualify.

Good to see you enjoying the Lakes Tim, will be up there soon on two wheels hooning round Kirkstone and Whinlatter!

[Cecile]

I administer a smidgen of short acting if I’m lounging ’til late – but unfortunately you do have to wake up to do that (unless you have a trained time-sensitive puff adder loaded with the required dose… if you work on your peripheral neuropathy, you won’t feel a thing!)

[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).

[Anonymous]

Bit of a result in recent weeks….. Been doing a course called InSight which is run by the OCDEM in Oxfordshire. It’s a similar plan to DAFNE but is completed over the course of 6 weeks, the idea being that each bit of knowledge is put into pracice during the week and looked at at the next meet. So far I have discovered that I was ramming too much juice into my system (wrong bolus ratio) and that it takes longer than my natural impatience can handle for changes to take effect – ho hum.

Saying that, my himalaya style chart is now more representative of rolling cotswold hills and I can see that my basal may need to be increased a bit.

A useful and educational course that I can reccommend. I believe it’s not exclusive to the oxford area and is being rolled out around the country.!

Here’s to a sub 7.0 HbA1c at some point!!

[Author]

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