Lost hypo awareness?!

[donnellysdogs]

Okay, thanks for all this advice I will drop it to 10 and see how it goes

Much better to see clearly from
A higher playing field than constantly worrying about hypo's.

As levemir lasts for a longer while in our bodies as a background you may be higher all day tomorrow.

Check your readings if you can on waking and 2 hourly tomorrow.

It may well be that you will go higher around tea time in which case that is a sign that you may need a small morning dose as well.

However, the most important thing is not to panic. You need to stop night hypo's.

Do you have pens that will deliver a 1/2 unit dose.. The novopen echo does this..

Please report back how you get on overnight and tomorrows levels...

Running higher for a short while doesn't impact hugely. Far better to be able to sleep without fear.. And then gradually change when you have a few days of readings..

Are you inder a consultant at a hospital?

 

[TooMuchGlucose]

Much better to see clearly from
A higher playing field than constantly worrying about hypo's.

As levemir lasts for a longer while in our bodies as a background you may be higher all day tomorrow.

Check your readings if you can on waking and 2 hourly tomorrow.

It may well be that you will go higher around tea time in which case that is a sign that you may need a small morning dose as well.

However, the most important thing is not to panic. You need to stop night hypo's.

Do you have pens that will deliver a 1/2 unit dose.. The novopen echo does this..

Please report back how you get on overnight and tomorrows levels...

Running higher for a short while doesn't impact hugely. Far better to be able to sleep without fear.. And then gradually change when you have a few days of readings..

Are you inder a consultant at a hospital?

No I don't have a half unit pen, the last few days I think may need one. I just don't know what's caused this drastic change in insulin requirement have a lot of questions for my dsn, I have a consultant at a specialist centre which I see every couple of months or so.

 

[donnellysdogs]

As you are seeing consultants or care team every couple or months then this highlights that they are concerned with your levels and control.

First off I would ask for a 1/2 unit pen and a meter like the accucheck expert which calculates bolus's etc in 1/2 units. This allows for greater fine tuning.

Lots of things impact on our insulin requirements. In early diagnosis it can be the last of the insulin from our pancreas kicking out the dregs of insulin for a while or can be due to holidays, heat (I wish!) etc.

Sometimes its easier to look at what made insulin needs more.. Ie changing jobs, stress, winter, less active etc...

I think you will find you are raised today but if you report back there are a few people here that are superb on the acting times of insulin etc. i know @robert72 helped me enormously when changing back to MDI from my pump. And others too. I will see if I can get them here on your post to help further.

I know its a pain. But its the hypo's that must be stopped. Higher levels can be brought down safely. It may well be that similar to others that instead of 1 injection at night that a splut dose morning and night is needed.

Please watch levels wvery 2 hours. I hope indeed that your levels were ok sleeping over night.

Keep in touch. You can do this...

 

[tim2000s]

The evidence presented by NICE suggests that twice daily Levemir is the best way to reduce hypos and maintain a good bg level. As @donnellysdogs has suggested, it would be worth either working out your own split if you are confident in basal testing or discussing with your DSN. I think this may get you nearer where you want to be.

 

[donnellysdogs]

The evidence presented by NICE suggests that twice daily Levemir is the best way to reduce hypos and maintain a good bg level. As @donnellysdogs has suggested, it would be worth either working out your own split if you are confident in basal testing or discussing with your DSN. I think this may get you nearer where you want to be.

Thanks @tim2000s. Hadn't got round to tagging people.. Thanks. I know you all helped me so much.

 

[TooMuchGlucose]

I am newly diagnosed in February Hb1AC 151 had a DKA with 7.6 ketones so I guess there is some concern in that, only seen the consultant once, but the DSN every couple of months. Last night I took 11 Levemir thought 10 would possibly send me into 15s. Went to bed - 14.8, 5am - 8.7 woke up - 5.2. I have been more active in the past couple of months but not to a huge amount I'm not doing 5km runs or anything like that just some walking. Had thought about a half unit pen and taking two basal a day instead of one, definitely think these would help.

 

[donnellysdogs]

Good. (Sort off!!) well done on testing over night too.
Keep testing today as we need to see if you go up higher because of less basal last night. This would then indicate that you need a split dose and perhaps giving a shot in the morning.

This can only be determined with 2 hourly tests daytime.

In all honesty as you are still high at night pre bed time it looks like your basal levemir could be running out around tea time. In which case having a few units in the morning would help this.

Keep checking today and please report back daytime levels. We don't want you just to start a morning dose without knowing day levels as this would be dangerous.

You need to speak to your DSN. Most DSN's are contactable by phone and can run things through by phone.. However she would need to know your levels for day time too...

You are still dropping 9ml over night and that is way too much of a drop. Dangerously so.

If I were in your shoes I would be you looking at lowering the basal more possibly down to 8 at night and perhaps 5 in the morning. At some point you are going up too high before bed and we need to see when this starts etc. you need to test two hourly for daytime to see next steps...

You are doing well.. We don't want you just to jump in as your safety is paramount here.

 

[iHs]

Hi @ TooMuchGlucose

Your going to bed bg level is a bit too high at the moment so try to get it a bit lower by adjusting your eve meal bolus and giving yourself a bit more Novorapid so that when going to bed, your bg is about 8mmol. From a bg level of 8mmol, then adjust the background Levemir to keep you ok without the risk of going low overnight. If you are below 7mmol before bed, eat a small snack to get yr bg up to the 7mmol mark again as it looks as though your bg levels tend to drop downwards in the early hours of the morning which is common for a lot of diabetics. You can adjust the bolus the following eve if need be to get the right target bg that you want.

Using basal bolus is very trial and error to begin with and its all about adjusting the basal to achieve the correct balance with the bolus so try not to be frightened to adjust, just make sure that you can set alarms to wake you up in the night and then you'll be able to get on top of things.

Once you get your overnight Levemir dose sorted, then start to see how your bg rises in the morning and if you need to use a lot of bolus to cover your morning food, then that's a good sign for you to adjust the Levemir upwards to get good targets like 6-7mmol before eating food, then allow for a rise up to 9mmol mid way which wont require you to eat a snack most probably, and then your bg level will fall back hopefully to the 6-7mmol mark again before your next meal is due . If your bg is only 7mmol mid way, then you will need to eat a small snack otherwise the acting time of the bolus will most likely make you go low late mid morning.

Lots of bg testing, trial and error, log the carb that you eat down and adjust those ratios with the basal.

 

[donnellysdogs]

Whilst dropping 9 units over night still @TooMuchGlucose cannot just bring down the evening bed time rates. If they being down without raising the morning ones to get up to at least 8.0 then they are just going to mess up... It may not even be the evening bolus that is incorrect...

 

[donnellysdogs]

Going to bed at 8.0 now with a drop still of 9 units over night is not advisable until more readings are in to assess day time levels or what is happening.

 

[iHs]

Whilst dropping 9 units over night still @TooMuchGlucose cannot just bring down the evening bed time rates. If they being down without raising the morning ones to get up to at least 8.0 then they are just going to mess up... It may not even be the evening bolus that is incorrect...

I will leave you to help TooMuchGlucose as you know so much

 

[donnellysdogs]

I'm just concerned that if still dropping by 9 units overnight and going to bed at a level of 8 would be dangerous...
The huge drops have to stop before addressing the high at bedtime.

 

[TooMuchGlucose]

Good. (Sort off!!) well done on testing over night too.
Keep testing today as we need to see if you go up higher because of less basal last night. This would then indicate that you need a split dose and perhaps giving a shot in the morning.

This can only be determined with 2 hourly tests daytime.

In all honesty as you are still high at night pre bed time it looks like your basal levemir could be running out around tea time. In which case having a few units in the morning would help this.

Keep checking today and please report back daytime levels. We don't want you just to start a morning dose without knowing day levels as this would be dangerous.

You need to speak to your DSN. Most DSN's are contactable by phone and can run things through by phone.. However she would need to know your levels for day time too...

You are still dropping 9ml over night and that is way too much of a drop. Dangerously so.

If I were in your shoes I would be you looking at lowering the basal more possibly down to 8 at night and perhaps 5 in the morning. At some point you are going up too high before bed and we need to see when this starts etc. you need to test two hourly for daytime to see next steps...

You are doing well.. We don't want you just to jump in as your safety is paramount here.

The reason for me being 14.8 at night is because I purposely took less units with my last meal 6 units for 130g because when I was 15.2 I dropped to 4.4 didn't want this to happen again, if I'd taken more insulin with that meal I'd have been in better range maybe 5-7 and gone low again some point in the night. My usual night time is about 9 or less and still woke up within the 4-6 range. I plan on getting an appointment if possible, if not I'll tell her all the readings I have for the past two weeks and see what can be done.

 

[donnellysdogs]

I totally agree with you. You cannot keep dropping so hugely and it is better to keep high at night pre bed.. Whilst sorting out a night dosage of basal. Dropping 9ml overnight is dangeroys and you are doing the right thing.

 

[donnellysdogs]

IHs is thinking you have your bolus wrong and you haven't... You are just petrified of night hypos because you are dropping so much....

Totally agree with what you are doing.. It undicates a split dosage of levimir is needed.

I would still in your position drop the night dosage more... We need to get you a tad higher in the mornings with less dropping over night.

Please let us know how your day levels have been today with less basal though...

 

[TooMuchGlucose]

IHs is thinking you have your bolus wrong and you haven't... You are just petrified of night hypos because you are dropping so much....

Totally agree with what you are doing.. It undicates a split dosage of levimir is needed.

I would still in your position drop the night dosage more... We need to get you a tad higher in the mornings with less dropping over night.

Please let us know how your day levels have been today with less basal though...

Okay thanks for saying I'm doing something right nice to get some encouragement. Okay so today:

Breakfast 5.2 ate 32g (toast) 2 units 2hrs later 10.9 then lunch 7.3 ate 83g took 5 units waiting for my next check in between meals.

 

[robert72]

Agree with DD - dropping 9mmol overnight suggests too much overnight basal. Definitely ask your DSN about splitting Levemir and getting the basal right - you can't work on your boluses unless basal is keeping you stable.

 

[donnellysdogs]

Agree with DD - dropping 9mmol overnight suggests too much overnight basal. Definitely ask your DSN about splitting Levemir and getting the basal right - you can't work on your boluses unless basal is keeping you stable.

Thanks for joining in @robert72. Even with 30+ years... Only just going back to MDI I was beginning to doubt myself.

I jnow that yourseld and Tim2000s gave me incredible help to get my basal right again. Thanks to you too I am all singing and dancing on back on MDI from a 5 year break being on the pump.

Thankyou for confirming.

Will be good to see how blood levels for rest of day pan out. I do suspect a split dose is needed but sometimes I think I put too much relevance to jow my body works.

The raise to 10 may well be waking phenomenen and may need a short, small bolus... But this will really need a morning basal rate check done if @TooMuchGlucose can do it.

You are by the way doing enormously well, the fact you are here @Tomuch glucose proves you are caring for yourself and that is vitally important. Many people don't join until they really are seriously illl and desperately needing help.. Normally with DKA.

Bear with us.. I may well disagree with iHs but (as previous) but Being back on MDI myself even after 30 yrs as a T1 is still a learning curve for me.. The fact that @robert72 and @tim2000s are here helping gives me a little more confidence that we need to stop the overnight drops before then looking at what you are doing in the evenings.

As you are newly diagnosed things will change. Even winter and being cold can increase basal requirements.
You are doing well so trust in yourself and do talk to nurses about getting a 1/2 unit pen and a blood meter that recommends carbs in 1/2?unit doses too. I know the expert meter does as I have it.

Please keep in touch with rest of levels. Whatever Tim and Robert say is better explained than me probably..

 

[iHs]

Hi

Everyone using bolus basal has to start somewhere during the day or night adjusting the insulin to reach the correct bg levels which ideally is easier to do working from targets than just using guesswork and hoping for the best.

I never said in my message that you should still carry on using the 11u of levemir without doing some blood testing in the night to see how low you were dropping and if necessary to eat some glucose or carb. All I said was that going to bed with a high bg level wasnt too good and if that was me, Robert or DD, we would be doing a correction to get ourselves down to a sensible target which is why I mentioned the 100 rule.

I think you will find that as you work your way around each meal time, adjusting the bolus with the basal, by the time you get back to bedtime again, your basal dose will probably need to lower even more than when you first started lowering it.

so good luck with getting your basal ok again with the food and bolus you are using.

 

[tim2000s]

Just to stick my oar in, I'm a huge advocate of split dosing, especially with Levemir, which at the doses you are using wears off quickly. I don't know your weight but for me with 0.14u per kg of body weight, I find that a 14u dose wears off in 12-14 hours.

In your shoes I would suggest splitting your levemir dose to 6u in the evening and 6u in the morning (12 hours apart) and monitoring every couple of hours.

If you then saw a flat profile overnight, you could address whether you are bolusing with the correct ratios. You could also look at the evening shot being taken at around 8pm to give you a chance to see how your bg levels were changing before bed.

@iHs is right though. Going to bed that high is not a good thing and you do need to get your basal balanced to stop the massive drop over night and give you a much more comfortable level before bed.