Disappointing Results

[ljwilson]

Just had a phone consultation with my DN, HBA1c 7.8, down from 7.9 in April, so still way too high but more worrying my GFR (kidney function) is down from 26% to 22% This is more than likely due to my high HBA1c. We were assuming that my liver was dumping and that was why i was waking with morning highs but now the nurse says I may not be having enough Levemir. My fasting BG's are always high so I am going to set my alarm for 2:30 am and see what my BG is and take it from there. I am really fed up with it all now!

Lorna

 

[robert72]

Re: Dissapointing Results

Hi Lorna

Sorry to read about your results. I'm not really up on kidney stuff, so not sure what it means, but hope you manage to sort out your morning highs.

Robert

 

[jopar]

Re: Dissapointing Results

It maybe that your levimer needs splitting rather than increasing as such..

Apart from raised BG's first thing in the morning have you got any other symptoms that your liver is dumping overnight, such as a hangover feeling, disrupted eyesight etc...

But yep get those overnight BG's to see what's happening..

 

[noblehead]

Re: Dissapointing Results

Sorry about your news Lorna, I think it's a good idea to test your bg for a few nights to see what is happening.

 

[smidge]

Re: Dissapointing Results

Hey Lorna!

Sorry about your results. It is disappoiting when you've worked hard and the results are higher than you expected. As Jo and Nigel have said, it would be good to see what your BGs are doing overnight - I'm going to do this too in a few weeks when I have some time off work. I think you need to take a few readings overnight, though, as things seem to turn pretty quickly during the night - one hour it's fine, the next it's high :roll: The other thought I had is testing a few times at one-hour post-meal to see if the after food spikes are ridiculously high - I know my 2 hour BGs are fine most of the time, but I don't know what's happening before that. Not sure if that is relevant to you?

Anyway, I hope you sort it out!

Smidge

 

[ljwilson]

Re: Dissapointing Results

so at bedtime (10:30) my BG was 7.2 at 2am it was 6.1 and at 6:30 it was 13.5! I will do some more night testing throughout the rest of the week but I am beginning to thing my Levemir needs to be increased.

Jopar, I already split my Levemir in to 2 doses, 7am and 7pm. I have also stopped taking my Humulin S or eating after 7pm as I am now wondering if it could have been the last dose of this that was making me go low overnight as this stays in the system longer than a lot of the other bolus insulins.

Really frustrating that after 37/38 years on insulin I am now having these problems. Although, if I am honest, for the first 10-12 years I didn't really care about my diabetes, common among young teenagers unfortunately, and it was only when I got married and wanted to have children that I really got it under control and since my CKD was diagnosed 6 years ago I try to keep tight control.

Thanks for all your advice

Lorna

 

[SophiaW]

Re: Dissapointing Results

Lorna would you consider using a pump at all or is it something you don't want to use? My daughter had a very similar problem with her morning readings, she'd drop low at around 2am and then start to rise from about 6am. The only way in the end I could solve it (whilst using injections) was to wake up at 4am and give her a small injection of Novorapid to keep that rise at bay. It wasn't practical to do this long term and so she went onto a pump, problem solved as now I can adjust the basal profile as often as I want to. We also were splitting Levemir but it didn't help, either it was too much and we were waking at 2am dealing with hypos or it was too little and I was waking at 4am to give extra insulin. Hopefully you can find a solution that works for you with the injections but if you can't then maybe a pump is the way forward for you.

 

[ljwilson]

Re: Dissapointing Results

I would love to have a pump! Nor sure if I meet the criteria though. I don't see a consultant at the hospital just a DN at my GP's. This is something I am trying to change but am having difficulty getting her to refer me. My renal consultant thinks i should be seen at the hospital so I am hoping that my GP will refer me after getting the latest report from my renal consultant!

Lorna

 

[SophiaW]

Re: Dissapointing Results

You might want to look into it, read the input website and insulin pumpers org websites. For my daughter her HbA1c was within acceptable levels (because of me waking to do an early morning injection) so I didn't think we'd qualify for a pump but after discussing with our consultant he said that she was eligible because injections were proving impractical and it was impacting adversely on our way of life. The reason being is that waking at 4am to do injections on a daily basis was impractical and as a result of having done that for months I was becoming stressed and exhausted. Without doing the 4am injection we were then either waking at 2am to treat hypos or her waking readings were not good resulting in a higher HbA1c and detrimental effect on her long-term health. Of course if you can fix the morning readings by making adjustments to your Levemir then that is good and you can solve the problem but if you've tried everything and it's still not working then I feel you'd have good reason to justify a pump. You need the support of a consultant rather than a GP if you're going to get a pump so I'd keep pushing to be seen at the hospital clinic.

 

[alaska]

Re: Dissapointing Results

Hi Lorna

If you're injecting at 7am and 7pm and we assume that your levemir lasts for around 18 hours (levemir is listed as lasting for about this many hours in most people)

Your morning injection will be active until 1am the next day (07:00 + 18 hrs = 01:00)
Your evening injection will be active until 1pm the next day (19:00 + 18 hours = 13:00)

So your day will look like this:

00:00 to 01:00 - both morning and evening dose active
01:00 to 07:00 - only evening dose active
07:00 to 13:00 - both morning and evening dose active
13:00 to 19:00 - only morning dose active
19:00 to 00:00 - both morning and evening dose active

So we see this gives a good explanation of why you may be getting high blood sugars during the night -as only your evening dose is active for around a 6 hour period between 1am and 7am.

You may also find that your blood glucose levels are also elevated between 1pm and 7pm. However, your lunch time short term injection may mean that you do not notice this rise.


Is there a solution?

For me, I decided to split my levemir dose into 3.

I take an injection at 07:00, an injection at 15:00 and an injection at 23:00

This gives me much more consistency over the level of active levemir. As it happens I get three different 2 hour periods in which all 3 doses are acting, but this is a short enough time not to have caused me problems.

Any significant change in dosing should be discussed with one's diabetes team first of course

Hope this is at least interesting.

Best wishes

Ed

 

[ljwilson]

Re: Dissapointing Results

Thanks for that Ed, makes sense to me I shall start splitting my Levemir in 3 and see how it goes

Lorna

 

[ljwilson]

So today I am going to start taking my Levemir over 3 doses, as suggested by Ed. Last night before bed my BG was 6.8 then at 3am it was 13.5! I knew as soon as I woke it was going to be a high number. I took 10 units of Humulin S to bring it down and then when I got up at 6:30 my bg was 10.2. Fingers crossed splitting the Levemir will help.

I know a lot of you will think that taking 10 units of Humulin S to bring it down seems an awful lot but anything less with me will not touch a reading of 13.5

Lorna

 

[daisy3174]

Hi Lorna, yes think it would be a good idea to find out whats going on at night, maybe have one night and check it say every 2 hours to get a rough idea.Are you post meal readings always good? Smidge has mentioned your 1 hour pp readings,I know mine are always high,say around 18 at the hour mark and down between 7 -13 at 2 hours, so its worth checking.Hope you work somethng out soon x