Insulin Dilemma

[Libby3781]

Hi all,

Please can you give me some advice. My diabetic nurse has advised me to increase my insulin dosage on a Tuesday & Saturday evening.

Currently I am injecting 26u’s at night, this then brings my blood glucose level down to anything from 7.3 - 10.2 the following morning. These have been the results for the last two weeks.

The dilemma I have is should I increase tonight to 28u’s?

My current routine has been to increase insulin level, monitor for approximately 2 weeks then increase again and repeat the routine.

My nurse once my glucose levels to consistently be in single figures, that isn’t happening tho...they are changing morning to morning.

Therefore, I’d be very grateful for you’re thoughts, advice, hints and tips.

 

[dancer]

What difference is there on Tuesdays and Saturdays so that you need more insulin?

 

[Libby3781]

No differences, just the days she’s told me to increase. Every 3 days, that’s the only pattern.

 

[dancer]

It's probably too late now but I would follow DSN's instructions only if I was in double figures consistently. I certainly wouldn't want to increase insulin if my BG was 7.3. However, I am Type 1 and am insulin sensitive, so you would have to take your own circumstances into account. Are you likely to go hypo? That is the main question

 

[kitedoc]

Hi @Libby3781, Could you please detail your current insulin type and regime , to help sort things out a bit?

 

[Libby3781]

Currently I’m on Levemir last thing at night....along with 500g Metformin twice a day.

Blood glucose levels down in the morning, then steadily increase throughout the day regardless of what I eat.

DNS’s instructions to increase insulin on a Tuesday & Saturday night to get blood glucose into single figures consistently.
Increased to 28u’s last night. BG level 11.7 at bedtime now 6.9 this morning but that will increase consistently by Tuesday.

 

[kitedoc]

Thank you @Libby3781, As I understand it levemir is long acting insulin of approx. 12 to 16 hours (24 hours at the outside) duration and most take it twice daily so that it covers 24 hours.
Also it has little effect on BSLS rises from meals because its effect on BSLs is low and extended, as basal insulin should do..
And fasting morning BSL gives me information about how my evening levemir (talking some 7 + years ago) is working. I used to also say, skip lunch and see how my BSL was say, 2 hourly from 12 to 6 pm as a way of seeing how that 6 hours was going basal-wise. And same for say, 6 pm to 12 mn(no evening meal) , 12 mn to 6 am, 6 am to 12 md (no breakfast) etc. .
But if say, my evening meal led to a BSL after 2 hours of 12 mmol/l, then I could not expect my evening levemir (or a daily levemir) to do much about that reading and a higher than normal fasting morning BSL may result the next day. Putting my levemir dose up was not going to solve that.
The beauty of twice daily Levemir though, was that that at the 12 hour mark (the next of the twice daily doses) I had an opportunity to have a different dose of Levemir. After all we eat more between say 8 am and 8 pm than between 8 pm and 8 am, and maybe there is less stress when sleeping than during the waking hours so we may not need the same level of basal through 24 hours.
So I am suggesting you inform your DSN about what your BSLs 2 hours after each of your meals are, to see that there was not problems there and particularly to report if the after evening meal and even the before bed time BSLs tend to be high.
And consequently whether fasting BSL the next morning was high as well.
And about whether twice daily Levemir was a better regime or not.
High BSLs 2 hours after meals may need a different solution, I would suggest, to the use of Levemir by itself - see what your DSN suggests.
Best Wishes

 

[Libby3781]

Thanks Kitedoc, I think somehow my regime is going to have to change. The one dosage of insulin isn’t keeping my BG levels down beyond when I start eating.
I’m hoping to have a baby in the not to distant future so my BG levels have to be consistently low before, during and obviously after a pregnancy.
So going forward I’m not quite sure how this is likely to be achieved, that said this is where the DSN’s nurse comes into the equation.