High morning readings

[theedom83]

Hi all! I'm new to the forum and wanted some advice from people who live with diabetes as my doctor is not as clear about what I should be doing.
My sugar before bed is between 5 and 8 most eveings. ( I always test at least 2 hours after my dinner) And I'm taking 34 units of levemir, normally in the thigh but last night I tried the stomach, but this morning as well as others it's far too high, 20.9 mmol this morning! During the day I can get my readings back to normal, but getting this levemir right is proving to be very difficult. My doctor says I'm taking too much levemir? Is this the only problem or could there be other reasons? Wandering whether I should try taking 28/30 tonight to see if that helps? Any help would be hugely appreciated.

 

[noblehead]

Are on on a once daily dose or a split dose for your levemir?

 

[theedom83]

Just once daily. I was taking it straight before bed. But the last 3 nights I tried 2/3 hours before bed but that hasn't helped either. I heard about split dose but it has never been suggested by the doctor, even talked about.

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[jack412]

the T1's will help you with your ratio, but maybe you are also building an insulin resistance and metformin might be worthwhile. If your Dr doesn't know get a referral to an endo to sort you out.

 

[gemma2402]

Hi do you carb count aswell

 

[Charles Robin]

Try looking into The Dawn Phenomenon. For reasons not entirely understood, blood sugars tend to rise for 2-3 hours after waking. One theory is that some bodily organs shut down a bit during sleep, and when we awake the body overcompensates, releasing glycogen stores which cause blood sugars to rise. The other things to consider are your injection sites, your insulin pen and your reusing of needles. To keep insulin absorption good, it's really important to rotate your injection sites. Until a few weeks ago I did not pay this much heed. My DSN took one look at my stomach from across the room and told me exactly where I injected all the time, because a lump was fairly obvious. I started avoiding that area, and suddenly my blood sugars were through the floor. I was amazed how much less insulin I required. It's also best to check your insulin pen and make sure it is working correctly. Every now and then I squirt a couple of units into the sink before I inject, in order to see that insulin is coming out. Lastly, insulin absorption will suffer by reusing needles. Again, I did not worry too much about this, but my control was suffering. Changing needles after every single injection has helped make my insulin requirements more predictable.

If all else fails, it may be worth speaking to your diabetes team about changing insulin type. Levemir is not the only brand on the market, and another type (such as humalog) may suit you better. Best of luck!

 

[smidge]

Hi theedom!

Splitting the Levemir dose is almost always a good approach. For most people it doesn't last 24 hours and you end up taking big doses to try to make it last longer. Much better to take 2 smaller doses.

I split mine 12 hours apart 6.30 morning and evening, but some people split unevenly at say 6.30am and 10pm. I take slightly more in the morning than the evening. It's pretty much trial and error to see what works best for you, but as a starting point, you could try an even split of your existing dose morning and evening and see how you go. Splitting it also makes adjustments easier.

Smidge

 

[Daibell]

Hi. Are you overweight? That high Levemir level implies you may be (apologies if I'm wrong). It can be difficult balancing insulin if insulin resistance is also present. Are you low-carbing? It is important even for T1s to control the carbs to avoid weight gain and high insulin doses and swings. Although most users do split Levemir doses my nice DN wanted to just add Bolus insulin to the Basal. I now prefer this as it removes a morning injection and in the evening when the Levemir is wearing off I can have enough Rapid to get my blood sugar right. With a light breakfast it means a total of 3 injections a day rather than 5.

 

[Engineer88]

Have you done night time testing to make sure it isnt from a rebound (ie going hypo while asleep?)

 

[noblehead]

Just once daily. I was taking it straight before bed. But the last 3 nights I tried 2/3 hours before bed but that hasn't helped either. I heard about split dose but it has never been suggested by the doctor, even talked about.

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Your bed time levels are fine so I suspect your basal insulin dose needs addressing. Ask your DSN about split dosing with your levemir as most find that this insulin only lasts 18 hours max, I've tried levemir insulin myself and couldn't get decent control with it despite split-dosing, lantus is a better basal insulin and usually gives a good 24 hour coverage.

 

[Danaemac]

I was advised previously to check my basal dose by taking a reading 4 hrs after meal to ensure bolus is used and nothing else affecting the reading and get up and test every 3 hrs until breakfast this will show if your basal is correct it can also be done during the day by missing a meal your readings should only move by around 2 mmol if not then increase or decrease and test again I am on 40 units of lantus a day and I am not overweight however have been t1 for 18years and do have insulin resistance it's not always about weight, if your basal is correct then it would suggest dawn phenomenon which I combat by eating supper and taking insulin with it or not eating after 7pm but check your basal first it may be you need more

 

[theedom83]

Thanks for your advice everyone! I'm not overweight ( so no apology needed ) I haven't done the early hour testing so I will do that tonight and see how that goes, I was also told by a relative that I could be taking too much so try half of what I have now (34 units of levemir) and work my way up or down from there to get the balance right? I will definitely ask about lantus and split dosing when I finally get to see the diabetic team. I have just been seeing my doctor for at least 7 years, but now I need help the doctor only gives vague advice rather than telling me how exactly to get my blood sugars right. I have just eaten so I will wait until 10.30 to test my blood (4 hours)

 

[donnellysdogs]

Hopefully a consultant thatis specialising indiabetes and not a person generalising inpracticing meds will help you more and perhaps assist in lowering your insulin resitance. In the meantime, do not worry about the units you are dosing...
To me, its not qtyof weight you may have, but the qty of exercising and movement youdo in24 hours...


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[theedom83]

Morning everyone, I had dinner at 18.30 and tested my blood at 20.30 which was 5.4 and then again before bed at 22.30 which was 5.1 and I had a few small sips of lucozade as my doctor said my readings should be between 7/9 before bed? I had my levemir dose at 21.00 (30 units) So I go to bed with great sugar levels, I woke up at 2.30 and it was 13 and then woke up again at 5.30 and it was 16, so I then took 4 units of novorapid and went back to sleep. Woke up 45 minutes ago and its 11.9. Does this mean I wasn't taking enough in the first place as there was no low reading during the course of the night?

 

[DunePlodder]

It's still possible you are having a low between going to bed & 2:30, that's a big jump for a few sips of Lucozade.
Try doing a test half way between going to bed & 2:30.

 

[theedom83]

Ok I will do that tonight. Will report back tomorrow. Thanks!

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[Spiker]

To be honest this is a pretty weird result. The only way too much Levemir before bed would cause you to go high is if you were having a night time hypo and then 'rebound' high blood sugar, as suggested by Engineer and others. Are there any signs of a hypo such as soaked sheets, sore muscles? Do you have a partner in bed with you that might notice a hypo?

My guess would be that your Levemir isn't working at all, and this is why your blood sugar is rising overnight. I would replace everything - new cartridge from a new box, check the injection pen is working by shooting into a saucer or something, change the needle obviously, and probably change the injection site you are using in case you have developed hyperlipotrophy at the injection site and that's blocking the insulin.

And just in case this problem has been going on for a while maybe reduce the Levemir dose the first time, say to half. If that gets you half way to a normal blood sugar in the morning, increase it back to your normal dose. But if you have been injecting duff insulin and increasing the dose to try to compensate, you don't want to give yourself a shock when the Levemir actually starts working again.

Thanks for posting all the specific detail, that really helps in trying to make suggestions about what might be going on.

 

[theedom83]

I don't feel like I have had a hypo, as I used to sometimes wake up in the night if that happened in a cold sweat and shaky. But that could have been from a late dinner using novorapid rather than levemir. I always replace the needles, hold the pen facing up and make sure its working and no air is trapped in the cartridge. The last 2/3 nights I have also injected into my stomach ( which I have never done before) I will get a cartridge out of a new box tonight and take 22/26 units and see how that goes. Is there other insulins that do the same job as levemir? I hear things about lantus but I don't know much about it. I used to be on Humalog mix 25 over 8 years ago but I couldn't deal with the 2 injections a day again as I like the freedom of when/what can eat. (to a certain extent of course)

 

[Spiker]

If you really don't want more injections then Lantus might be a better choice or, even better, degludec could be worth a try. But first you need to the bottom of what's (not) happening with your Levemir. I suppose it might be something to do with injecting in the stomach though I can't for the life of me think why that would affect it so much. But maybe best to go back to your previous way of injecting. Not the exact same spot of course.

 

[theedom83]

I don't mind more injections, I prefer it as I can eat when I like and have different amount of carbs each time. The problem is the levemir, as during the day my blood sugars are mostly perfect (between 5/8 mmol) I just need this base insulin to work and I would be happy. Also I have always injected in the leg since I was 16 (I'm now 30) so I have done the last few nights in the stomach so I know the insulin isn't blocked, but if my novorapid is working then why would the levemir not do it's job?. I have just taken 26 units so I will see how that goes tonight and hopefully have some better results for tomorrow.