Need help. BG are ruining my life.

@paulpapa try the graph below. There are differing opinions on whether you lump the total levemir dose or treat as two separate profiles. I was an 2x22u doses at 9am/9pm and always found it peaking at 6-8 hours so I I favour the seaparate doses view. That would put you close to the 0.4u/kg profile where you can see the evening drop off I suggested earlier. As always look at the hypothesis and see it if fits your experience.

steve_p6 said:

@paulpapa try the graph below. There are differing opinions on whether you lump the total levemir dose or treat as two separate profiles. I was an 2x22u doses at 9am/9pm and always found it peaking at 6-8 hours so I I favour the seaparate doses view. That would put you close to the 0.4u/kg profile where you can see the evening drop off I suggested earlier. As always look at the hypothesis and see it if fits your experience.

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The experience of the DAFNE cohort (and bear in mind that this is evidenced based) is and the latest NICE guidelines suggest that Levemir split twice daily is the most effective way to do MDI with either Lantus or Levemir. In fact they make you swap to Levemir in some areas before doing DAFNE now.

Hi @paulpapa, are you doing PGCE?

paulpapa said:

I just tried having a low carb meal, a pack of fried cherry tomatoes and two eggs cooked into a kind of eggy scramble and it still spiked me up from 9.9 to 12.9. I worked out that the carbs are only about 10g of carbs but didn't inject to cover it as today I had a bad hypo from injecting to cover some veggie sausages and eggs I had. Injected 1 unit an hour ago hoping it would lower me down by 2mmols and now I'm 13.5mmols.

I feel really lost with it all. I'm starting to think that maybe I need to inject another unit to cope with where the BG will be by the time the Novorapid has kicked in. I'm just a bit cautious of doing so as I'm scared of dropping too low - especially as it's nearing bedtime.

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A lot of people find they have to bolus for eggs. I have to count one egg as 4 carbs.

Do you just guess your correction doses?
If you are "average" 1 bolus unit would bring you down by 3ml on your blood test. So if 12.0 on blood test you would need 2 units and that should get you down to 6.0 5hours later ideally.

Levemir doses when split are not necessarily split 50/50... You may need less with one injection.. Mine was less on my night dose but am on tresiba now.

Hello paulpapa!
Here are my thoughts:

Firstly and most importantly, whatever adjustments you decide to make in relation to your insulin, should always be in collaboration with your doctor/diabetes nurses. In this forum we are sharing thoughts or suggestions but, we are in no way able to make a suggestion on someone’s insulin regime.

Having said that, I will divert you to the following website:

http://www.diabeticretinopathy.org.uk/prevention/insulindoseinsulin.htm

As a general rule, (as you will also read in this website) background insulin is determined by body mass (and other parameters such as exercise/activity for example.) Most people need a total of 0.5 - 0.8 units of insulin per kilogram of body weight each day. Roughly half this insulin is needed for food intake (Novorapid) and half is the basal rate (Levemir). Sometimes it can be 40% Levemir and the rest Novorapid, but this is the general idea.

In my view, before you experiment with anything else (like a low carbohydrate diet, vegan/vegetarian diets or bolusing for protein/fat) make sure that your Levemir is correct. If your background insulin is not correct then, nothing works well.

I would suggest that you go through a series of basal tests to determine if your Levemir dosage is correct of if it needs reduction. I suggest that you discuss your findings with your diabetes nurse/doctor.

Do you know how to run a basal test?

As soon as you have your Levemir dosage correct then everything else becomes more manageable.

I also do not suggest that you switch to Tresiba, at least not before your find your correct basal rate. The reason is that Tresiba takes about 4 days to give a steady state (being an ultra long-acting insulin). If you hypo on Tresiba and you realise that you need to reduce your dosage, you will be running after hypoglycemias for 2-3 days until your new dosage kicks in.

Keep in mind that, generally, Tresiba is more aggressive insulin and it is very possible that you will need less amount than Levemir.

I hope this helps.
Regards
Josephine