Regular increase in BG levels in afternoon - advice please!

[eg56]

Hi all,

Long time reader and first time poster - always found reading the topics on here very helpful, so thought I would pitch my own quandary and see if anyone can throw any light on it!

I am a type one on MDI - Humalog and Levemir (split dose). I feel like I have got my ratios almost correct (ignoring curious anomalies), but there is a regular occurrence which I don't understand and can't seem to come up with a solution to. I will post ratios and basal doses below the question.

I am usually fine and controlled in the mornings up until lunch, and my levels are acceptable 2 hours post lunch (6 - 8, which I am perfectly comfortable with). From this point, however, my levels will often rise, sometimes to as much as 14 or 15 before supper, with absolutely no carbs taken onboard. I have tried everything I can think of for this - especially increasing my morning Levemir, as you can see from my doses below, the morning far outweighs the pre - bed dose! I have even shifted it later in the morning than I have been doing it before in the hope it would last later in the day. The only problem with this being, I now have an almost instantaneous BG drop after my morning Levemir, which is more pronounced the more I increase it - I have to compensate with a mid morning snack, something I don't always want to have to do.

If this afternoon increase happened every day like clockwork then I could combat it, I'm sure - with a dose of QA in the afternoon, or trying to exercise around that time etc, but it doesn't - it happens a lot, but not every day.

Any ideas or thoughts would be appreciated!

Thanks

Breakfast 1u Humalog : 8.5g Carb

Morning Levemir 11am (22u)

Lunch 1u Humalog : 15g Carb

Dinner 1u Humalog : 10g Carb

Bedtime Levemir 11pm (10u)

 

[hale710]

Re: Regular increase in BG levels in afternoon - advice plea

Hi! I've just come across this. I'm afraid I don't have the answer, but I'm bumping it up to see if someone else can help!

I know you asked a while ago now but I figure you might still be curious

 

[Snodger]

Re: Regular increase in BG levels in afternoon - advice plea

How odd - but odd is kind of normal in Type 1.
It's not unusual to have very different insulin requirements/ratios at different times of day, but this sounds a bit more tricky than just a question of needing more background.
I wonder if your night time levemir is running out at that point and your morning dose, which was doing fine with the extra boost of the overlapped night time levemir, is struggling to manage when it's doing it all by itself in the mid to late afternoon.

Suggestions:
- do a full 24 hour no carb day and record what happens to your bloods, to get an idea of how the levemir is working in your body. This is tedious to do but at least then you'd have the full data on how long the two doses last (is the other dose running out too, perhaps at a time when you usually eat, forcing you to compensate with QA, for example?)
- split the levemir into 3 doses, rather than overloading your morning one and getting a dip straight afterwards
- ask to change your background insulin and see if you get on better with another type. Some people do split doses of Lantus, which lasts longer in the body than Levemir, and this might be a solution for you if you get on with Lantus. I'd also ask to consider some of the older background insulins, if you have a friendly/helpful doc.
- longer term, this could be something a pump might be able to help with, because you can programme it to change amounts of insulin at different times of day...but then you'd have to persuade your PCT to fund it, never an easy battle

don't know the answer but these thoughts may help...? hope so

 

[eg56]

Re: Regular increase in BG levels in afternoon - advice plea

Only just stumbled on your replies - thankyou! I will look into your suggestions. I have previously been on Lantus and it didn't work for me - but may be worth trying split.

My doctor is not massively helpful - I tried to explain the problem to him recently and he stared at me blankly, told me I was doing very well and sent me on my way! I guess with an HbA1C of 7.2 he has people in a worse situation to worry about and doesn't have time to concern himself with my fine tuning!



Sent from the Diabetes Forum App

 

[eg56]

Re: Regular increase in BG levels in afternoon - advice plea

Just a thought - might it be worth pushing my "morning" Levemir even later and taking it with my lunch, around 1 - 2pm? This may deal with the drop of BG due to the overlap with the night-time and mean I don't get an afternoon rise? This may risk an overlap with the nighttime dose I guess.

Does anyone else split their Levemir 8 - 10 hours apart rather than 12?


Sent from the Diabetes Forum App

 

[donnellysdogs]

Re: Regular increase in BG levels in afternoon - advice plea

I would try to get your highs reduced by getting the overlap doses ro be concurrent at these times.....

Sorry, I missed ur posting.. Hooefully more experts will come along now...