Morning highs getting me down HELP

[Michey]

Hi there,
I'm new to this forum, but have been using it ALOT to try and figure out my morning readings.
I'm on MDI using Levemir and Novarapid. I inject my levemir in the evening at 8.00pm - 31 units. I discovered basal testing using this forum and discovered my nightime fasting was creeping up in the night, therefore increased my background to 32 units.
I’ve had the same food for dinner each night for the tests, made sure my levels are ok before bed and there is no quick acting in my system.
Heres my results so far and i'm very confused:

31units Before bed 9.8mmol Morning 11.2mmol
31 Before bed 9.2 Morning 10.8 Weekend
31 Before bed 6.2 Morning 8.9 Weekend
31 Before bed 9.3 Morning 14.3
31 Before bed 5.7 Morning 11.2
31 Before bed 6.2 Morning 11.5
32 Before bed 9.9 Morning 12.7
32 Before bed 8 Morning 16.6

31 units doesn't seem to be enough and my levels were creeping up over night (test at 2am 7.8mmol, 4am 11.2mmol)
So I decided to increase my dose to 32 units – you can see the problem, 16.6mmol this morning which is even worse and maybe suggests low sugars in the night.
So 31 is too little, 32 is too much?? I’ve tried a snack before bed on 32 previously and I woke up with a reading of 18mmol.
What am I doing wrong? None of this makes sense and I’m starting to get incredibly disheartened – the more I try, the less consistent it is.
Me and my husband want to start trying for a baby, but i've been trying to sort out my morning readings for a year now and the nurses are baffled
Any advise or words of wisdom from you fellow type 1's would be greatly appreciated.

Michey Type 1 diagnosed 1989

 

[stoney]

Hi Michey

From what I can gather Levemir can be split into two one in morning and one in night. Maybe this is the answer for you. My son is on Lantus but was told not to split his. He is also struggling at the moment with highs in the morning.

I am sure someone using Levemir will be along soon to help you.

Good Luck and Take Care x

 

[Michey]

Thanks for your reply. I've tried splitting the dose and this actually makes it worse My insulin requirement is very high in the morning and 75% less in the afternoon which is crazy! I'm starting to think the pump might be my only option, but getting one through the NHS is proving to be a battle. I've been waiting 2 years now.

 

[iHs]

Hi

Try leaving your Levemir eve dose until bedtime. You will probably need to use more bolus to cover your eve meal but as long as you get the same bg levels before you go to bed, you can then calculate the correct dose of Levemir. As always though when making changes ........ test your bg levels frequently so you can monitor the changes.

If that doesn't work then see a consultant and discuss using an insulin pump. You will have grounds to get one....

 

[Michey]

Thank you iHs. I used to inject before bed and have recently changed to 8pm so that the levemir peak combats dawn phenomenon. Now i've increased to 32, maybe I can try before bed again. Its so hard when theres no clear patterns and my levels contradict what should work. Maybe my liver is rebelling......

 

[Fallenstar]

Hi Michey
It really is hard to advise people about adjustments as we only really have our own personnel levels to go on from personnel experience and we are all so individual with our Diabetes management. So what works for one of us will no doubt not work for someone else ,the biggest difference is when and what we eat really.
A couple of things I have picked up on in the last week or so through my team and speaking to other Type 1's is myself and another girl I know were having nighttime lows with the Lantus. We are insulin sensitive , you may not be . She has changed on to Levemir and is on the same amount as she was on Lantus but it has stopped the nighttime hypo's .The Levemir does not seem to act as strongly as the Lantus for her.
So if you need a stronger acting Basal this may be that bit stronger for you and help keep you lower for longer if that is what you need. This may be worth discussing with your team..maybe a change in insulin :idea: :?: I know over the years when I have changed insulins my control has changed a lot sometimes for the better ,sometimes for the worse :roll:

The flip side of this is that you may be going low in the night....I did do often and my Liver would always (luckily) dump and I would wake up well into the high teen's . Maybe this is what is causing you the problem with AM highs. I have reduced my Lantus from 22 units to 12 ...and no more Hypo's ,no more morning highs ...My problem was I was using the Lantus like an old mixtard because I was scared of my Apidra due to my insulin sensitivity..now my Lantus is down I'm gaining confidence again in my Apidra and along with low carbing (and carb counting) I'm having excellent results ....It's not easy to work out sometimes why we get into a rut with our control but hopefully you will suss it out.

Are your team helpful? It also depends what you eat at bedtime if you are eating a lot of carbs at supper maybe your tummy is not emptying until the early hours and you get a spike. I Eat low carb, especially now my Lantus is right and I don't need the big carbs I used to have at supper and I now have a level BG on a night with a morning BG of 5 ish... It has been SUCH a long time since I had this. I have my Lantus in a morning instead of night...You could try this and cut right back on carbs at tea and into the early evening and see how this balances out :?:

Sorry I'm no nurse , and probably none of this will help or apply to you so just a few more ideas really to add to the other good advice above, but it is best to try and get your team behind you for any changes and plenty of testing which I'm sure you have already done.
Good luck and I hope you get to better figures and good luck with your baby plans.

 

[smidge]

Hi Michey,

I use an intermediate acting basal (insuman basal) at night to help get the morning levels under control. I use only a small amount, but it seems to work for me usually. I inject it at bedtime. It has a profile of reaching its peak at about 4 to 6 hours (not a flat profile like the long-acting basals) so it reaches its peak just as the dawn phonomenum is kicking in and counters that. I don't know if you can use it together with other basals as i don't have to use a long-acting one at the moment because I'm LADA and I still produce some of my own basal. I use Apidra for my meals and Insuman Basal in the morning and at night.

Might be worth asking your HCP about. But as I say, I don't know if that would be suitable for you as full Type 1.

Smidge

 

[Jen&Khaleb]

My son is on Levemir (split) and I do find that he can be 10 mmol or so at 10pm, drop down into the 5's by 2-3am and then be back up to 8-10mmol by 7am. If I increase his Levemir he hypos in the night so I just accept a bit of a higher reading in the morning. I've tried changing times and this can help a little but I'm satisfied that overall his night is good even though waking in the 5's isn't really an option. My son's last hba1c was 6.2 so I'm not concerned about a few hours above 8mmol if I can sleep at night and know he will be safe. Have you done a few checks through the night to see what is happening?

 

[wendy_doncaster]

I think the advice about lower carbs at evening meal may be worth giving a go. I have found that when I have a large dinner (especially if fatty foods like fish and chips) my BG will be very high in the morning. Also, a late evening meal can throw me, if I eat and inject less than 4 hours before bed it gives a false bedtime BG, so my BG might drop further causing a hypo then a peak when my liver kicks in.

Try eating a low carb meal at least 6 hours before bed and be careful not to snack or drink anything that may cause your sugars to go up. Take your insulin at night before bed and set your alarm for a reading during the night. and let us know how you get on. x

 

[Michey]

Thank you for all your advice everyone, I really appreciate it.
I eat low carb in an evening so I don't think its the food interfering. I did have a breakthrough at the weekend which i'm going to discuss with my team. I had a late night Saturday night as I was at a party and my sugars dropped, so I treated the hypo. I went to bed at 2am and my sugars were 13.7mmol so I "cautiously" injected a correction dose thinking I had nothing to loose as I've tried most other things. I woke up to sugars of 4.8mmol, the best result in months!!!
I think this strongly points to dawn phenonenom, so as Smidge suggested i'm going to discuss using an intermediate insulin at bed time and see if that helps.
Will keep you all posted - my journey is a frustrating one but maybe others can learn from me..........

 

[chrisdown123]

Set your alarm for 1am, 3am and 5am and test to see if you are going low in the middle of the night which can make your body release glycogen from your liver which increases your BG which makes your test high in the morning.

Are you sure you you are injecting enough fast acting insulin to match your evening meal ? Often a higher ratio of insulin to carbs is needed in the evening especially if you eat later in the evening.

Good luck

 

[holliebobstarr]

I'm also on Novorapid and Levemir.
When my blood sugar show a pattern of increased morning test, I up it by one unit. Then see if there's any change, if still not what you want, up just one more. Not more until consulting your doctor.

Although, if you're testing before bed, this should show if you're injecting enough at night, but I really do reccomend increasing Levemir!

 

[Michey]

Hi Hollieobobstarr,
Thanks for the advice. I found that increasing the levemir made my readings higher! And this was not due to hypos in the night, it just made them creep up even more for some reason - like it made my dawn phenonenom worse! I know this goes against logic, but everybodys unique I guess. I am now injecting Novorapid before I go to bed with a small bowl of cereal around 11pm and injecting my levemir at 8pm so that it peaks in the night. So far so good, I'm seeing single figure readings upon waking for the first time in years. I can only assume I need a boost of insulin in the night to combat my liver and maybe my snack is a distraction too! Who knows!
I'm on my 4th night of doing this and its working so who cares about the science bit!
Its a nuisance having to have a snack before bed as i'm never hungry, but I am on a list for the pump so fingers crossed this will do a better job at dealing with Dawn P which I believe to be the culprit to my nightime chaos.