any suggestions?

[Nomi]

Hi folks,

I've been having a few issues with my BS recently, i think i may have reached the end (or at least stopped for a bit) of the honeymoon period. I was diagnosed a yr and a half ago and had reasonable BS levels, i didn't really understand the importance of having super tight control. i usually averaged between 6-9 mmol/L with the odd 12 or 13, but now it seems t be all over the place, and i haven't really changed anything.

I'm t1, i take novorapid with food, and i'm on levemir twice a day. I had been on levemir once daily taken about 10.30pm but found that my BS tended to increase by the following evening, so about 8 months ago i started on 2 shots a day. I take one about 8.30am and one about 11pm. initially it was 5 units in the morning, and 6 units at night, though i have recently increased it to try to combat morning highs, and am now taking 6units in the morning and 7 units in the evening.

currently my fasting BS is usually over 13mmol/l (when i first increased the levemir it came down to a more reasonable 7or 8, but has since gone up again). I don't seem to have as many problems during the day, but i do compensate for any highish readings using the novorapid.

I wondered if anyone has encountered a simialr thing before and could give me a few pointers?

I play squash for about 3hrs once a week, but have never had any after effects from exercise before. I do tend to eat about 9pm and go to bed about 11.30pm would this have any effect?

I have found that even if i check my blood sugar before bed (even when i haven't eaten for the past 2 hrs or so) and its say 8mmol/l i will still wake up with it higher, usually in the double figures.
also even if i take novorapid to correct any high readings at the same time(inject a different place) as i take the levermir it seems to have no effect and i wake up with high BS.

i'm really lost, i'm looking into following a low carb diet just to see if that helps at all, and i can't get an appointment at the diabetic clinic until may!

My last HbA1c was 8.2%, the previous one to that i think was last summer, at 6% so somethings defnately going on!

If you have any ideas i would love to know!

Thanks

Naomi

 

[lilibet]

Hi Naomie

Couple of things to try

-increase your Levemir again cause your basal might be the problem and if thats not right then the novo might have less effect. Skipping a meal on consecutive days will tell you what your basal is doing (ie skip brekkie one day, then lunch on another etc)

-is your Novo ratio ok for what you are eating (ie do you dose adjust for your food)?

-High morning readings are a HUGE pain in the backside. Are you familiar with Dawn Phenomenon? Its not at all phenomenol but it is the bain if Diabetics the world over. In essence its a rise in bg due to your bodys need to prepare for the day after a fast. It involves the liver's release of glucose stores (glycogen) and also other counter regulatory hormones such as cortisol which all serve to give high bg despite good bedtime readings. Some people eat protein based snacks before bed to try and 'trick' their body into thinking they are not fasting (ie cheese, ham)

You made reference to low carb diet. Cutting carbs will keep your insulin requirements lower, avoid spikes in bg and make the margin for error in shooting the Novo better. I am on premixed insulin and with honeymoon and low carb my 2nd A1c was 5.1. Have a skoot about the forum - hundreds to read on low carb. Most people start with the obvious such as pasta, rice, mashed and other potatoes.

We are all different though so you might manage some carbs, though basic science suggests NOT for diabetics, irrespective of insulin.

Thats just my tuppence worth, hope it helps a bit

l

 

[Nomi]

hi

how do you mean skip meals to see what my basal is doing?
do you mean if i don't eat and i hypo its too high?

thanks for you reply

 

[jopar]

Nomi

Not an easy one,

There could be 2 basic reasons fore the increase over of your numbers overnight...

1, that you have what is called the dawn phenomenon, where the live is trickling more glucose in to your system pushing your morning levels up..

2, you could be getting low during the night, sleeping through it, and the liver is dumping glucose to raise your BG’s, and you don’t have enough insulin to sort it...


The best way to tackle and to try to resolve what is happening to be able to resolve is,

To check your BG around 2-3am, it is suggested that the body is at it’s lowest ebb for all hormone production, so around this time usually 2amish, should be your lowest your BG will get during the night…

But you really need to build a good picture, and the only way of doing this is time, by which on different nights you start off first night BG at 2am, then on another night (next night or a couple in between if it suits better) BG at 3am, continual with this until you’ve covered all the hours, this should give a indication on what’s happening to your BG’s over night.

You can if you want, either do all the testing over one night, or split over a couple of nights where you test hourly over several hours over night..

It would also be a good idea to go back to some daily intensive testing, first thin in the morning, before and after meal, before bedtime, include what you’ve eaten (and carb count for that meal/snack) whether you’re working, exercising, if you feel under the whether stressed, as this will also give can give you a trend pattern so that you then can figure out where the problem might lay..

As it could be that you might need a different carb-insulin ratio at different times of the day/meals or change how you inject for a particular type of carb within that meal.. The better the picture/dairy you keep the easier it can be to see what’s happen…

 

[lilibet]

Hi
Jopars advice is sound

What I mean re skipping meals is obviously to skip a mean and therefore you wont have to inject your Novo
The whole point of Levemir is to keep you on a flat bg profile where theoretically you dont have to eat for the whole day if you dont want but if its set right (basal means background insulin) then your bg should stay fine and hypos/hypers should be nil Thats the theory, at least but of course this is diabetes and things dont always do what they say in the tin!
Unlike the premixed insulin you used to be on, you shouldnt HAVE to eat on demand

So, if you are getting fasting readings that are higher, then this may be arising from a number of things, Dawn Phen, or not enough Novo (though this should be out of your system by morning after night time meal at any rate) or your Levemir at night is not enough to keep you low enough to wake on good numbers.

My point about skipping meals was to check at any point whether your levemir was set right. If you dont eat/inject novo and skip meals it should tell you when it starts to run out.
What I would do is consider

-injecting your Levemir earlier perhaps, or change the time of day and amounts.
-needle sizes/injecting ok? Some find changing sites, sizes make a difference

Maybe in the first instance trying taking it a bit earlier, taking a bit more Levemir, taking dinner earlier, (Dawn Ph can be worsened by eating late if i recall_) taking a protein snack before bed.

Good luck

 

[Nomi]

right then, thanks guys for your help, i'll give it a try and see what happens. i'll let you know how i get on

 

[Nomi]

just a thought - if the levemir is set right, and say i don't eat. will it compensate if i do exercise? if it keeps things on an even keel, will it just allow the liver to release glucose?

 

[TerryMD]

I suggest you discontinue with Levemir and replace it with Lantus as your basal insulin. I have used both. Lantus is clearly superior for adult glucose control.

 

[jopar]

nomi

I would deal with your excercise separately from you basal injections...

You need to decide how you react to the exercise to see if you need to adjust either your carb/insulin ratio before hand... whether you need to consume a small amount of carbs to maintain sugar levels to accomplish the exercise...

You also need to keep a eye for rebound effects after you've finished your exercise, as you might need to adjust carb/insulin ratio to prevent a hypo later...

The problem with slow acting insulin is that it can take several days to show how a increase or decrease is going to effect the basal blood sugar levels... So doesn't lend itself to adjusting to individual daily requirements from one to the next....

If you are a person who exercises a lot, then a insulin pump might be a advantage, as it only uses quick acting insulin, and you can programe several different basal profiles which you can swap from one to another to suit your needs... I have several set on my pump, one for general day to day, then 2 for work purposes to match my different needs to where I'm working to..

As to what background insulin is better than the other, this would really depend how it worked with you... Levermir tends to lend itself to splitting better than Lantus, but again this is individual to what works better for you...

 

[Nomi]

ok then. thanks
I will keep adjusting my levemir giving a few days to see what happens. I only went onto split injections because i found that if i took it on a night by the following evening my sugar levels were creeping up. Exercise doesn't usually have any after effects on me, but i do have a snack if my BS is quite low, so i'll try to get my levemir sorted and then attack the exercise front.
thank for all your help, you guys are great

Nomi