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could too much levemir actually raise BSL?

R

rainbow fish

Active Member
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Hi
I am still trying to get to my position of ideal control here, got the latest quarterly test and HUGE improvements (7.7 from 11.6) but not yet on the mark. Two questions to the experiences of others:

i am taking levemir and metformin, what I am finding is that as the levemir dose increases, so does the BSL. Maybe not by huge amounts but certainly not getting lower. Could there be an explanation for that, or does it just need a bit of time to infiltrate the system? :?: :?:

Also I am now on 500gm + 1000gm metformin, and the doctor isn't keen to increase it due to risk factors. Has anyone else any information about associated risk factors with larger doses? :?: :?: My gut reaction is that with another increase in dose plus my continued weight loss, I could be hitting the zone. (I have been lucky compared to some, with only a couple of weeks of flatulence issues after each increase in dose, which touch wood more or less settles down)

Diet and exercise are refined to the point that is livable and sustainable, it seems the next step is a routine of 3 daily injections with a short acting insulin, which on one hand I understand and am prepared for, on the other it seems an extreme step to drop down maybe 2.5 mmols.
thanks in anticipation
bruce
 
2 thoughts. On the Insulin front, you may be affected by the morning effect when your liver produces more glucose (gluconeogenesis). This is often explained as a preparation for morning activity. Also, if you have neen quite low overnight the gluconeogensis will kick in. Maybe a small snack before bed will switch off the gluconeogensis and give you the morning BS levels you are after. It might be worth doing a BS check in the middle of thr night to see. I have changed my split levemir dose form 30%/70% to 20%/80% but till use the same total dose (100 units). I notices a big imrpovemtn in BS without hypos.

I notice if I take my metformin early with a meal (5pm-6pm) my morning level is higher. I take 1000mg twice a day. MF has a half life of 6 hours and primarily works by inhibiting liver gluconeogensis. (In Type 2 diabetes, gluconeogensis is 3 times higher than in normal people). If I take my MF early, I often take another 500 mg just before going to bed in order to maintain the MF effect al night. That has a wonderful effect on the morning reading. So much, that I might ask my diabetologust to change me to 850mg 3 times a day . The alternative is to go on Glucophage SR which is slow release and will than last all day without the same dip. I have been lucky in that MF doesn't upset my gut at all. It is a great drug if you can tolerate it.

Good luck.

ps there is no great hurry. Change your doses slowly. I have only just leanred how to cope with the occasional curry/chinese. Food type will obviuosly have an effect.
 
Thanks for all the information guys, I really appreciate it. THanks again for the "relax, take your time" message Martin, you said it to me a couple of months ago when I was rather frantic and it really was some essential advice!!

Last night I inadvertently, or at least without diabetes related agenda!, ate a snack before bed and today there was a decent drop in the morning levels. I am finding however that in any case the daytime readings are lower than ever even if the morning one has increased slightly. Clearly there is quite a window of opportunity for adjusting the metformin and levemir doses and timings, so that is reassuring. Since I don't have any more carbs at dinner than I have at other meals, I was thinking that maybe I should have the 1000gm metformin in the morning instead, but from Martin's comments it seems that larger dose is needed to cover the night time goings on. Perhaps I should talk to the Dr about 1000gm twice a day, although his opinion is that there is danger in having too high a dose. I will also keep an eye on when I take it, I work in the evening a few times a week so there can be a 2 hour difference between when I take the tablet. I would be happy staying with one injection too but if 2 shots of levemir will ward off a 4 shot regime, I will go with it.
THanks again, it gives me a lot to plan for in refining all of this, and is HUGELY appreciated. I thought I'd go on record as the one unanswered question posted on the board but there you go! :lol:
 
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