Struggling With Mornings

[Alison54321]

Did I read that you always take the second Levemir dose at 10 pm? What time is the hypo?

It might be worth changing the times so you get the hypo out of the way before you go to sleep, and then you could, maybe, increase the night time Levemir dose a bit, so that might have a knock on effect of reducing the Dawn Phenomenom a bit.

I use Levemir and Novorapid, I just switched from Lantus, and quite like it. I inject about 8 am and 8 pm, and in the evening there is a dip about 2 hours after I take it, but that's at 10 pm, so I can correct it before I go to sleep, or at least make sure it doesn't dip too low.

Before, when I took Lantus, it was dipping about 4 hours after I took it, which was about midnight, and it kept me awake sorting it out, the Levemir still has a dip, but it's at a much more convenient time.

This might seem like just a small thing, but I find it much more convenient to get the night time peak out of the way before I go to sleep.

 

[Levy]

Did I read that you always take the second Levemir dose at 10 pm? What time is the hypo?

It might be worth changing the times so you get the hypo out of the way before you go to sleep, and then you could, maybe, increase the night time Levemir dose a bit, so that might have a knock on effect of reducing the Dawn Phenomenom a bit.

I use Levemir and Novorapid, I just switched from Lantus, and quite like it. I inject about 8 am and 8 pm, and in the evening there is a dip about 2 hours after I take it, but that's at 10 pm, so I can correct it before I go to sleep, or at least make sure it doesn't dip too low.

Before, when I took Lantus, it was dipping about 4 hours after I took it, which was about midnight, and it kept me awake sorting it out, the Levemir still has a dip, but it's at a much more convenient time.

This might seem like just a small thing, but I find it much more convenient to get the night time peak out of the way before I go to sleep.

The hypo on a higher dose of Levemir is the result of a continuous drop throughout the night. It's not something I can really move, a continuous downward line throughout the night means the dose is too high.

 

[Levy]

As foot on the floor is a hormonal response I don't see how Tresiba would stop it.....although it sounds like it may have previously done a good job of hiding it.....

using two basals isn't too crazy I suppose, I wouldn't personally do it......I am quite strongly for a split basal, always...

You and me both, but it did stop it bizarrely enough. I read someone else had a similar experience on Tresiba too

 

[kitedoc]

It is a great thought as the 'stacking effect' of Levemir on Tresiba is likely to be only some 10 hours, during the day when you most need it !!
Flexibility is key.
Nobody has a problem with Novorapid and Actrpaid prescribed with Tresiba and those two last 6 and 8 hours respectively. And on Novorapid, the effects of the previous Novorapid will overlap with the next during the day if taken at say , 9am, 1 pm and 6 pm, and thus the total 'stacking time' is about 12 + hours. similar to levemir.
See if the specialist can doubt your logic !!
You certainly have minimal apparent risk of absorption irregularities and no obvious causes of increased insulin resistance. The hypos at 4 to 6 am suggest Levemir is working at least 8 hours but who knows how much longer.? Provide the specialist with your BSL data, your diligence with injection sites etc and the stacking issue logic - you are well prepared for the debate and a very good betting risk to win !!!

 

[novorapidboi26]

But it never used to be! I don't understand how my correction factor can suddenly have doubled from one day to the next

That's diabetes for you......

Have you ever changed your correction factor.....?

after I done DAFNE, it was simply stated that 1 unit drops us by 2-3mmol, but no one told us that could change, if I remember......

I actually had a scale of correction factors depending on what level my BG was, based on the theory that the higher you are, the more resistant you become....

but that was my own special journey....ha ha..

 

[novorapidboi26]

You and me both, but it did stop it bizarrely enough. I read someone else had a similar experience on Tresiba too

Would be interesting to explore the mechanisms behind that......assuming that foot on the floor is the same as DP, hormones and glucagon, released due to fast and absence of a quickly accessible fuel source...

 

[Levy]

It is a great thought as the 'stacking effect' of Levemir on Tresiba is likely to be only some 10 hours, during the day when you most need it !!
Flexibility is key.
Nobody has a problem with Novorapid and Actrpaid prescribed with Tresiba and those two last 6 and 8 hours respectively. And on Novorapid, the effects of the previous Novorapid will overlap with the next during the day if taken at say , 9am, 1 pm and 6 pm, and thus the total 'stacking time' is about 12 + hours. similar to levemir.
See if the specialist can doubt your logic !!
You certainly have minimal apparent risk of absorption irregularities and no obvious causes of increased insulin resistance. The hypos at 4 to 6 am suggest Levemir is working at least 8 hours but who knows how much longer.? Provide the specialist with your BSL data, your diligence with injection sites etc and the stacking issue logic - you are well prepared for the debate and a very good betting risk to win !!!

Thanks! Definitely something to bear in mind if I can't work this out. I'll try bringing my morning dose forward first and see how I get on

 

[LooperCat]

That's diabetes for you......

Have you ever changed your correction factor.....?

after I done DAFNE, it was simply stated that 1 unit drops us by 2-3mmol, but no one told us that could change, if I remember......

I actually had a scale of correction factors depending on what level my BG was, based on the theory that the higher you are, the more resistant you become....

but that was my own special journey....ha ha..

I have a scale of correction factors for the mornings too - works perfectly (usually) between 3 am and about noon. I have it printed off and pinned by the side of my bed so when I wake at hideous o’clock and need a correction, I don’t have to think about it too hard!

​

 

[novorapidboi26]

I have a scale of correction factors for the mornings too - works perfectly (usually) between 3 am and about noon. I have it printed off and pinned by the side of my bed so when I wake at hideous o’clock and need a correction, I don’t have to think about it too hard!

View attachment 26945​

Mine was quite convoluted, went something like this:

<10 1 unit drops 2.5
10-13 - 1 unit drops 2.0
13-17 - 1 unit drops 1.5
>17 1 unit drops 1.0

now I am pumping however my corrections seems to be a lot more responsive and I don't use this scale...

it seemed to work though, so there must be something right in the madness....lol....

 

[Alison54321]

The hypo on a higher dose of Levemir is the result of a continuous drop throughout the night. It's not something I can really move, a continuous downward line throughout the night means the dose is too high.

Fine. I used Levemir a few years ago, and ended up splitting the dose on my own initiative, but it wasn't an equal split, and it was very unstable, so I switched to Lantus. Now I have 6 units in the morning, 7 in the evening, and do a small morning correction for DP, and my breakfast of 50g of carbs peaks at about 7 mmol.

But hey, what do I know.

 

[Levy]

It still seems to me like something weird is going on. I took a further 2u correction to try and bring me down slightly more from 9.6 before lunch, but it barely had any impact whatsoever and its been 1.5 hours!

 

[becca59]

I assume you have done some basal testing due to the insulin change......? is it a single dose...?

Its best to rule out dosing inaccuracies first you see.....

is your waking correction always the same and do you wake at the same level every morning? what is that level?

I would say looking at the graph basal was bang on.

 

[Fairygodmother]

Since switching to Levemir, I’ve trouble preventing spikes some mornings too. I think it may be because the evening dose has declined but there’s a gap of two hours before the morning dose becomes effective. In the evenings this gap’s bridged by the bolus for the evening meal. In the mornings the best solution’s been to have breakfast at the same time as I give myself the am Levemir but even then I have to watch carefully and sometimes end up doing multiple boluses to catch it before the rise gets away, which is impossible if I have to drive any distance or if I have a job that requires my undivided attention.
Bad-word annoying! Wishing there was an easy answer! Still, overall it’s proved more manageable than Lantus Was for the last few months before I switched.

 

[Brendon.Dean]

Hi, I recently swapped back from Tresiba (used it 5 months) to Levemir and I've really been struggling with my mornings since.

No matter how much insulin I take or how long I wait before eating, I spike like crazy after breakfast. This morning I took 2u on my way to work for dawn phenomenon. Then injected another 6u for a bacon sandwich (I'd normal take 4u for that). I waited almost an hour and ate after I saw it starting to drop, yet now I'm still spiking up like crazy?!

Apart from correcting the dawn phenomenon, increasing my IC ratio for breakfast AND waiting between injecting and eating, I have no idea what else I can do to stop this? I normally have yoghurt and blueberries with a little bit of granola sprinkled in and the same happens.

To clarify, this never used to happen on Tresiba or even when I was on Levemir before. I don't understand why it's happening now! Has anyone else struggled with this? View attachment 26943

One simple thing will fix this problem; fasted cardio in the AM. It has to be moderate to high intensity activity.

 

[Levy]

One simple thing will fix this problem; fasted cardio in the AM. It has to be moderate to high intensity activity.

Could you elaborate on the reasoning/research behind that?

 

[Brendon.Dean]

Could you elaborate on the reasoning/research behind that?

I have not a shred of research behind that, maybe there is some online I don't know.

The reasoning is it decreases your insulin sensitivity and as you continuously do it day after day you will notice the effect it has on your blood sugar.

Also make sure your night time meals carbs/fat intake are in check. I would say don't have very much fat any more than 6 hours before bed and less than 50g carbs to try and offset that 3am ride in blood sugar.

 

[kitedoc]

Hi @Levy ,
I still wonder whether Levemir at 9am and 10 pm is not providing sufficient basal, 'cover' particularly with the Dawn effect to account for..
My specialist is pretty dogmatic about the 4 am timing of the Dawn effect though he admits that night shift workers may have different timing. However he says studies show that people who have been on night shift for years quickly get back their 4 am DP when they retire or go on permanent day shift..
The blood sugar readings AFTER the start of DP may just indicate that the effect is happening but not necessarily when the DP event began.
The final thing on DP: disturbed sleep is associated with DP being more severe blood-sugar wise. Obstructive Sleep Apnoea (OSA) is a known cause of disturbed sleep and worse DP effect. Whilst being overweight and in T2D, are risk factors I was diagnosed with OSA 7 years ago. - TID, slimmish - and my diabetes control improved after I commenced CPAP therapy.
If your pm Levemir has petered out, I cannot see that cardio exercise say at 6 am before breakfast will help, but only make things worse - blood sugar-wise. When you were on Tresiba it sounds like there would not be a problem with before breakfast exercise except watching for hypos later on. Things to discuss with your doctor.
On the other hand some moderate exercise in the evening might make things easier blood wise in the morning as insulin sensitivity would be increased. Of course hypos early morning might be a risk.
In addition to your brilliant idea to try Tresiba again and some levemir in am, would Fiasp perhaps settle the morning BSL better than Novorapid?

 

[Levy]

In addition to your brilliant idea to try Tresiba again and some levemir in am, would Fiasp perhaps settle the morning BSL better than Novorapid?

It very well could in these situations. My consultant has brought up Fiasp before but the reason I've been reluctant to try it is that when everything is "normal", my Novorapid acts just as quickly. I never pre bolus for meals (the one time I did I dropped from 9.3 to 3.8 within half an hour) and I can normally see corrections starting to lie effect after 10 minutes. These morning "episodes" seem to both affect how quickly my Novorapid works and how effective it is.

It got to 3pm and like clockwork everything went back to normal for the rest of the day/night like every other day so far. I'm still sceptical it's too do with my morning Levemir because that's 6 hours after the injection, but I have it at 7am today so let's see where this goes!

 

[Scott-C]

The graphs at posts 1 and 15 look steady through the night and then a pronounced foot on floor rise from about 6 or 7 am. It suggests basal is ok, but maybe hit it with a more aggresive bolus to pin the foot on floor? I can wake at 4 or 5 and easily go up to 10 if I don't pin it. Sometimes 2u will be fine, but I'm not slow to fire in 4 to 6 if it's not co-operating.

 

[kitedoc]

It very well could in these situations. My consultant has brought up Fiasp before but the reason I've been reluctant to try it is that when everything is "normal", my Novorapid acts just as quickly. I never pre bolus for meals (the one time I did I dropped from 9.3 to 3.8 within half an hour) and I can normally see corrections starting to lie effect after 10 minutes. These morning "episodes" seem to both affect how quickly my Novorapid works and how effective it is.

It got to 3pm and like clockwork everything went back to normal for the rest of the day/night like every other day so far. I'm still sceptical it's too do with my morning Levemir because that's 6 hours after the injection, but I have it at 7am today so let's see where this goes!



View attachment 26963

Hi @Levy ,
I see what you mean ! Maybe it is the second Novorapid at lunch that helps get the level down.
I hope an earlier am Levemir helps.
If you were to consider taking Levemir every 8 hours you are going to be miss out on sleep.
If your specialist cannot nail the reason for your morning highs perhaps ask about sleep apnoea as a near to last resort !