New to Basal-Bolus, in need of some directions..

[mattwicks87]

Hello..
After some lack of help from my diabeties center as well as a lack of information, I decided to join up to seek some advise and help.

So I was put on the 4 injections a day. Basal - Bolus, Novorapid and Levemir. I was given some default injection levels.
Levemir - 30
Rapid:
Breakfast: 15
lunch: 15
dinner 15

So I tried these for a day or so and discovered that they were a bit enthusiastic with there levels...
After missing my appointment at the group counting carbs ect... thanks again to the hospital who sent my appointment to the wrong address again, and then I got it the day after... helpful...
So I lowered some of the levels until I could find a level that worked. Levemir to 22 / 23, an Rapid to 8, 8 and 15 evening.

Problem I am discovering is night times.
Back in April 2012, after a busy day in London I did my normal routeen, only then to wake up in Hospital after having a fit, which I have no record of in my memory. So quite understandably Im a bit paranoid about nights... this was back on the Novomix 30.

My levels on the Basal - Bolus, are getting on the high side to say the least.. tonight as I type this.. 11.7
Night before 18.2... managing to reduce that to 15.9... night before that 17.1 night before that 12.4.

I inject my Levemir the 24 hour injection about 00:15 in the morning, Im seeing some alarming to me, drops.. loosing around 5 - 7 units over night... and Im concerned.
A) becoming paranoid again... lacking alot of sleep due to me worrying and watching the levels.
B) Help from the DB Center.. is proving... well useless...

II would like to know from anyone who uses these injections, How can I firstly get the levels down to a suitable level, and How if at all can I stop the massive drop over night (When I do eventually get some sleep.) Can that be done through the level of the Levemir? or somthing else.
I woke up on the first day with a level of 5.2 which sort of rung alarm bells in my mind.

Any help or advice or direction would be greatfully received.
And if I don't get taken to a Hospital over night I will get back to you all.

Thanks in Advance.

 

[LaughingHyena]

I'm no expert, still trying to get my own leverls sorted out :lol:

I found this online course quite a handy reference when I first started all this
http://www.bdec-e-learning.com/

I'd also reccomend buying a copy of carbs and cals, either in book form or a phone app, it's really handy for working out the ammount of carbs in your meals.
http://www.carbsandcals.com/

As to the accual mechanics I think a lot of people start of with a ratio of 1 unit of insulin to every 10 carbs and adjust up or down as needed. Since you look like you have worked out your doses for a few meals you could count the carbs in them and see what ratios you are using now to get a starting point.

 

[Snodger]

Good advice from LaughingHyena.

Here are some of my thoughts:
HIGH EVENING SUGARS #1
Levemir's the background insulin as you know. So it's meant to be working on the sugar that your body chucks out into the blood whether you've eaten or not. And in some people it doesn't last 24 hours. So your evening highs could be because of that - your background insulin's given up and so your background sugars are rising.
Poss solutions: change insulin (eg to Lantus which lasts longer) or split your Levemir dose, half in the morning, half 12 hours later.

HIGH EVENING SUGARS #2
You don't say exactly what rapid acting insulin you are using or when you are eating before bed. But if you're on something like Novorapid (works for about 3-5 hours) and you are eating at 10pm then testing your blood with your evening Levemir at midnight, the novo won't have finished doing its job and you may get an artificially high reading.
Poss solutions: test a full 4 hours after your rapid acting insulin to see what happens when it's had time to do its job fully.

DROP IN THE NIGHT
Sounds very much to me like your levemir is also a little bit high still if it's bringing you down so much. Also, it's meant to be a gentle action with no 'spike' but in some people that's just not the case, it spikes as it starts to work. I had exactly this problem with Lantus, and solved it totally by injecting in the morning rather than last thing at night, so I was awake when it started to spike and could deal with the low if necessary. I also reduced it slightly and now night hypos seem to be entirely a thing of the past.
Poss solutions: change the timing of your Levemir to morning and try that first, also consider reducing it slightly (try splitting it first, see previous point)

hope that is of some use, sorry if it isn't very clear

 

[iHs]

Hi

As far as I can remember from using both Lantus and then switching to Levemir,

Lantus is the 24hr background insulin
Levemir is the 12hr background insulin

When Levemir first became available after Lantus was already in use, it was thought that some people might be ok injecting it once daily but for the vast majority many found that Levemir needed to be injected twice daily to enable better background cover.