Levemir split has made me worse?

[AntLockyer]

Hi all I have a feeling this might be a long post so please bear with me.

I was diagnosed type 1 last year and put on Levemir/Novorapid. Ended up eventually at 22 units at 10:00pm in a single dose and a carb to insulin ratio of 1 unit per 12-15 grams. My A1C went from 13.5% to 6.0% in 6 months and my last one a couple of weeks ago was 5.5%. So far so good.

I did have semi regular lows usually in the 3. something range and always symptomatic. I treated them with 15 grams of carbs and all was well. I struggled at times with exercise specifically the driving range and playing golf. The former I dealt with by having about 30 grams of carbs before and the latter I just ate all the way round. For running I would take a jelly baby every 5-10 minutes and would make sure I started at 8 or more. I never hypo'd during a run or because of a run.

I saw a consultant for the first time about three weeks ago and she commented on the lows and thought we could (should) reduce them. She said that splitting my levemir dose into 2 would enable me to have a bit more flexibility so I could redue my bolus before I played a round of golf so I wouldn't need to eat as much.

It took a couple of weeks of highs to finally get to 2 doses of 12units with a carb to insulin ratio of 10:1

My lows have been fewer but I've felt hypo when I've been in the 5s and 6s and generally have felt a bit worse than normal.

My routine for golf is to eat breakfast at home, drive to the course and then play my round. Depending on the course it can be a good couple of hours between breakfast and starting. The 2 times I've tried reducing my morning basal I've gone high enough to feel high (over 13) and still had to eat as much while playing to stop going too low.

So right now I'm considering just going back to how I was, I'm happy with 5.5% and my routine is easy to deal with. Before I do, any thoughts?

My morning numbers are usually in the 5s
I've discovered that I drop about 2 mmol 2 hours after breakfast and then come back up again (if I didn't correct for a hypo). This is with pinhead oats which are very low GI.

Generally feeling a bit negative which is totally out of character for me.

 

[donnellysdogs]

5.5 is a good level of hba1c.. But pretty low for a type 1 mdi person... As you will be having too many lows.

As a driver.. My consultant didnt even like me at hba of 6.6 and wanted me to have a hba1c of 8!!! If you are driving then your consultant will be especially trying to suggest you get yourself higher. And for playing golf and running and or exercising... You should not be reliant upon having to eat to cope with hypo issues or worries everytime.

I personally would stay with splitting your levemir, but tweaking your injections slightly, or asking for consideration for a pump. I too have felt hypo at 5 or 6's..but this I believe is my body having a better response to hypo awareness. Like you I recognise hypo's but feel better with having a warning at 5 and 6 to watch myself than 4 when typically.... You should really have helped yourself already.

I've never used levemir, but know iHs has, so hopefully she will come along and offer some help ref splitting doses and tweaking. Others split too, so they'll be better advice from others.

I personally think its just your bodys initial responses to higher levels and better, imoroved awareness...

 

[AntLockyer]

That is interesting. When I say semi regular lows it would be once a week I'd dip below 4. I'm perfectly happy being in the 4s and feel 100 times better there than the 6s. She did not think it was an issue other than trying to reduce the amount I needed to eat during exercise.