Struggling With Mornings

[Antje77]

Another thing I was potentially thinking - and this is going to sound very controversial - is going back to Tresiba to keep the nice flat lines and stop the 'foot on the floor'. Stick with the lower dose that kept me flat during the night/morning, but then top it up with a small dose of Levemir in the morning to deal with my increased need during the day.

I doubt that would get any support from a professional though

Sounds like it could work very well

 

[kitedoc]

@Levy,
Another thought ! Is it worth checking for ketones when you wake, both at 6 am and later through the hours til ? 12 md or so.
My daft thinking is: if there is a dearth of insulin action say at 5 am and onwards any ketones produced can increase insulin resistance and make the Novorapid less effective. Unlikely to have been a problem on Tresiba which would be lasting through that time of morning.
I know that does not explain why Levemir worked OK in those hours last time you were prescribed it..
As you probably know better than I some glucometers can measure ketones with special test strips or there are urine testing strips. From my days of doing urine testing for glucose (1966 to about 1980) one has to empty one's bladder to flush out what has collected in the bladder since the last voiding, drink a glass or two of water and then test say an hour later to best check on recent developments ketone-wise. I can understand why they introduced the blood testing method !!
Like all good detective novels, collecting the evidence is often the key to solving the mystery.
I do hope you are making progress and the arghhhhh! moments are less often !!

 

[Levy]

Today I skipped breakfast. My levels (after 1.5u to stop "foot on the floor") remained perfectly in range all morning. Then I had lunch, and now the exact same thing is happening, except later!

Levels spiked up as soon as I ate, and now won't come back in range despite several corrections. I'm so confused, because it seems it's not time bound (so unlikely to be caused by basal running out or whatever). Argh!!

 

[donnellysdogs]

Another thing I was potentially thinking - and this is going to sound very controversial - is going back to Tresiba to keep the nice flat lines and stop the 'foot on the floor'. Stick with the lower dose that kept me flat during the night/morning, but then top it up with a small dose of Levemir in the morning to deal with my increased need during the day.

I doubt that would get any support from a professional though

My version of insulin horrified my consultant and educator. After faffing around doing things their way, they have now given me complete free reign to carry on-as they cannot get a better regime for me or better results...

I have listed this many times here, so please skip if you have read it before...

After changing my evening tresiba dose to mornings and tweaking insulins over last few weeks/days I now have the following:

Insulatard: 3.30am 12 units.
Insulatard: 8am 6units
Tresiba: 8am 1.5 units
Novorapid: 7 units but adjusting this as I am now trying to eat a homemade breakfast.... this includes my breakfast bolus... I havent worked out the carbs to be honest...

I know I have to reduce insulin still but compared to when I miss my 3.30 insulatard.... well...or just tresiba or just insulatard... this is superb.

I know I still have tweaks but only started this regime yesterday.

My breakfast is made up to 3 days in advance and left overnight. Breakfast consists of: 1oz steel cut gluten free porridge oats, (evthing is organic if I can get it): teaspoon each flax and chia seeds: 2 tsp hemp seeds, 1/4 teaspoon cacoa powder, goats yogurt (check out blueberries with greek yogurt-not the best..), and soya milk 2-2.5 oz each, 10 blueberries, 4 cherries (both frozen and put in mix frozen) oh and scrapes of lovely coconut, and almonds and walnuts crushed on top with pumpkin and sunflower seeds in the morning..

I have never ate breakfast but wanting to get some extra nutrition in me, I found this mixture. I eat it cold, straight from fridge the next 3 mornings. I make triple quantity.

I have obviously overdone the hypo at 13.43 but this was actually just a 13.9g carb "proteinbar" not the best hypo stopper but I wanted it to kick in for longer...it certainly upped my levels!!

To me, long and short version... do what you think is right for your body. Superb advice here told me that " consultants are specialists and we are the experts".... and that gave me the courage to work to my needs and not the "average" persons needs.

Photos below of two days readings:

 

[kitedoc]

My version of insulin horrified my consultant and educator. After faffing around doing things their way, they have now given me complete free reign to carry on-as they cannot get a better regime for me or better results...

I have listed this many times here, so please skip if you have read it before...

After changing my evening tresiba dose to mornings and tweaking insulins over last few weeks/days I now have the following:

Insulatard: 3.30am 12 units.
Insulatard: 8am 6units
Tresiba: 8am 1.5 units
Novorapid: 7 units but adjusting this as I am now trying to eat a homemade breakfast.... this includes my breakfast bolus... I havent worked out the carbs to be honest...

I know I have to reduce insulin still but compared to when I miss my 3.30 insulatard.... well...or just tresiba or just insulatard... this is superb.

I know I still have tweaks but only started this regime yesterday.

My breakfast is made up to 3 days in advance and left overnight. Breakfast consists of: 1oz steel cut gluten free porridge oats, (evthing is organic if I can get it): teaspoon each flax and chia seeds: 2 tsp hemp seeds, 1/4 teaspoon cacoa powder, goats yogurt (check out blueberries with greek yogurt-not the best..), and soya milk 2-2.5 oz each, 10 blueberries, 4 cherries (both frozen and put in mix frozen) oh and scrapes of lovely coconut, and almonds and walnuts crushed on top with pumpkin and sunflower seeds in the morning..

I have never ate breakfast but wanting to get some extra nutrition in me, I found this mixture. I eat it cold, straight from fridge the next 3 mornings. I make triple quantity.

I have obviously overdone the hypo at 13.43 but this was actually just a 13.9g carb "proteinbar" not the best hypo stopper but I wanted it to kick in for longer...it certainly upped my levels!!

To me, long and short version... do what you think is right for your body. Superb advice here told me that " consultants are specialists and we are the experts".... and that gave me the courage to work to my needs and not the "average" persons needs.

Photos below of two days readings:

View attachment 27005View attachment 27006

With hindsight which is soo easy to use compared to foresight, it could be that having Insultard at 3.30 am and again at 8 am plus whatever Novorapid is likely to cause hypos midmorning because it is a form of insulin stacking, and the ups and downs that follow are the aftermath of the hypo and 'correction food' etc.
The best answer maybe to go on an insulin pump as that can best 'sculpt' out your basal insulin requirements, deal with any dawn effect etc - but that would depend on what you and your docs say, what you are eligible for and whether the pump is something you wish to try.
Meanwhile in my personal experience of over 51 years on insulin is to the Kept It Sweet(well not sugar-wise) and Simple principle is likely to be easier . @ Levy is thinking about a Tresiba daily dose with an am levemir 'overlay' to smooth out the basal situation, and let us face it MDI involves overlays, or stackings of insulin, e.g. long-acting insulin (s) with short-acting on top to cope with meals. The total time that three shots of Novorapid overlap the long-acting insulin's iactivity is for about 15 hours a day.
I reckon Insultard has its own peaks which make it act a bit like a medium-acting insulin in some ways. I was on Isophane, same as Insultard. for about 28 years before the Lantus and Levemirs came along and it was a real struggle with unreliable absorption as one of the bugbears, unlike the later insulins mentioned just above. I also found that any change of insulin doses and types takes a good 3 or more days to gauge the overall effect. Of course if hypos seem to be related to the change in insulin(s) then adjustments may need to be sooner, but then 3 to 4 days is needed to reassess further.

 

[Levy]

@kitedoc Moved my Levemir forward to 7am and increased my breakfast IC ratio but still no difference

 

[kitedoc]

Hi @Levy,
Sucks. It sounds like Tresiba and perhaps Levemir in am is worth speaking with the doctors about.
It is very puzzling the way the bsl rises after breakfast or lunch. Is Fiasp worth considering ? Even before switching back to tresiba ? That would be something for your doc to discuss with you.
However going back to basics with Tresiba and Novorapid plus them consider adding in Levemir then also Fiasp is the other way,
Hope that helps.

 

[LooperCat]

Hi @Levy,
Sucks. It sounds like Tresiba and perhaps Levemir in am is worth speaking with the doctors about.
It is very puzzling the way the bsl rises after breakfast or lunch. Is Fiasp worth considering ? Even before switching back to tresiba ? That would be something for your doc to discuss with you.
However going back to basics with Tresiba and Novorapid plus them consider adding in Levemir then also Fiasp is the other way,
Hope that helps.

I don’t know about @Levy ‘s team, but mine won’t issue more than one type of each insulin. I’ve tried getting Levemir to add a quick unit of basal to my Tresiba once a month for a slightly resistant week.

 

[Levy]

Thanks both! I've got an appointment in 2 weeks so at least I'll have a chance to try it out and bring it up then. Really hoping I can crack this one!

 

[kitedoc]

Thanks both! I've got an appointment in 2 weeks so at least I'll have a chance to try it out and bring it up then. Really hoping I can crack this one!

Best Wishes !

 

[kitedoc]

Thanks both! I've got an appointment in 2 weeks so at least I'll have a chance to try it out and bring it up then. Really hoping I can crack this one!

Yes, there is that. I just hope they can be flexible. And become more flexible everywhere !!

 

[donnellysdogs]

With hindsight which is soo easy to use compared to foresight, it could be that having Insultard at 3.30 am and again at 8 am plus whatever Novorapid is likely to cause hypos midmorning because it is a form of insulin stacking, and the ups and downs that follow are the aftermath of the hypo and 'correction food' etc.
The best answer maybe to go on an insulin pump as that can best 'sculpt' out your basal insulin requirements, deal with any dawn effect etc - but that would depend on what you and your docs say, what you are eligible for and whether the pump is something you wish to try.
Meanwhile in my personal experience of over 51 years on insulin is to the Kept It Sweet(well not sugar-wise) and Simple principle is likely to be easier . @ Levy is thinking about a Tresiba daily dose with an am levemir 'overlay' to smooth out the basal situation, and let us face it MDI involves overlays, or stackings of insulin, e.g. long-acting insulin (s) with short-acting on top to cope with meals. The total time that three shots of Novorapid overlap the long-acting insulin's iactivity is for about 15 hours a day.
I reckon Insultard has its own peaks which make it act a bit like a medium-acting insulin in some ways. I was on Isophane, same as Insultard. for about 28 years before the Lantus and Levemirs came along and it was a real struggle with unreliable absorption as one of the bugbears, unlike the later insulins mentioned just above. I also found that any change of insulin doses and types takes a good 3 or more days to gauge the overall effect. Of course if hypos seem to be related to the change in insulin(s) then adjustments may need to be sooner, but then 3 to 4 days is needed to reassess further.

For me- been there done that with pump....this was only first couple days..
of trying something quite major for me.. eating in mornings has very rarely ever been done by me... least of all something that sticks to my colon walls and needs extra laxative meds to handle!! I mentionef it needs tweaking and this was also my first time of trying this new breakfast concoction of foods to try and level off...

My bars for the hypo alerts are set at 4.6 for day time. I also have stomach and colon issues to contend with too, and this week is really angst time for waiting for serious incidents reports from hospital as to their investigations why my husband was not assessed for 8 hours through A&E and died...so with those additional factors added in I am really pleased that the swing of highs in mornings have levelled downward...