Long-acting / Basal Insulin Issues

[lewis10694]

I have been taking the same basal insulin since being diagnosed 3 years ago and have never really experienced problems that differ at different times of day. I have had to change the amount I take on many occasions due to being more active, weight gain/loss etc. I always have found a number of units I can take that, without eating any carbs, would keep me stable consistently.

My issue at the moment is that I can take my Abasaglar insulin in the evening (6:30pm) and find that when I'm going to bed I can't stop my levels from dropping (this is more than 4 hours after my last bolus insulin dose). I have to eat around 20 grams of carbs at midnight (usual 5 units of humalog for me) and can still sometimes find I'm having a minor hypo during the night.

The answer sounds like it should be take less basal but here is my other issue... Around 6am while I'm still asleep my levels start rising. When I wake up it can take 5 units of bolus insulin to control this without eating any carbs. This obviously makes it difficult to control and often I have to skip breakfast to avoid going hyper. This phase of increasing levels without eating carbs usually lasts until late afternoon when things start to stable out for a period before again beginning the decrease to hypo as it gets later in the evening.

Is there any methods to control this without changing from using pens? I wonder if changing the time of day of my basal would help? Any advice or similar stories would be helpful, thanks.

 

[In Response]

I would recommend taking a look at the profile of your basal insulin.
(Google "profile of ..." and look at the graph).
I used to take Lantus and although it was supposed to be flat, it could have a "kick" in it which would lead to lows about 4 hours after taking it. I overcame this by changing the time I take my basal to ensure I was awake and able to (or coinciding with) something to eat when the kick came in.

The morning peak is likely to be Dawn Phenomenon (DP). This is common (even people without diabetes experience it) . Some people find it more pronounced than others. There are many many many threads about DP on the forum. Some find eating a little something when they wake helps to reduce the peak.

 

[urbanracer]

Hi @lewis10694
I used Abasaglar for approximately 18 months when I first started MDI. I never got more than 18hrs cover out of it. This was very obvious when I got the Freestyle Libre and started to watch my levels climb from about 15:00 every day. I ended up splitting the dose to try and even out the peaks and troughs. (I have to say, - speak to your medical people before changing your dosage.)

I use Levemir now which is a twice a day insulin but it keeps my background levels much flatter. Don't be afraid to ask your doctor if you can try something else. Levemir (Detemir) is now the NICE recommended basal insulin for T1's on multiple daily injections.