Basal tweaking issue (Levemir)

scotteric said:

Also remember that nuts can hit you hours later causing a spike, past the time your of your bolus. I usually extend a bolus on my pump for a couple hours or so if I eat nuts. Fruit and yogurt can cause spikes in the morning and I tend to avoid them. Lastly your liver was probably dumping glucose due to the DP when you woke up, so treating the hypo may have made things worse since the DP might've taken care of it and then some...! You'd probably be amazed to see how much your BG rises in the first couple hours after waking due to DP. The process accelerates when you get out of bed. I can skyrocket from 5 to 12 in no time, even if my basal is set right if I don't take any insulin or increase my basal upon waking. The fading Levemir probably makes it so much worse!

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I had no idea that nuts can cause a spike in blood sugar! Is that because of protein, or just carb? I had always thought plain white yogurt was a good low-carb option, but do I need to account for protein here also? I'm new to thinking about protein - the DAFNE program only taught carb counting, and I'm a little baffled about how to account for protein in insulin ratios. Should my basal cover it, if it's set right?

HS13 said:

And I'm not so keen on having to get up at 6am every morning...!

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Yep, which is why I recommend an insulin pump if you're able to get funding for it. If not, see if you can try Tresiba which lasts longer than Levemir.

HS13 said:

I had no idea that nuts can cause a spike in blood sugar! Is that because of protein, or just carb? I had always thought plain white yogurt was a good low-carb option, but do I need to account for protein here also? I'm new to thinking about protein - the DAFNE program only taught carb counting, and I'm a little baffled about how to account for protein in insulin ratios. Should my basal cover it, if it's set right?

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Nope, technically your basal shouldn't cover it unless it's at a dose that's too high. I found this really difficult about MDI vs being on a pump. You can take shots after eating as well as before to deal with it, or use R insulin (Actrapid) which has a longer profile but is difficult to use and can cause hypos if not used correctly. Almonds have lots of carbs, the high fat content delays their digestion which is why they will hit you hours later.

@scotteric How long did it take for you to get on a settled regime with the pump? I have been offered the pump, but am a little weary that it might take a long time to get on stable dosage. I'm in the final stages of writing up my PhD, which makes the thought of having an extended period of experimentation and potentially sugars further out of whack as I transition onto the pump not very appealing. But perhaps it isn't necessarily such a disruptive process?

DSN has reduced my nighttime levemir to 4 (it was 6 before). Woke up this morning at 11.4mmol/L with ketones at 1.5mmol/L. Now am at 13.3mmol/L, and ketones still at 1.5mmol/L. I have been told not to correct between meals, but have just disregarded that and given myself 1.5units of novorapid...

Levy said:

And just like that, I see my consultant this afternoon and he's changing me to Tresiba

now I can start the whole process over again

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How are you getting on with the Tresiba @Levy ?

HS13 said:

@scotteric How long did it take for you to get on a settled regime with the pump? I have been offered the pump, but am a little weary that it might take a long time to get on stable dosage. I'm in the final stages of writing up my PhD, which makes the thought of having an extended period of experimentation and potentially sugars further out of whack as I transition onto the pump not very appealing. But perhaps it isn't necessarily such a disruptive process?

DSN has reduced my nighttime levemir to 4 (it was 6 before). Woke up this morning at 11.4mmol/L with ketones at 1.5mmol/L. Now am at 13.3mmol/L, and ketones still at 1.5mmol/L. I have been told not to correct between meals, but have just disregarded that and given myself 1.5units of novorapid...

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I had a really easy time with it honestly, but I went on it fairly quickly which made it a lot easier. I know they say it's best to wait a while to get used to how insulin works, etc. but I picked everything up fairly quickly and pumping just made sense from the day I connected it. I also think there is an advantage to starting early because I was still honeymooning meaning my insulin requirements were lower, I had no scar tissue from MDI injections so absorption was consistent and lastly I hadn't developed any bad MDI habits so I learned how to manage diabetes from a pumping mindset right away. It's a much more logical way to think about everything since it is closer to how a pancreas releases insulin. I think I remember being told not to correct between meals but I think this is just clinicians being too fearful about hypos. It's also harder to correct on MDI since you can only dose in single units or half units, and have to make sure you've kept track of your insulin on board that may still be bringing you lower. The pump is made for correcting between meals since it can dose in very small amounts and will keep track of insulin you've already taken and how much should still be active. On my pump I'll correct even if I'm in the 6s sometimes. I wouldn't dream of this on MDI.

My dad is a type 1 as well and had much more trouble than I did when he started the pump at the same time as me. I think this was mostly caused by years of thinking in terms of injections though, so it doesn't mean you will have issues. For example, I don't think he carb counted before starting the pump and this was a big adjustment for him. You have to be more accurate at carb counting on the pump too since your basal dose can't clean up mistakes for you the way Lantus or the other basals can sometimes. What you could try is the untethered method meaning you keep taking your basal but use the pump for bolusing/corrections only until you're done your Phd. Otherwise, just go for it, you can always disconnect it if it isn't working for you right now. It should make your nights/mornings much easier. When I tried Levemir I found that I needed to take a low dose at night to prevent hypos, but that meant it wouldn't last long enough to keep me from spiking when I woke up. I think this is a common problem with it and something you won't have to deal with again once you start pumping!