# Lantus - Splitting



## mum2westiesGill (Aug 10, 2014)

Is it better to start with a 50/50 split or take slightly more am due to being more active then slightly less pm due to being less active?

I'm on 18u.

Thanks in advance for any help.


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## Bessiemay (Aug 10, 2014)

I am no expert but I was advised to start 50/50 which I do 8 units at 8am and 8 at 8pm.   I have never changed because I can't see a pattern even though my numbers aren't very good.  I put it down to poor carb counting even though I know how to do it. Also forgetfulness.


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## mum2westiesGill (Aug 12, 2014)

So I've not done my split yet but was thinking of doing it gradually so instead of going from 18u at night to 9u am & 9u pm which I thought might cause some very wicked highs I was going to do it like this:
I'm on 18u at the moment then 
1st night take 17u & just 1u the following morning 
2nd night take 16u & 2u the following morning 
3rd night take 15u & 3u the following morning
4th night 14u & 4u........
5th night 13u & 5u.......
6th night 12u & 6u......
7th night 11u & 7u........
8th night 10u & 8u.......
9th night 9u & 9u

what does anyone think of this please?


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## Northerner (Aug 12, 2014)

Gill, I think that it might be better to do some basal testing so that you know when the problems are likely to occur. Doing it as you suggest will take a long time, given the way lantus takes a while to register changes. I would run it past your DSN and see what he/she suggests


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## mum2westiesGill (Aug 13, 2014)

Yes like you say I could get a couple of overnight basal tests in before I do or even maybe do a split. Again like you say doing a split that way would take forever. I spoke with my DSN (who is the practice nurse at my GP surgery) yesterday & she said doing the split that way would take forever. She said she would just go for it & do it 50/50 but just do lots more monitoring.


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## KookyCat (Aug 13, 2014)

Hi Gill

I think it would be really good for you and your nurse to have a plan in terms of what you're going to do with all those additional readings.  It sounds to me like splitting the dose could cause lots of confusion so I'd need a plan to make sure I wasn't overwhelmed by a soup of numbers 

For example 
1.  Split dose and monitor closely for three days, watching for lows in particular and only adjust the ratio to address lows.
2.  Day four focus on overnight/evening dose with basal testing to get to the point where you stay stable overnight (ignoring whether the bedtime reading is too high because that's about daytime control). When that's stable move on to daytime.
3.  Look at daytime readings with basal testing 

I'm not saying that's the right plan just that I'd want to have a very very clear idea of how to do all that testing and how to take it step by step so I didn't end up in a pickle.  Would your nurse help you do that?


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## mum2westiesGill (Aug 23, 2014)

Not done my split yet but here's my last 11 days BGs

12/08
Bedtime 15.3 > 8.3 13/08 - dropped 7mmol

13/08
Bedtime 14.8 > 7.7 14/08 - dropped 7.1 mmol

14/08
Bedtime 8.8 > 3.8 15/08 - dropped 5mmol

15/08
Bedtime 6.7 < 7.9 16/08 - rose 1.2 mmol

16/08 
Bedtime
no test - 8.6 teatime > 5.0 17/08 - dropped 3.6 mmol

17/08
Bedtime 17.6 > 4.6 18/08 - dropped 13mmol

18/08
Bedtime 19.1 > 16.7 19/08 - dropped 2.4mmol

19/08
Bedtime no test - 13.7 teatime > 9.6 20/08 - dropped 4.1 mmol

20/08
Bedtime 10.0 > 5.4 21/08 - dropped 4.6 mmol

21/08
Bedtime 10.5 < 12.3 22/08 - rose 1.8mmol

22/08
Bedtime 14.8 > 10.7 23/08 - dropped 4.1mmol


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## KookyCat (Aug 23, 2014)

mum2westiesGill said:


> Not done my split yet but here's my last 11 days BGs
> 
> 12/08
> Bedtime 15.3 > 8.3 13/08 - dropped 7mmol
> ...



Hi Gill
You've got some pretty big drops overnight going on there . I have a similar issue with overnight drops in blood sugar, no dawn phenomena for me!  Have you thought about reducing your dose before the split?  I've reduced my Lantus dose quite a bit and have managed to get it to the point where I drop on average about 1.5 mmol/l which seems to keep everything ticking over.  I don't sleep well when my blood sugar is falling overnight so it also improved my sleep too which is a nice brucey bonus


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## Northerner (Aug 23, 2014)

Gill, I know I've asked this in the past, but are your bedtime tests taken at least 5 hours after your evening meal dose of Humalog? That's the only way you can be confident that your bedtime reading is a true reflection without any remaining insulin on board i.e. your levels could continue to fall because of mealtime insulin and not the lantus.


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## mum2westiesGill (Aug 23, 2014)

12/08
Bedtime 15.3 > 8.3 13/08 - dropped 7mmol

13/08
Bedtime 14.8 > 7.7 14/08 - dropped 7.1 mmol
Teatime 19:51 - Bedtime 23:05

14/08
Bedtime 8.8 > 3.8 15/08 - dropped 5mmol
Teatime 19:36 - Bedtime 22:33

15/08
Bedtime 6.7 < 7.9 16/08 - rose 1.2 mmol
Teatime 20:17 - Bedtime 22:46

16/08 
Bedtime
no test - 8.6 teatime > 5.0 17/08 - dropped 3.6 mmol
Teatime 20:10 - Bedtime 00:01

17/08
Bedtime 17.6 > 4.6 18/08 - dropped 13mmol
Teatime 18:08 - Bedtime 22:25

18/08
Bedtime 19.1 > 16.7 19/08 - dropped 2.4mmol
Teatime 20:45 - Bedtime 22:34

19/08
Bedtime no test - 13.7 teatime > 9.6 20/08 - dropped 4.1 mmol
Teatime 22:21 - Bedtime 22:59

20/08
Bedtime 10.0 > 5.4 21/08 - dropped 4.6 mmol
Teatime 19:05 - Bedtime 22:25

21/08
Bedtime 10.5 < 12.3 22/08 - rose 1.8mmol
Teatime 20:08 - Bedtime 22:40

22/08
Bedtime 14.8 > 10.7 23/08 - dropped 4.1mmol


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## mum2westiesGill (Aug 25, 2014)

Northerner said:


> Gill, I know I've asked this in the past, but are your bedtime tests taken at least 5 hours after your evening meal dose of Humalog? That's the only way you can be confident that your bedtime reading is a true reflection without any remaining insulin on board i.e. your levels could continue to fall because of mealtime insulin and not the lantus.




I usually take BI with my supposed bedtime test as a way of remembering to take it. I take my BI at 10:30pm ish or half an hour either side.

In future & to get the true reflection of my bedtime tests would it be better to make sure I only do my bedtime test 5 hours after my evening meal? So if I've eaten my evening meal at eg 7:30pm I do my bedtime test at 12:30am / 8pm I do my bedtime test at 1:00am?


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## Northerner (Aug 25, 2014)

mum2westiesGill said:


> I usually take BI with my supposed bedtime test as a way of remembering to take it. I take my BI at 10:30pm ish or half an hour either side.
> 
> In future & to get the true reflection of my bedtime tests would it be better to make sure I only do my bedtime test 5 hours after my evening meal? So if I've eaten my evening meal at eg 7:30pm I do my bedtime test at 12:30am / 8pm I do my bedtime test at 1:00am?



In a word, yes, which can be inconvenient. I solved the problem by just making sure I eat around 5-6pm so it's always around 5 hours by the time I go to bed. For example, the other night I tested 2 hours after injecting and I was at 9.7. An hour later I was at 8.4, but by bedtime (5 hours after injecting) I was 3.2 so needed to treat it before bed. I might have gone to bed thinking I was OK on an 8.4, but you can see how much it fell! 

It's easy for me though, as I don't have to fit my mealtimes in with anyone else, like family.


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## mum2westiesGill (Aug 26, 2014)

Last night:
teatime - 18:25pm - 12.4
bedtime - 22:39pm - 18.3 - did QA correction & also BI
- maybe because I did carbs for tea but not for a bowl of ice cream & choc sauce which I ate aftrerwards . But look at the time difference between teatime & bedtime.


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## mum2westiesGill (Aug 27, 2014)

Last night:
teatime - 20:39pm - 15.1
bedtime - 00:41am - 16.4

Found this for Humalog/QA & lantus/BI action times
http://www.diabetesnet.com/about-diabetes/insulin/insulin-action-time
- on my X-Pert insulin course which I went on in the handbook it says
*Humalog - onset of action - 10 - 20 mins / maximal effect - 1.5 - 2.5 hours / duration of action - 3 - 5 hours
so would I be OK doing a reading after/between  3 - 4 hours?*
Lantus - onset of action - 1.5 hours / maximal effect - 3 - 24 hours / duration of action - steady-state levels reached after 2 - 4 days of once daily dosing


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## mum2westiesGill (Aug 28, 2014)

Last night:
teatime - 20:04pm - 4.8
20:24pm - had an extra 2u QA because ate jaffa chocolate orange cake for pudding
bedtime - 23:50pm - 9.4


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## Northerner (Aug 28, 2014)

mum2westiesGill said:


> Last night:
> teatime - 20:04pm - 4.8
> 20:24pm - had an extra 2u QA because ate jaffa chocolate orange cake for pudding
> bedtime - 23:50pm - 9.4



Your quick acting may still have been working by the bedtime tests, hence your fall to 5.2 - but much better than you have had lately!


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## Pattidevans (Aug 28, 2014)

When I was on Humalog I found it had quite a kick in the tail.  It could drop me quite fast between 4.5 hours and 5 hours.


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## mum2westiesGill (Aug 29, 2014)

Last night:
teatime - 19:48pm - 12.5
- had pizza for tea, did split injection of 5u then 2u at 20:48pm 7u in total advised my my meter
bedtime - 23:52pm - 5.0
- well below my bedtime target of 8 - 12 - ate 1 chocolate digestive


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## mum2westiesGill (Aug 30, 2014)

Last night:
teatime - 19:15pm - 10.7
- carb counted & took insulin for tea but a little while after ate a bowl of ice cream with no carb counting or insulin - it's so easy just to sit down with a bowl of ice cream & not do anything about it
- also ate a small packet of mini cheddars
bedtime - 23:16pm - 12.6
- after testing when I went upto bed ate 2 chocolate digestives


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## Northerner (Aug 30, 2014)

mum2westiesGill said:


> Last night:
> teatime - 19:15pm - 10.7
> - carb counted & took insulin for tea but a little while after ate a bowl of ice cream with no carb counting or insulin - it's so easy just to sit down with a bowl of ice cream & not do anything about it
> - also ate a small packet of mini cheddars
> ...



Gill, you really can't have all that carbohydrate without insulin, at a guess at least 60-70g carbs in addition to your meal, and you were already in double figures. But the problem is that having extra insulin later in the evening lays you open to night hypos. I know the feeling of not wanting to 'bolus for a biscuit', which is why I very rarely do - I just go without the biscuit and have some cheese instead!

What I tend to do is take extra insulin with my main meal, knowing that a couple of hours later I'm almost bound to want a snack. That way I've already got insulin working. The drawback is that if I don't eat extra later then I'm going to have a hypo, but if I really don't feel like a snack later I just have some jelly babies or lucozade to 'top up'. By the time bedtime comes along I no longer have insulin active and my bedtime reading is a fairly reliable guide.

This works well for me, but I realise it wouldn't work for everyone. I'm pretty consistent in my eating habits which means things are pretty predictable for me (yes, I am lucky also!). 

Hope you can find the balance soon


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## mum2westiesGill (Aug 30, 2014)

Northerner said:


> Gill, you really can't have all that carbohydrate without insulin, at a guess at least 60-70g carbs in addition to your meal, and you were already in double figures.




Bowl of ice cream - from carbs and cals - 16g or may have been 24g if  it was nearer to the bigger portion size
Mini cheddars - 12.9g
Chocolate digestives - 10.8g x2 = 21.6 
Total - 50.5g or 58.5 if  iceream was nearer to the bigger portion size





Northerner said:


> But the problem is that having extra insulin later in the evening lays you open to night hypos. I know the feeling of not wanting to 'bolus for a biscuit', which is why I very rarely do - I just go without the biscuit and have some cheese instead!




Exactly re the hypos. Your idea of having cheese instead of the biscuit is a good idea




Northerner said:


> What I tend to do is take extra insulin with my main meal, knowing that a couple of hours later I'm almost bound to want a snack. That way I've already got insulin working. The drawback is that if I don't eat extra later then I'm going to have a hypo, but if I really don't feel like a snack later I just have some jelly babies or lucozade to 'top up'. By the time bedtime comes along I no longer have insulin active and my bedtime reading is a fairly reliable guide.
> 
> This works well for me, but I realise it wouldn't work for everyone. I'm pretty consistent in my eating habits which means things are pretty predictable for me (yes, I am lucky also!).
> 
> Hope you can find the balance soon




Yes having the extra insulin knowing that you might be snacking later is a good idea then like you say If there are no snacks eaten you can just top up with jelly babies. Also like you say when bedtime comes along the teatime insulin can then be out of the system.......

Thank you Northerner for all your help


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## mum2westiesGill (Aug 31, 2014)

Last night:
lunch: - 15:58pm - 5.8
teatime - skipped tea due to going out for the evening then having a later supper when arriving home
bedtime - 01:24am - 19.0
- ate pizza for supper approx 36g cho at this time of 01:24 - during the evening had alcohol 3 or 4 spirits with diet mixer - meter advised 6.5u QA for pizza but due to going to bed I halved this & took 3.5u QA


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## mum2westiesGill (Sep 1, 2014)

Last night:
teatime - 18:29pm - 12.5
- ate 1 packet of mini cheddars 12.9g carbs during the evening - was going to do extra insulin at teatime to match up to the carbs in the cheddars but forgot
bedtime - 22:31pm - 16.0
- ate some ham & cheese just after bedtime test


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## mum2westiesGill (Sep 2, 2014)

Last night:
teatime - 19:00pm - 12.5
- entered 10g of extra carbs into my advisor meter for crisps/snacking later in the evening - ate mini cheddars 12.9g carbs
bedtime - 23:07pm - 11.8
- after doing this test the downfall came & I ate 2 chocolate digestives 20g approx carbs  


- keep getting lots of really big drops between bedtime & fasting/breakfast so don't know whether to reduce BI
- also BGs are rising quite often from teatime to bedtime so don't whether to split my BI


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## Northerner (Sep 2, 2014)

mum2westiesGill said:


> Last night:
> teatime - 19:00pm - 12.5
> - entered 10g of extra carbs into my advisor meter for crisps/snacking later in the evening - ate mini cheddars 12.9g carbs
> bedtime - 23:07pm - 11.8
> ...



It does look like you might have too much lantus at night Gill. Given that you were 11.8, plus those biscuits and then you woke to a 5.4. It depends what you want to do really - the high level before bed and the biscuits probably stopped you from going hypo. If you want to continue having bedtime snacks then you could continue as you are now, although that can be a bit unpredictable. What I used to do when I was on lantus was, if my bedtime reading was around 6 or below I'd have a snack like a slice of peanut butter on bread, but if it was higher e.g 8 or above then I wouldn't have the snack, or I'd have a non-carb snack.


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## Pattidevans (Sep 2, 2014)

> also BGs are rising quite often from teatime to bedtime so don't whether to split my BI


With due respect I would say that the reason your BGs are rising between teatime and bedtime is because of the snacking you do in the evening.  Taking extra insulin with your tea won't really cover those snacks due to the profile of the fast acting insulin and how it works.  In order to cover the snacks you really should bolus for them individually.  I know it's a PITA - and it's why (until I got the pump) I never ate between meals because it was too complicated as you tend to stack insulin, making the results unpredictable.

I understand you're dropping quite a lot overnight, but to truly test your basal to see if it's right you need to have at least one evening with no snacks, so that all food and rapid acting insulin are out of your system before bed.  See How to discover (or adjust) your basal insulin dose (about half way down the page).


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## mum2westiesGill (Sep 3, 2014)

Last night:
teatime - 17:18pm - 9.7
- ate 1 packet of cheese & onion crisps which I think were approx 17.1g carbs - took the extra insulin for the crisps at teatime
bedtime - 22:36pm - 9.2
 - ate chinese for supper approx 43g carbs - bloused for this - meter advised 4u but had half of this because of going to bed


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## mum2westiesGill (Sep 4, 2014)

Last night:
teatime - 19:38pm - 18.9
bedtime - 22:55pm - 13.7


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## mum2westiesGill (Sep 5, 2014)

Last night:
teatime - 20:53pm - 17.3
- ate chinese for tea - didn't split injection
bedtime - 00:58am - 20.0
- meter advised 3.5u correction but only did 1u because don't like going to bed with QA in system
- full of headcold


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## Northerner (Sep 5, 2014)

Hope you are soon feeling better Gill


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## Sally71 (Sep 5, 2014)

Oh dear the cold won't help your levels - get well soon


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## mum2westiesGill (Sep 5, 2014)

Northerner said:


> Hope you are soon feeling better Gill



Thank you



Sally71 said:


> Oh dear the cold won't help your levels - get well soon



Thank you

I guess it's a bit of insulin resistance - body coping with diabetes & trying to fight off the cold as well


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## mum2westiesGill (Sep 6, 2014)

Last night:
teatime - 19:02pm - 17.9
bedtime - 23:43pm - 15.6
- full of headcold


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## mum2westiesGill (Sep 7, 2014)

Last night:
teatime - 19:43pm - 14.4
- ate an indian for tea but didn't eat all of it - did a split injection so 6u before eating then 3u an hour after starting to eat
bedtime - 23:50pm - 17.1
-  because the chocolate digestive munchies kicked in & I ate x3 of these 10.8g carbs each = 32.4g carbs & no bolus 
- headcold getting better


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## mum2westiesGill (Sep 8, 2014)

Last night:
teatime - 19:32pm - 14.8
bedtime - 23:37pm - 22.2
- no snacking during the evening
- had 4u QA correction as advised by meter
- headcold getting better


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## Sally71 (Sep 8, 2014)

Gill you need more insulin!  You shouldn't be that high all the time.

Unfortunately my daughter was ony on MDI for about a week before we got the pump so I don't know what to advise, maybe someone will be along soon to help you!


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## mum2westiesGill (Sep 8, 2014)

I'm getting highs often from teatime to bedtime plus also during the day which is probably meaning I need more insulin but also big drops from bedtime to fasting


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## Sally71 (Sep 8, 2014)

If you are splitting your Lantus that sounds like you need more in the morning and less at night.  Don't change it drastically though; just change it by a couple of units, wait a week to see what effect that has, then change it a bit more if necessary.  A bit of a slow process but you don't want to change it too much and then send yourself into a massive hypo - I've made that mistake with my daughter before 

Fortunately as we are on a pump it was easy to change it back again - I learnt then though that it's a very fine line sometimes!


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## mum2westiesGill (Sep 8, 2014)

I've not split it yet. I don't know whether to. I've seen lots about it saying that lantus is ok to be split I think there's a link on the forum somewhere saying about lantus and levemir. Somehow I can't pluck up the courage to split it & see how it goes. It would be fine with my practice nurse who looks after my diabetes at the GP surgery in fact when I asked her about it a few weeks ago she said just go for it & do a straight 50/50 split. Somebody somewhere said to do it gradually ie know 1u per night off & add it onto the morning until I get to the split:
18u
1st night 17u - am 1u
2nd night 16u - am 2u
3rd night 15u - am 3u....... but doing it this way would take forever - was also mentioned at the beginning of this thread


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## Sally71 (Sep 8, 2014)

You can't change it every day, I think it takes 2-3 days for the effects to fully kick in when you change your Lantus dose, so you'd end up very confused!  Hence why I said wait a week between each change so you get a few days to see exactly what difference it makes. 

Here's where I don't know enough about it, I can't possibly advise where to start, but if your nurse thinks 50/50 would be ok then why not try that and take it from there?


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## KookyCat (Sep 8, 2014)

Hi Gill
Like you I have quite bid drops overnight and it took me a while to work out how to deal with it.  If you're feeling nervous about it maybe you should book a longer appointment with the DSN and ask her to make a plan with you.  You must feel wiped out by those very high blood sugars and she should be able to help you attack it.


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## mum2westiesGill (Sep 9, 2014)

Last night:
teatime - 18:59pm - 13.8
bedtime - 22:54pm - 9.7
- during the evening ate 1 small pack of mini cheddars 12.9g carbs but no bolus because my thinking is that 12.9g is only just a bit higher than 10g. 
- ate x1 chocolate digestive after bedtime test
- headcold getting better


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## mum2westiesGill (Sep 12, 2014)

10/09 Last night: on 09/09
teatime - 20:22pm - 10.2
- injected at 21:01pm after tea as was out for meal
bedtime - no test

11/09 Last night on 10/09
teatime - 19:33pm - 11.4
bedtime - 23:37pm - 10.4

Last night:
teatime - no tea so at lunch time 14:55pm - 25.7  
- no breakfast this morning. Went to costa coffee & had hot chocolate with cream to drink & 1 marshmallow
bedtime - 23:24pm - 9.7


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## mum2westiesGill (Sep 13, 2014)

Last night:
teatime - 16:45pm - 5.7
- an evening out with alcohol involved  Ate a few crisps but not a complete packet
bedtime - no test


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## Northerner (Sep 13, 2014)

It's a shame you didn't test before bed Gill - did you have any insulin in the evening, or just at teatime?


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## mum2westiesGill (Sep 13, 2014)

I had insulin QA at teatime then BI when I was out during the evening at my usual time.

I have increased my BI by 2u on Thursady evening so I'm now taking 20u  instead of 18u.


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## Northerner (Sep 13, 2014)

mum2westiesGill said:


> I had insulin QA at teatime then BI when I was out during the evening at my usual time.
> 
> I have increased my BI by 2u on Thursady evening so I'm now taking 20u  instead of 18u.



I hate to say it, but it looks like that increase might have been the reason behind the hypo - with some additional help from the alcohol and very little food


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## mum2westiesGill (Sep 13, 2014)

Northerner said:


> I hate to say it, but it looks like that increase might have been the reason behind the hypo - with some additional help from the alcohol and very little food




What to do now re the increase do I give it until Monday & then decrease by 2u back to 18u?

Have also just had another hypo 3.4

Really want to get rid of all the high Bgs too


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## Northerner (Sep 13, 2014)

mum2westiesGill said:


> What to do now re the increase do I give it until Monday & then decrease by 2u back to 18u?
> 
> Have also just had another hypo 3.4
> 
> Really want to get rid of all the high Bgs too



I would give it a go tonight. Try and make sure your evening meal insulin is taken 5 hours before your bedtime reading if possible, and set your alarm for a night test. With no test last night at bedtime, plus the alcohol, it's hard to determine what happened. Getting rid of those variables and also making sure that your evening meal bolus is 'expired' by bedtime should show more realistically how much the lantus is dropping your levels by overnight


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## mum2westiesGill (Sep 13, 2014)

*Hypos Hypos Hypos!*

As the title says!
Today:
07:44am - 2.1
07:59am - 5.7
10:39am - 5.4
13:51pm - 3.4
14:06pm - 4.8
16:23pm - 3.9
16:38pm - 3.5


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## Northerner (Sep 13, 2014)

Lantus increase is not looking good Gill  Although, did you have much to drink last night? I find that, if I've had a few pints the night before then the following day I can experience quite a few lows - probably due to the liver not working at full capacity putting out the glucose.


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## mum2westiesGill (Sep 14, 2014)

Last night:
teatime - 21:18pm - 5.8
- a very late tea but it was a buffet at a friend's 80th
bedtime - no test
- 05:01am during night (for me) - 8.3


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## Northerner (Sep 14, 2014)

mum2westiesGill said:


> Last night:
> teatime - 21:18pm - 5.8
> - a very late tea but it was a buffet at a friend's 80th
> bedtime - no test
> - 05:01am during night (for me) - 8.3



What time did you take your basal Gill? Another hypo on waking suggests the dose of lantus is too high now


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## mum2westiesGill (Sep 14, 2014)

I took my basal 20u at 22:53pm whilst I was at the birthday party.

Lantus was increased on Thursday evening - from 18u to 20u


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## Northerner (Sep 14, 2014)

mum2westiesGill said:


> I took my basal 20u at 22:53pm whilst I was at the birthday party.
> 
> Lantus was increased on Thursday evening - from 18u to 20u



My personal opinion, but I think it is too much now, given the evidence of your last couple of nights and all the hypos you had yesterday


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## mum2westiesGill (Sep 14, 2014)

So do I decrease again this evening back from 20u to 18u? Then will have to give it 2+ or 3+ days to see any effects. Then what to do about all the highs? Maybe I could tweak some mealtime ratios, I'm currently on 1.5u: 10g of carbs - breakfast
1u: 10g of carbs - lunch
1u: 10g - teatime


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## mum2westiesGill (Sep 15, 2014)

Last night:
teatime - 19:39pm - 10.6
bedtime - 00:11am - 16.6
- during the evening ate 1x packet of mini cheddars 12.9g carbs - no QA because this was only shortly after having tea
- before bedtime test ate supper - 2x ham slices/mussels/drizzle of sald cream
- during night - 03:55am - 19.7  

- rediced lantus from 20u to 18u so will need to give this another 3+ days to see any effects


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## Redkite (Sep 15, 2014)

Hi Gill,

I think you ought to be bolusing insulin with your snacks - the 13g carb in the mini cheddars wouldn't be covered by your tea bolus unless you had added that amount on.  Also, carb-free snacks that are high in protein WILL raise your blood glucose level.  Your snacks are definitely causing you problems with your overnight levels - if I were you I would avoid them entirely while you are trying to do tests to check your insulin ratios, otherwise you won't be able to see the wood for the trees.  But if you really can't do without, then do remember to take extra insulin with your snacks.
Re-reading this message it might come across as sounding bossy - sorry, don't mean to!  I'm just saying what I would do in your place.


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## KookyCat (Sep 15, 2014)

Redkite said:


> Hi Gill,
> 
> I think you ought to be bolusing insulin with your snacks - the 13g carb in the mini cheddars wouldn't be covered by your tea bolus unless you had added that amount on.  Also, carb-free snacks that are high in protein WILL raise your blood glucose level.  Your snacks are definitely causing you problems with your overnight levels - if I were you I would avoid them entirely while you are trying to do tests to check your insulin ratios, otherwise you won't be able to see the wood for the trees.  But if you really can't do without, then do remember to take extra insulin with your snacks.
> Re-reading this message it might come across as sounding bossy - sorry, don't mean to!  I'm just saying what I would do in your place.



I think redkite's hit the nail on the head Gill, the additional snacks are skewing your results so it's hard to see if your ratios are wrong or if the basal is out.  Given the impact the increase in Lantus Had I have a gut feeling the Lantus may be too high even at 18 but the snacks without insulin obscure everything.  I know you've mentioned before you don't like the idea of insulin stacking, but I suspect that's because your dosages are out at the moment so the effects are unpredictable.  If you can do a weeks worth of testing without snacking you should have everything you need data wise to understand what's going on, and then you'll be confident in your ratios and how much insulin to have for snacks.  As Redkite said I hope I'm not coming across as a bossy britches I just want to help you get those highs sorted because I know how horrible they can make you feel.  Also I find when I was swinging high to low a lot I was absolutely starving most of the time, but now I'm more stable I'm not


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## mum2westiesGill (Sep 16, 2014)

Last night:
teatime - 16:18pm - 9.1 
- very early tea for me but skipped lunch & used this as an early tea - did injection/QA after eating as I ate out & doing this is easier for me 
bedtime -  22:42pm - 16.8 
- purposely didn't do a correction due to basal testing
- the munchies kicked in after bedtime test & I ate 2x slices of ham
- no snacking during the evening
- during night - 04:20am - 13.1
- this is the time I woke
- purposely didn't do a correction due to basal testing

- rediced lantus from 20u to 18u so will need to give this another 3+ days to see any effects


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## mum2westiesGill (Sep 17, 2014)

Last night:
teatime - skipped tea due to having a late supper
- lunchtime 15:16pm - 5.4
bedtime - 22:15pm - 7.7
- was hypo at 22:00pm
- no snacking during the evening
- ate chinese shrimp fried rice approx 1/2 the container after bedtime test

- rediced lantus from 20u to 18u so will need to give this another 3+ days to see any effects


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## mum2westiesGill (Sep 18, 2014)

Last night:
teatime - 19:42pm - 4.6
bedtime - 00:10am - 13.7
- no snacking during the evening but did eat 2x slices of ham after bedtime test
- during night - 02:41am - 14.0

- rediced lantus from 20u to 18u so will need to give this another 3+ days to see any effects


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## mum2westiesGill (Sep 19, 2014)

Last night:
teatime - no test
- lunchtime - 15:26pm - 4.9
bedtime - 22:53pm - 8.0

- rediced lantus from 20u to 18u so will need to give this another 3+ days to see any effects


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## mum2westiesGill (Sep 20, 2014)

Last night:
teatime - 20:00pm - 4.8
bedtime - 22:45pm - 18.9
- not really a propper bedtime test because less than 4 - 5 hours between teatime & bedtime
- before bedtime test ate an indian - 1x poppadom (7g carbs), 1/4x paratha bread (10g carbs), didn't eat much at all of prawn tikka or pilau rice , small tub of choc mint ice cream, 2x glasses of champagne, 2x whiskies with diet mixer - all this & no bolus! 
- after bedtime test ate 4x bourbon cream biscuits (8g carbs each = 32g carbs) - no bolus!


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## mum2westiesGill (Sep 21, 2014)

Last night:
teatime - 20:24pm - 6.1
bedtime - no test  and my first night of reducing lantus 
- bad night again because after having my lantus at 22:58pm I then ate 4x custard creams which were very enjoyable but no QA was taken!


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## Northerner (Sep 21, 2014)

mum2westiesGill said:


> - after bedtime test ate 4x bourbon cream biscuits (8g carbs each = 32g carbs) - no bolus!





mum2westiesGill said:


> - bad night again because after having my lantus at 22:58pm I then ate 4x custard creams which were very enjoyable but no QA was taken!



I think I can see part of the problem Gill!


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## mum2westiesGill (Sep 21, 2014)

Having the carbs & no bolus?


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## Sally71 (Sep 22, 2014)

Gill - we were taught that if the snack comes to less than 10g carbs you can ignore it and forget about insulin, otherwise ALWAYS bolus because your BGs WILL go up!

I realise that it's a bit easier for us on a pump, but if you really want to get your blood sugar under control, you've got three choices:

1. Stop all snacking and only eat at mealtimes when you bolus.
2. Only snack on non-carb foods such as cheese or carrot sticks (although some people find protein also raises blood sugar)
3. Always do the correct bolus with your snack!

Would eating more food with your meal perhaps make you less needing of snacks?

Sorry if this sounds like a lecture, it's not meant to, I'm only trying to help!  You are getting some better numbers creeping in now so keep working on it!


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## mum2westiesGill (Sep 22, 2014)

Sally71 said:


> Gill - we were taught that if the snack comes to less than 10g carbs you can ignore it and forget about insulin, otherwise ALWAYS bolus because your BGs WILL go up!
> 
> I realise that it's a bit easier for us on a pump, but if you really want to get your blood sugar under control, you've got three choices:
> 
> ...




Hi Sally,
Thank you for my lecture & help & for saying about the three choices  - let's hope this is now drummed into my mind & stays there


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## mum2westiesGill (Sep 22, 2014)

Last night:
teatime - 19:23pm - 4.9
- no snacking during the evening
bedtime - 23:28pm - 13.8
- no snacking after bedtime test & no carbs eaten after bedtime test without QA
- meter advised 1.5u QA correction but I didn't do this because I wanted to see how levels were during the night
- 02:24am - 13.7


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## mum2westiesGill (Sep 23, 2014)

Last night:
teatime - no test & no tea
- lunchtime - 15:27pm - 6.7
bedtime - 23:59pm - 13.8
- no snacking during the evening but at 22:13pm had a hypo of 3.2 treated with 4x jelly babies
- 22:29pm - 4.7 - 15 minute hypo check - ate 1/2x salmon bap for follow up treatment which practice nurse & DSN at drop in clinic are always saying to do
- after bedtime test ate pizza approx 46g carbs from carbs & cals book - meter advised 5u bolus which I did


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## mum2westiesGill (Sep 24, 2014)

Last night:
teatime - 19:21pm - 6.0
bedtime - 22:53pm - 4.8
- not enough hours here from teatime to bedtime but was hypo at 22:38pm so treated with 4x jelly babies then had some supper 36g carbs & 2u bolus as advised by meter
- no snacking during the evening


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## AJLang (Sep 24, 2014)

fantastic Gill that the 2 units advised by the meter for your snack last night  gave you that perfect 5.2 this morning. I'm so pleased for you x


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## mum2westiesGill (Sep 25, 2014)

Last night:
teatime - 20:14pm - 5.8
- snacked during the evening & ate a small bowl of salmon with  drizzle of salad cream
bedtime - 00:19pm - 9.0
- after bedtime test ate 1x shortcake biscuit 5g carbs - entered 5g of carbs in meter & it advised that I didn't need bolus for this amount of carbs, anymore than this & it would have advised to do bolus
- during night - 04:26am - 11.2


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## mum2westiesGill (Sep 26, 2014)

Last night:
teatime - 19:04pm - 6.0
bedtime - 23:04pm - 6.2
- no snacking during the evening
- ate 1x packet of mini cheddars (12.9g carbs) after bedtime test but meter must have advised no bolus - if I entered more carbs than this it was advising to do some bolus - my target for bedtime is 8 - 12


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## Pattidevans (Sep 26, 2014)

So what was your FBG today Gill?


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## mum2westiesGill (Sep 26, 2014)

Hi Pattidevans,

My fbg is in this thread - Group 7-day waking average? - & it was 3.9


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## Pattidevans (Sep 27, 2014)

Gill

I don't ever read that thread.  I had been wondering how people knew what your FBG was.  It would be much more useful if you could include it in your messages here.  

FWIW if you have to aim for 8 - 12 before bed and are snacking to keep that up and are then waking at 3.9 then your overnight basal is way too high.  I've been following this thread and thinking all the way through that you would be better off on Levemir which IS  given as 2 separate injections and is much more biddable than Lantus.  It lasts between 12 - 16 hours as a rule, so having a lower night time dose to account for your needs is much easier.  Would it be possible to speak to your nurse about a change?  My nurse has always been very sympathetic towards such requests.


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## mum2westiesGill (Sep 27, 2014)

Hi Pattidevans,
Thank you for your comments & for taking an interest & following the thread. I will bear all comments in mind


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## mum2westiesGill (Sep 27, 2014)

Last night:
teatime - 20:02pm - 10.4
-  Went to Ask & ate Risotto/tender chicken breast slices/sautéed mshrooms in a crmy white wine sce/tiramisu  
- forgot to do 1.5u bolus correction with my bolus injection for the meal
bedtime - no bedtime test
- after bedtime test ate 6x plain digective biscuits and no bolus


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## mum2westiesGill (Sep 28, 2014)

Last night:
teatime - 1935pm - 10.7
- ate a chinese for tea & did a split bolus so did rest of bolus at 2041pm
bedtime - 0037am - 14.7
- before this test I have no entry in my meter for BI which is normaly around 1030pm ish
during night - 0509am - 24.0
- meter advised a correction of 4.5u which was done


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## mum2westiesGill (Sep 29, 2014)

Last night:
teatime - 1925pm - 13.2
bedtime - 2157pm - 18.5
- was going to use this as my bedtime test then realised it was only a couple of hours after teatime
- after bedtime test I ate 2x chocolate teacakes 12g carbs each, 1x small pk of mini cheddars 12g carbs so a total of 36g carbs with bolus
- during night - 0407am - 12.4
- although this was during the night I used this as my bedtime test

- don't know if the higher levels are because I may have forgotten my BI on Saturday evening


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## mum2westiesGill (Sep 30, 2014)

Last night:
teatime - 1950pm - 10.1
bedtime - 2352pm - 6.0
- no snacking during the evening
- ate 1x chocolate teacake after bedtime test 13g carbs but meter advised no bolus


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## mum2westiesGill (Oct 1, 2014)

Last night:
teatime - 1935pm - 7.5
bedtime - 0017am - 9.1


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## mum2westiesGill (Oct 2, 2014)

Last night:
teatime - 1927pm - 12.0
bedtime - 2342pm - 6.0
- 15 mins before bedtime reading was 3.9 
- treated 3.9 with 4x jelly babies
- ate 1x oven bottom balmcake 33g carbs with salmon on & had 2u bolus which is what meter advised


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## mum2westiesGill (Oct 3, 2014)

Last night:
teatime - 6.4
- no snacking during the evening
bedtime - 8.6
- ate 2x plain digestives after bedtime test - meter advised 1.5u of bolus but I only did 1u - just wondered if 1.5 may be too much


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## mum2westiesGill (Oct 5, 2014)

Last night:
teatime - 2032pm - 11.9
- ate  2x custard creams during the afternoon with no bolus but really enjoyed them - this may be the cause of the 11.9
bedtime - 2332pm - 13.2
- this test was probably a bit too soon after teatime test to get an accurate bedtime reading
- meter advised to do a correction dose but I chose not to this because I still had active insulin
- ate 2x custard creams & 1x bourbon cream after bedtime test with no bolus


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## mum2westiesGill (Oct 6, 2014)

Last night:
teatime - 2001pm - 8.1
- no snacking during the evening
bedtime - 2352pm - 17.1
- no idea where this high came from
- did 2u bolus correction


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## mum2westiesGill (Oct 7, 2014)

Last night:
teatime - 2007pm - 5.8
- no snacking during the evening
bedtime - 0008am - 8.9


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## mum2westiesGill (Oct 8, 2014)

Last night:
teatime - 2010pm - 13.3
- no snacking during the evening whilst sat watching tv
bedtime - 0012am - 7.9
- bedtime target is 8 - 12
- ate 1x digestive biscuit because of BG being at this level. Meter advised 0.5u which was done


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## mum2westiesGill (Oct 9, 2014)

Last night:
teatime - 1949pm - 8.7
- no snacking during the evening whilst sat watching tv 
bedtime - 0009am - 5.7
- bedtime target is 8 - 12
- ate 1x digestive biscuit because of BG being at this level and for the 2nd night on the run. Meter advised 0.5u which was done 
__________________


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