About bloomin time!
I had heard about this some months ago, but then promptly forgot about it.
In April 2014 Sanofi launched the JuniorStar, a 1-30u insulin pen that can be used with Lantus (glargine) insulin and delivers doses in 0.5u increments. Woooo hooooo!
During my least years on MDI, wrestling Lantus into submission was more or less a full-time hobby. My basal requirement changes frequently in response to a wide range of factors (differences in general activity levels, warmer/cooler weather, or more frequently... just because it feels like it). On pump these tweaks are easier to manange, but more than once on Lantus I would seem to find myself in a position where a change of a whole unit up or down was just a bit too much, and I would have to settle for a Hobson's choice dose. It was particularly frustrating because of the 'some units are more equal than others' weirdness that I frequently see when my basal insulin dose is just a little bit out. A unit too much or too little of Lantus over 24 hours could leave me scoffing a massive stack of carbs to stave off relentless lows, or chasing high BGs with units and units of extra rapid-acting insulin corrections.
Diabetes is biology, not maths - and we can't always expect the numbers involved to behave in a predictable, logical way. This will be news to none of you.
So HURRAH to the fine French pharma folks for finally stepping up to the plate and launching a 0.5u pen. Mysteriously though Sanofi are yet another pharma company to market a half unit pen with a 'Junior' mindset (NovoNordisk did the same with the NovoPen Echo). It is as if only children could possibly find a use for half-unit increments. I can only hope that adult patients will not have difficulty* in accessing this potentially very useful addition to their Diabetes Gubbins stockpile.
EDIT: *Due to the ridiculous immediacy of the flow of information in the Twit-o-sphere, having posted this just a few minutes ago someone has already pointed out that the JuniorStar can be obtained directly from Sanofi, without the need to jump through tortuous prescription hoops and bothering your surgery/clinic. Simply contact the Sanofi helpline. Thanks to @davidcragg for the tip :)
Showing posts with label glargine. Show all posts
Showing posts with label glargine. Show all posts
Posted by Mike on Thursday, 14 August 2014
Posted by Mike on Monday, 19 July 2010
Lantus problems and going round in circles
And on and on and on...
When we began writing about our experiences of living with Diabetes it was, at least in part, in response to a nasty overnight hypo brought on (I suspect) by the action of Lantus glargine. From some reading I have done since it appears I am not alone in this. That there are other people with diabetes using Lantus and injecting their dose at night time (recommended by the manufacturer and for most people the best option) who find they sometimes go low overnight, or wake up low in the morning.
One of the difficulties in managing diabetes with MDI (multiple daily injection) basal-bolus is that if you don't get your basal (background) dose correct then everything else becomes incredibly difficult to manage. You have no firm footing on which to start your day.
I think the late-at-night injection timing is suggested because it puts Lantus's onset period (perhaps an hour two until full strength) at a time when you have finished eating for the day and are usually if not actually asleep, then pretty much at rest. When I moved my injection to the morning, though my overnight levels were suddenly very steady and reliable, I had problems with high blood glucose spikes after breakfast. In response I began to split the dose, morning and evening, having a little just before bed, and the rest at breakfast. My hope was that this would spread the activity more evenly over the day. Sadly though, after a few months I can see that this has caused more problems, and not really solved anything. I found I was waking up low again, or waking slightly clammy having gone hypo overnight. On several occasions my liver then took matters into its own hands and began dumping glucagon into my bloodstream as it's own emergency measure. I would wake high, inject rapid-acting insulin and wait until my levels dropped before eating breakfast. After 2 hours or so I would give in, my levels still stubbornly high, eat a fraction of my usual breakfast and wait to see how things were going at lunch. Not only that but if the smaller Lantus dose didn't send me hypo overnight, then it had run out of steam by breakfast anyway and I was heading for spike central again after breakfast. Smaller doses you see, tend to act over a shorter time. With no Lantus hanging around, and anything from 15-45 minutes for Humalog to get going even a fairly low GI breakfast was going to cause problems. What my neice might describe as an #epicfail.
So I've gone back to Lantus in the morning. Suppertime and pre-breakfast readings are more constant. The post-breakfast problem still exists, of course, but at least I've lost the overnight hypo and liver-dump double whammy. Last time I didn't spend much time experimenting with the timing of my breakfast bolus (rapid-acting) doses. My hope is that with enough time between injecting and eating I might be able to stay out of the teens between breakfast and lunch.
Maybe.
When we began writing about our experiences of living with Diabetes it was, at least in part, in response to a nasty overnight hypo brought on (I suspect) by the action of Lantus glargine. From some reading I have done since it appears I am not alone in this. That there are other people with diabetes using Lantus and injecting their dose at night time (recommended by the manufacturer and for most people the best option) who find they sometimes go low overnight, or wake up low in the morning.
One of the difficulties in managing diabetes with MDI (multiple daily injection) basal-bolus is that if you don't get your basal (background) dose correct then everything else becomes incredibly difficult to manage. You have no firm footing on which to start your day.
I think the late-at-night injection timing is suggested because it puts Lantus's onset period (perhaps an hour two until full strength) at a time when you have finished eating for the day and are usually if not actually asleep, then pretty much at rest. When I moved my injection to the morning, though my overnight levels were suddenly very steady and reliable, I had problems with high blood glucose spikes after breakfast. In response I began to split the dose, morning and evening, having a little just before bed, and the rest at breakfast. My hope was that this would spread the activity more evenly over the day. Sadly though, after a few months I can see that this has caused more problems, and not really solved anything. I found I was waking up low again, or waking slightly clammy having gone hypo overnight. On several occasions my liver then took matters into its own hands and began dumping glucagon into my bloodstream as it's own emergency measure. I would wake high, inject rapid-acting insulin and wait until my levels dropped before eating breakfast. After 2 hours or so I would give in, my levels still stubbornly high, eat a fraction of my usual breakfast and wait to see how things were going at lunch. Not only that but if the smaller Lantus dose didn't send me hypo overnight, then it had run out of steam by breakfast anyway and I was heading for spike central again after breakfast. Smaller doses you see, tend to act over a shorter time. With no Lantus hanging around, and anything from 15-45 minutes for Humalog to get going even a fairly low GI breakfast was going to cause problems. What my neice might describe as an #epicfail.
So I've gone back to Lantus in the morning. Suppertime and pre-breakfast readings are more constant. The post-breakfast problem still exists, of course, but at least I've lost the overnight hypo and liver-dump double whammy. Last time I didn't spend much time experimenting with the timing of my breakfast bolus (rapid-acting) doses. My hope is that with enough time between injecting and eating I might be able to stay out of the teens between breakfast and lunch.
Maybe.
Posted by Mike on Wednesday, 23 June 2010
Basal driving me bonkers
This is ridiculous.
Perhaps I've brought it on myself with a few smug posts about feeling that I'm doing a little better lately, and how I finally seem to have wrestled Lantus into submission, but diabetic readers will be unsurprised to know that it's gone a little pear-shaped over the last few days.
Most annoyingly of all, my recent successes with Lantus have evaporated and I've been waking to early morning test results around 3.5mmol/l again. Starting the day a little low invariably has a knock-on effect for my control for the whole rest of the day for me, and I've been struggling to rediscover my recent run of good form. Diabetes is like walking a tightrope with complications on one side and hypo-induced coma on the other. Tricky enough if your balance is good to start with, but if you start out wobbly you're in for a difficult time.
So I'm basal testing again to see if I can discover the new magic numbers.
The technique I've come across goes like this:
I'll let you know how it goes.
Update: Day 1 test went well despite the wobbly start. Completely solid bgs from mid-morning onwards. Now, do I sloppily move on to lunchtime? Or do it properly and complete the morning test a few more times? Hmmmmmmmmm...
Update: Lantus problems and going round in circles
Perhaps I've brought it on myself with a few smug posts about feeling that I'm doing a little better lately, and how I finally seem to have wrestled Lantus into submission, but diabetic readers will be unsurprised to know that it's gone a little pear-shaped over the last few days.
Most annoyingly of all, my recent successes with Lantus have evaporated and I've been waking to early morning test results around 3.5mmol/l again. Starting the day a little low invariably has a knock-on effect for my control for the whole rest of the day for me, and I've been struggling to rediscover my recent run of good form. Diabetes is like walking a tightrope with complications on one side and hypo-induced coma on the other. Tricky enough if your balance is good to start with, but if you start out wobbly you're in for a difficult time.
So I'm basal testing again to see if I can discover the new magic numbers.
The technique I've come across goes like this:
- Choose a day when you are not doing anything particularly strenuous and your fbg is in range
- Take basal and any other medication as usual but miss breakfast and don't inject any bolus insulin.
- Don't eat anything and drink only water until lunchtime and test every hour or two
- If your basal dose is correct you should remain within 1 or 2 mmol/l of where you started
- Repeat the test for another 2 days (they don't have to be consecutive)
- Then move on to missing lunch, then evening meal
- If you are really hardcore you can also test every hour or two overnight (I confess I've never quite managed this part of the process, and have always been able to convince myself that my dose must be about right, surely?)
- If you notice a consistent rise or fall in bgs during the tests consider making (or talking to your doctor about) a modest change in your basal dose, perhaps 1 or 2 units up or down
- Then start the testing process again
I'll let you know how it goes.
Update: Day 1 test went well despite the wobbly start. Completely solid bgs from mid-morning onwards. Now, do I sloppily move on to lunchtime? Or do it properly and complete the morning test a few more times? Hmmmmmmmmm...
Update: Lantus problems and going round in circles
Posted by Mike on Wednesday, 19 May 2010
Timing is everything
Injecting Lantus first thing in the morning... Just a quick follow up to my recent post about switching my Lantus dose to first thing in the morning. It works!
I've just looked back over some old bg readings for the last few years and they suggest I've been waking up to a low level hypo perhaps 2 or 3 times a week. Since switching the timing of the dose 10 days ago my levels have pretty much all been in the 3.9 - 7.5 mmol/l range with the majority between 4.4 and 6.7 mmol/l.
I got into an email conversation with Matt Jones who said he used to have a similar experience and had pretty much solved it overnight by injecting Lantus in the morning. I'd tried slightly altered doses (having got hold of a 1-unit Autopen) and having a small amount of slow-release carbs last thing at night to beat the morning lows but neither had been particularly effective.
I seems it wouldn't work for everyone - I mentioned switching the dose timing when speaking to my DSN and she had said that in her experience it just 'moved the problem', but for me the difference has been amazing.
Thanks Matt. I owe you one :)
Update: Morning and Evening
I've just looked back over some old bg readings for the last few years and they suggest I've been waking up to a low level hypo perhaps 2 or 3 times a week. Since switching the timing of the dose 10 days ago my levels have pretty much all been in the 3.9 - 7.5 mmol/l range with the majority between 4.4 and 6.7 mmol/l.
I got into an email conversation with Matt Jones who said he used to have a similar experience and had pretty much solved it overnight by injecting Lantus in the morning. I'd tried slightly altered doses (having got hold of a 1-unit Autopen) and having a small amount of slow-release carbs last thing at night to beat the morning lows but neither had been particularly effective.
I seems it wouldn't work for everyone - I mentioned switching the dose timing when speaking to my DSN and she had said that in her experience it just 'moved the problem', but for me the difference has been amazing.
Thanks Matt. I owe you one :)
Update: Morning and Evening
Posted by Mike on Monday, 22 February 2010
Some units are more equal than others
All units of insulin are equal, you would think. But it seems some are more equal than others.
A week or so ago I had a very odd hypo. In fact it was that experience and some of the conversations we had about it afterwards that were the catalyst for us as a family to begin this blog. A place where we could write about our own experience of living with diabetes. Look at it from different angles, poke it with a stick, turn it over and over. The very act of writing these things down means you have to think about them quite carefully. To consider how you feel. To wonder what they mean. This in itself probably makes the writing worthwhile. Not in some maudlin, self-pitying, navel gazing way, but because when you've lived with a condition for a decade or two there is a tendency to begin to ignore it. To stop really thinking about it in any front-of-mind way. It's just there, the elephant in the room, squashing furniture, generally making a mess and getting in the way but largely ignored.
So even if you weren't reading this, it would still have been worth my writing it. Well not this bit actually, this is just the preamble. But the next bit definitely. In fact probably best if you just skip forward to the next paragraph and save us both some time. Here is an amazing thought though. A week or so ago I had an odd experience with a condition that I've been living with for about 20 years. And now, just a few days later you can read about that even if you live on the other side of the world. And if you have shared an experience that you read here, you can make a comment and you and I will know that someone else has been there. That it's not just us.
When the dust had settled on the hypo of the weekend before last we wondered why some of the symptoms of low blood sugar had extended for hours after normal and even quite high blood sugars had been restored. Why it had taken almost until the evening for me to fully 'get my words back'. It didn't help that when asked whether he thought this might ever happen again the doctor gave a pretty unequivocal, "Yes". It seems possible (though we are only guessing really) that a slight miscalculation of the size of jacket potato the night before might have led to a quite extended period of hypoglycaemia overnight. I woke with a start from a dream at one point which might have been my body trying to kick me back into consciousness to get something sugary, though my hypo-addled brain made up a convincing story about Derren Brown, subliminal mind control, advertising, Apple products and Twitter(!) and I just turned over. Maybe the length of period I spent with low blood sugars meant that part of my brain got stuck in hypo mode?
Overnight hypos are never a good thing. I'm lucky in that they are a far rarer thing for me now than they have been in the past, and they were never more than a few times a year even then. Nevertheless we have been left with a desire to try to tighten control again. If I am honest my focus has always been on keeping my sugar levels down rather than avoiding an occasional low blood sugar. Avoiding long-term complications and accepting hypos as a price to be paid for aiming at the tiny target range. Now I felt like I was being pulled in the opposite direction. Wanting to avoid having a hypo like that ever again.
I've been on Lantus glargine, a peakless basal insulin for a few years now. Peakless has always made a lot of sense to me in the context of a basal-bolus system and I certainly believe that it has helped cut out some night time hypos associated with a long-acting insulin which has a peak of activity. Of course peakless doesn't really mean peakless, it's just that the peak of activity for glargines is much less marked and the activity profile is far more level than other long-acting insulins. The shift to glargine involved the inevitable period of experimentation in terms of getting the new levels right. After the switch I found I was usually high first thing in the morning. I increased my night time dose from 10 units in increments of two in an attempt to get things back in line again. Initially I settled on 16 units, but all that extra insulin sloshing around made hypos during the day more common and after some more weeks (and quite a bit of chocolate) I settled on 14 units of glargine. Any diabetics reading will not be surprised to know that it wasn't quite as simple as that though... in that classic altering-your-doses-Kerplunk way, there was another unexpected consequence. Since beginning on a basal-bolus pen-injection system I had always taken my short acting injections before eating. Since I began using NovoRapid this has been immediately as I started eating. Now I was finding that if I injected before eating (especially if my levels were in the 4-6 target range) I would end up going low just after the end of the meal. It was almost as if the short-acting insulin, on top of the glargine was pushing sugars out of my bloodstream so rapidly that my digestive system couldn't keep up. The obvious answer was to give my digestive sytem a bit of a head start and wait till after the meal to inject. Obvious, yes; but after fifteen years of injecting before a meal I can't tell you how hard it was to try to remember the injection once it was all over and time for the washing up. I forgot to inject ridiculouosly often. Several times I even double-dosed forgetting that I had remembered. Not good.
After perhaps a year I spoke to my doctor about the difficulty and wondered whether there might be a different, slightly less aggressive short acting insulin I could switch to. Her advice was that it was more likely to be the higher level of background insulin and that I would be better reducing my night-time dose of Lantus. I tried it for a day or so, but immediately my morning sugar levels rose up and I went back to 14 units. Better the devil I knew.
So here I was again looking at my doses and thinking, maybe the 14 units of glargine was the reason for the hypo from hell. Maybe I did need to reduce that dose after all. It was time to give it a bit more of a thorough test. I tried it all last week. It was very interesting, and really quite confusing.
Two units of Lantus glargine make an impossibly big difference.
Over the last year or two it has not been uncommon for me to wake up with slightly low blood sugar. Something in the 3.5-3.9 range. Once or twice a week sometimes. A little fun-size bar with my morning coffee and I'm quickly back to normal. A few times a year I've woken up a little lower still and my brain function has started to fall to pieces. Repetitive action, confusion, talking nonsense and general family hilarity all round. So from that, I reduce my glargine night-time dose by 2 units and wake every morning with sugar levels pushing into the teens.
But it didn't end there.
Of all my meals, breakfast must be my most consistent in terms of matching units of short-acting insulin with carbohydrate. More often than not it's a bowl of high fibre cereal weighed on a set of scales, with skimmed milk and low fat natural yoghurt. Dietetically I'm on my best behaviour. But suddenly the usual rules did not apply. I would over-jab and under-eat and two hours later rather than finding my earlier high sugar levels corrected things would be just as bad or even slightly worse. I would find myself adding an extra four units of NovoRapid to bring my sugar levels down in between breakfast and lunch. Four units. Four.
Again after lunch some perfectly guessable bread/sandwich/piece of fruit carbs when matched with their usual dose of NovoRapid would result in significantly higher blood sugars than I would expect. Another four extra units of NovoRapid to try to keep things under control.
Well at least you managed to stave off the hypos though you say. Nope. Not a bit of it. Possibly partly because I was struggling to stem the ever-rising tide of blood sugars with usual meal/dose calculations no longer seeming to apply. Extra correction doses seemed to work OK as long as I was sat at my desk, but any kind of physical activity - even just a short walk to get some milk - was enough to drop me into needing something sugary. Thank goodness I didn't go to the gym that week.
I don't know whether this extremely fine balance between short and long-acting doses is familiar to anyone else but I find it very odd indeed. I can't explain how the reduction of just two units on one type of insulin can have such a huge effect on requirements for other dose-and-meal combinations, adding in an extra 8-12 units over the course of a day. Previously I had only experimented it for a day or so before reverting to what I knew, but to see the same things happening over the course of a whole week convinced me that it was not just a matter of miscalculation or bad guesswork. The whole balance of how many units to how much carbohydrate with how much activity had completely shifted. I may have had a few fewer hypos, but my overall control was so much worse that I felt I couldn't continue.
So for now I'm back to square one. The usual rules are applying again, and I'm just testing a whole lot more often. I might go back to having supper again. A piece of fruit just before bed that used to stave off the overnight peak activity of Insulatard in the years before the switch to glargine and the whole what-to-do-about-waking-up-high conundrum.
Your guess is very nearly as good as mine.
Update: Curiouser and curiouser...
A week or so ago I had a very odd hypo. In fact it was that experience and some of the conversations we had about it afterwards that were the catalyst for us as a family to begin this blog. A place where we could write about our own experience of living with diabetes. Look at it from different angles, poke it with a stick, turn it over and over. The very act of writing these things down means you have to think about them quite carefully. To consider how you feel. To wonder what they mean. This in itself probably makes the writing worthwhile. Not in some maudlin, self-pitying, navel gazing way, but because when you've lived with a condition for a decade or two there is a tendency to begin to ignore it. To stop really thinking about it in any front-of-mind way. It's just there, the elephant in the room, squashing furniture, generally making a mess and getting in the way but largely ignored.
So even if you weren't reading this, it would still have been worth my writing it. Well not this bit actually, this is just the preamble. But the next bit definitely. In fact probably best if you just skip forward to the next paragraph and save us both some time. Here is an amazing thought though. A week or so ago I had an odd experience with a condition that I've been living with for about 20 years. And now, just a few days later you can read about that even if you live on the other side of the world. And if you have shared an experience that you read here, you can make a comment and you and I will know that someone else has been there. That it's not just us.
When the dust had settled on the hypo of the weekend before last we wondered why some of the symptoms of low blood sugar had extended for hours after normal and even quite high blood sugars had been restored. Why it had taken almost until the evening for me to fully 'get my words back'. It didn't help that when asked whether he thought this might ever happen again the doctor gave a pretty unequivocal, "Yes". It seems possible (though we are only guessing really) that a slight miscalculation of the size of jacket potato the night before might have led to a quite extended period of hypoglycaemia overnight. I woke with a start from a dream at one point which might have been my body trying to kick me back into consciousness to get something sugary, though my hypo-addled brain made up a convincing story about Derren Brown, subliminal mind control, advertising, Apple products and Twitter(!) and I just turned over. Maybe the length of period I spent with low blood sugars meant that part of my brain got stuck in hypo mode?
Overnight hypos are never a good thing. I'm lucky in that they are a far rarer thing for me now than they have been in the past, and they were never more than a few times a year even then. Nevertheless we have been left with a desire to try to tighten control again. If I am honest my focus has always been on keeping my sugar levels down rather than avoiding an occasional low blood sugar. Avoiding long-term complications and accepting hypos as a price to be paid for aiming at the tiny target range. Now I felt like I was being pulled in the opposite direction. Wanting to avoid having a hypo like that ever again.
I've been on Lantus glargine, a peakless basal insulin for a few years now. Peakless has always made a lot of sense to me in the context of a basal-bolus system and I certainly believe that it has helped cut out some night time hypos associated with a long-acting insulin which has a peak of activity. Of course peakless doesn't really mean peakless, it's just that the peak of activity for glargines is much less marked and the activity profile is far more level than other long-acting insulins. The shift to glargine involved the inevitable period of experimentation in terms of getting the new levels right. After the switch I found I was usually high first thing in the morning. I increased my night time dose from 10 units in increments of two in an attempt to get things back in line again. Initially I settled on 16 units, but all that extra insulin sloshing around made hypos during the day more common and after some more weeks (and quite a bit of chocolate) I settled on 14 units of glargine. Any diabetics reading will not be surprised to know that it wasn't quite as simple as that though... in that classic altering-your-doses-Kerplunk way, there was another unexpected consequence. Since beginning on a basal-bolus pen-injection system I had always taken my short acting injections before eating. Since I began using NovoRapid this has been immediately as I started eating. Now I was finding that if I injected before eating (especially if my levels were in the 4-6 target range) I would end up going low just after the end of the meal. It was almost as if the short-acting insulin, on top of the glargine was pushing sugars out of my bloodstream so rapidly that my digestive system couldn't keep up. The obvious answer was to give my digestive sytem a bit of a head start and wait till after the meal to inject. Obvious, yes; but after fifteen years of injecting before a meal I can't tell you how hard it was to try to remember the injection once it was all over and time for the washing up. I forgot to inject ridiculouosly often. Several times I even double-dosed forgetting that I had remembered. Not good.
After perhaps a year I spoke to my doctor about the difficulty and wondered whether there might be a different, slightly less aggressive short acting insulin I could switch to. Her advice was that it was more likely to be the higher level of background insulin and that I would be better reducing my night-time dose of Lantus. I tried it for a day or so, but immediately my morning sugar levels rose up and I went back to 14 units. Better the devil I knew.
So here I was again looking at my doses and thinking, maybe the 14 units of glargine was the reason for the hypo from hell. Maybe I did need to reduce that dose after all. It was time to give it a bit more of a thorough test. I tried it all last week. It was very interesting, and really quite confusing.
Two units of Lantus glargine make an impossibly big difference.
Over the last year or two it has not been uncommon for me to wake up with slightly low blood sugar. Something in the 3.5-3.9 range. Once or twice a week sometimes. A little fun-size bar with my morning coffee and I'm quickly back to normal. A few times a year I've woken up a little lower still and my brain function has started to fall to pieces. Repetitive action, confusion, talking nonsense and general family hilarity all round. So from that, I reduce my glargine night-time dose by 2 units and wake every morning with sugar levels pushing into the teens.
But it didn't end there.
Of all my meals, breakfast must be my most consistent in terms of matching units of short-acting insulin with carbohydrate. More often than not it's a bowl of high fibre cereal weighed on a set of scales, with skimmed milk and low fat natural yoghurt. Dietetically I'm on my best behaviour. But suddenly the usual rules did not apply. I would over-jab and under-eat and two hours later rather than finding my earlier high sugar levels corrected things would be just as bad or even slightly worse. I would find myself adding an extra four units of NovoRapid to bring my sugar levels down in between breakfast and lunch. Four units. Four.
Again after lunch some perfectly guessable bread/sandwich/piece of fruit carbs when matched with their usual dose of NovoRapid would result in significantly higher blood sugars than I would expect. Another four extra units of NovoRapid to try to keep things under control.
Well at least you managed to stave off the hypos though you say. Nope. Not a bit of it. Possibly partly because I was struggling to stem the ever-rising tide of blood sugars with usual meal/dose calculations no longer seeming to apply. Extra correction doses seemed to work OK as long as I was sat at my desk, but any kind of physical activity - even just a short walk to get some milk - was enough to drop me into needing something sugary. Thank goodness I didn't go to the gym that week.
I don't know whether this extremely fine balance between short and long-acting doses is familiar to anyone else but I find it very odd indeed. I can't explain how the reduction of just two units on one type of insulin can have such a huge effect on requirements for other dose-and-meal combinations, adding in an extra 8-12 units over the course of a day. Previously I had only experimented it for a day or so before reverting to what I knew, but to see the same things happening over the course of a whole week convinced me that it was not just a matter of miscalculation or bad guesswork. The whole balance of how many units to how much carbohydrate with how much activity had completely shifted. I may have had a few fewer hypos, but my overall control was so much worse that I felt I couldn't continue.
So for now I'm back to square one. The usual rules are applying again, and I'm just testing a whole lot more often. I might go back to having supper again. A piece of fruit just before bed that used to stave off the overnight peak activity of Insulatard in the years before the switch to glargine and the whole what-to-do-about-waking-up-high conundrum.
Your guess is very nearly as good as mine.
Update: Curiouser and curiouser...
Subscribe to:
Posts (Atom)