Sorry to hear you're having such difficulties lately, Marburg. I, too, am on both a long-acting and rapid insulin but, I count carbs and constantly adjust my rapid insulin doses throughout the day. Often called the "poor man's insulin pump", this type of regimen is called intensive therapy.
I'm what they've termed a "brittle diabetic" (meaning my BGLs fluctuate wildly even with strict monitoring). I found myself NEEDING to understand things like my basal/background insulin requirements (this is where the long-acting dose comes into play), my insulin to carb ratios for different times of the day (most people are more or less sensitive to insulin at different times of the day), and most importantly, what my insulin correction ratio is (to correct high BGL levels). A really good site that helped me a lot with some starting points and those calculations is the Insulin Pumpers How-To web site, as follows:
Don't be turned away by the title being for pumpers. The same theories are used for MDI (multiple daily injection) regimens.
I won't lie, there is effort and education involved but, it's not as daunting as it first seems, especially if you take your time and do it step by step. Once the baseline (long-acting) insulin requirement has been established, the adjusting of rapid insulin for meals and/or correction doses, becomes a lot easier. The background insulin requirements are rarely adjusted once established but, there's a LOT of room for improving BGLs throughout the day with adjusting Rapid insulin requirements.
With some understanding of my insulin's action profiles as well as my own body's sensitivities, being on a CGMS (continuous glucose monitoring system) for 5 days also really helped my narrow down my specific daily requirements. Just for example, I inject 12 units of Levemir in the morning. Depending on my BGL and what activity I've planned, I'll breakfast with an I:C ratio of either 1:8 or 1:10 and usually eat about
15 grams/carbs. I'm most sensitive to insulin at lunch so, my I:C ratio is 1:12 and I usually eat 15-36 grams/carbs. Dinner is also 1:8 or 1:10 depending on BGL, what's for dinner and what time we eat. Sometimes an evening snack, sometimes not, all depends on the dinner routine but, this is where I have to be most careful with my Rapid dose - I DON'T want to go hypo during the night because of an insulin overdose. My BGL tends to drastically drop between 2:30-4:00AM (probably due to my 9:00PM, 14 unit Levemir shot "peaking" even though it's not supposed to), so, I really have to be careful.
Also, I could not do what I do without logging. Over 6 years as a Type 1 and I still log everything. If it's not measured, it's not managed - plain and simple, for me anyway. I couldn't find my patterns any other way. Well, OK, maybe with a CGMS but, I'm not ready to be hooked up yet
- Phishbowl (Type 1 since Jan'05 - Levemir, NovoRapid)
"What's Not Measured Is Not Managed"
"It is impossible for a man to learn what he thinks he already knows"-Epictetus
Post Edited (Phishbowl) : 4/6/2011 9:35:50 AM (GMT-6)