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In a bit of a pickle with evening dosages

JoeT1

Well-Known Member
Messages
277
Location
Ireland
Type of diabetes
Type 1
Treatment type
Insulin
Hi All,

Hope everybody is keeping well.

Things have been going reasonably well recently. Managing some good days with almost normal blood levels. Couple of things I am seeing, and I am pretty sure I know some of the answers I get will be more basal testing etc.

Say I manage to get my levels into range during the day, and manage to bolus for my lunch about 1pm and I am still nicely in range come 6pm....it's dinner time about 6.45pm-7pm. I am going by 1:10 ratio for breakfast and lunch, and have been trying 1:7 for dinner, but am still seeing a steady rise after my evening meal, so if I am say 5.5mmol, chances are i'll be 9mmol-10mmol by bedtime, which obviously leads me to being high starting off in the morning, so I then have to correct and am starting off on the wrong foot.

Have even tried giving myself an extra unit on top of this ratio this evening...but am still seeing the rise, even with 1unit etc of Levimir in the morning dose. I don't want to keep adjusting and guessing. It's just a frustrating thing as I know this will effect my HBA1C when I get it done in January, and although I shouldn't let numbers rule me, i'm afraid they do at the moment. I am wondering if i'm coming down with something, I went to see my GP yesterday about a bit of tightness in my chest, but she seems to thing it's all fine, just gave me the flu vaccine.

Also seeing, when I teach a gym class with my football team (i'm setting up and training them, rather than partaking), I see a big jump. It looks like addrenaline that's causing this, and am wondering now should I even bolus for this before the training.

Sorry for the long post. I'm super keen to get things back on track.
 
Sounds to me as if you are doing well.
The evening rise may be due to your basal not lasting the full 24 hours - when do you take it and could you split it?
I confess I never tried this but know lots of others do.

Regarding your adrenaline spike with the gym class, it could be worth trying a bolus beforehand. I used to do this before climbing which always resulted in a spike. I took enough bolus to target a BG of about 3.5 based on my usual dose. With the adrenaline of climbing, this resulted in a reasonably flat profile for a couple of hours. Then my BG would drop so I had to eat some carbs to ensure this did not happen.

I say this all in the past because I am now on a pump which allows me to adjust my basal for climbing and different times of the day. You may benefit from this but I think it is useful to inject to get your head around diabetes first.
 
I assume you're splitting your Levemir dose, I think that's standard procedure for that insulin. Also, why on earth to you go 1:10 for breakfast and lunch and 1:7 for dinner? You think your body knows it's dinner and adjusts and needs less insulin? Or you think it needs the same amount and so your blood sugar goes up higher after dinner because you didn't take enough?
 
@helensaramay Yeah, with Levimir it is a split dose. 9.30pm and 7am usually. 14u at night, 9u in morning. As for the bolus for adrenaline, I think i'll just have to try it tomorrow and see how it goes, will give myself enough to try and cover a 3-4mmol rise during the session.

@TheBigNewt I go 1Unit of Insulin for 10g of Carbs for breakfast and lunch, because that seems to be working for me currently, but at dinner, was seeing massive rises going by that, so dropped it to 1Unit per 7g carbs, but unfortunately I am still seeing a rise. I do wonder if the insulin in the morning is running out, but not sure whether to rise that more, or take it an hour later at about 8.30am
 
Maybe switch the Levemir 14 morning 9 night more around during the eating hours not as much sleeping. Maybe? I take my Lantus AM.
 
Before I went on a pump I was having similar issues even splitting my basal... My DNS suggested I try Toujeo which is more even and lasts a full 24 hours this may be an option you may want to consider with discussing with your DNS. Hope you get it sorted know how frustrating it can be!
 
@JoeT1 Your 9:30pm dose is 14.5 hours after your morning dose. Have you considered moving the evening dose to 7:00pm?
It probably takes the Levemir around 2 hours to get going so the second dose isn't having much effect on your evening readings.
I try to have around 12 hours between doses.
 
JoeT1 said:
Yeah, with Levimir it is a split dose. 9.30pm and 7am usually. 14u at night, 9u in morning
Click to expand...

That's likely your issue, your morning Levemir dose probably lasts 12 hours at most and then you are experiencing a gap until your evening dose ramps up. Maybe try taking your morning dose at 8am and evening at 9pm? I've been doing this and it works pretty well for me. As for stress highs, I deal with these too. I'm a criminal lawyer and my blood sugar starts skyrocketing the minute I step into a courtroom. One strategy I use is making sure I take my morning dose 2 hours before court so it is in full effect when the stress kicks in - so if I have to be at court by 9am I will take Levemir at 7am instead of 8.
 
I have a similar problem. It's suspected the Lantus (Basal) is wearing off. Keep upping your ratio gradually, that is what I'm doing as a stop gap until I go onto a pump. I delay the Lantus until about 10:30pm and almost double my Novo Rapid. I also take my Novo Rapid much earlier about 20min

Can you modify it so that you are more active while taking the class or do a fast hard private session just before or after setup? Adrenaline shouldn't be a factor after you have taken the class a number of times, especially if you know the guys, there maybe something else at play. There are plenty more hormones than adrenaline trying to screw things up.
 

Always have an Adrenalin rise after my swim fit sessions, and go twice a week. Rose from 5_16 yesterday in an hour! With usual food and insulin on board. If I turn up to swim and the trainer is not there, and I just swim for an hour, no rise. I never drop though following a swim, either that day or the next. I just become pro active with rapid insulin after the event, figuring doing the exercise is more important.
 
I find that I inject more for the evening meal as I am less active in the evening. On the move after breakfast and lunch means less Novorapid than in the evening. Basal testing shows my Lantus tails off slightly in the evening, but it's within range and adding another unit causes a fall.

I think we are all unique with respect to insulin and what suits one won't suit another. Test record and react accordingly,, Changes to the basal should get a few days to work through. That's what I was told by the specialist when first diagnosed.

Sadly, it's a bit of a moving target, with summer and winter requiring different ratios of both basal and fast acting. I find detailed record keeping helps to spot changed trends and alter to suit.
 

Mine is the other way re adrenaline, i can test before i race (about 15/20min before we go to the grid), be at 5mmol and then have a few biscuits and a 150mm can of coke.
When i come in il still be around 5mmol

On race weekends i can get away with only injecting a half dose of the background insulin.
 
It's amazing how we are all different. Serious exercise like bike riding has little impact on me. Skydiving that is also serious exercise and no real impact, if anything an hour latter I have dropped a little.
 
Thanks all.

So I injected for dinner yesterday, and saw myself rising drastically just before the session, so I gave myself 2 units of Apidra and found that by the end of the session, I was in range, but that meant that for the evening, I took 4 units for 12-14g of carbs. Even though I went to bed at 6.3, I woke to 9.3...

I am finding it very difficult to work out what's going on with myself. May need to go back to basics next week.
 
Just play around a little with it...i take 32 levimir in the morning and 42 in evening about 10...novo rapid just before meals..took a little time to get right levels but am bg is good regularly in 4s or 5s
 

If you're still finding yourself rising overnight you might have to up your evening dose a little bit as well. I'm currently playing around with my Levemir evening dose. I've got it set to an amount where it's keeping me stable overnight, BUT it's causing a similar evening rise to you. But then I've found that if I up the dose, it's making the evening rise disappear but at the same time it's making me drop overnight. Feel like I can't win at the moment!
 
my lantus evening dose takes 3 hours to start working so i jabbed at between 6-6.30 so it fills the drop in the morning one. maybe shift a few units to the evening as your day bg is fine.
 
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