New to Insulin [Levemir] & lows in the afternoon

[johnforster]

Hello Everyone. So glad to find this forum. I am Type II just gone onto Insulin once a day. I monitor my bs very regularly and recently every 2-4hrs to try to get the day right. Today is a typical day and has gone like this:-

Night reading = 03.27hrs 9.0 mmol
Tabs and Insulin @ 05.00hrs
Before breakfast reading = 07.48hrs 9.2 mmol
Breakfast = Porridge @ 08.30hrs
2hrs later reading = 10.44hrs 12.2 mmol
3hrs later reading = 12.50hrs 7.3 mmol
Lunch = 1 x Salami Sandwich @ 13.00hrs
After lunch reading = 16.00hrs 7.0 mmol
Before walking dog = 17.10hrs 4.8 mmol
1 x Apple 1 x Satsuma @ 17.15hrs
Walking the Dog @ 17.20hrs [1hr]
After Walking Dog = 18.15hrs 5.5 mmol
Dinner = Egg Salad & Salami Yogurt @ 18.30hrs
After dinner reading = 21.30hrs 7.6 mmol
Before supper reading = I expect 7mmol
Supper = None
Night reading = Usually between 9 and 11mmol

I just wondered if in conjuction with the DN we increased my daily Levemir to 18mmol [14 at the moment] the afternoon bs will be even lower. Should I really be on the daily regime or should I take a medium acting twice a day. I am my diabetic nurses first patient and she is still training.

I am so grateful for any help or advice offered and hope to contribute a lot to the forum in the future.

Regards John

 

[lilibet]

Hi John
Not an expert on meds but your numbers are still running a bit high in my opinion( hope ive not upset you by saying that) Im not very au fait with metformin (assume thats what it is) but it looks like something needs adjusting in the equation. You must feel rotten going up and down during the day

I would start with a change in diet if you can -maybe manage your carbs a bit more. Porridge has clearly given you a spike from 9 to 12 to 7 so what you need to do is watch what you eat, especially in the morning when most T2's are most insulin resistant (than usual). Im not sure if the timing of the metformin or strength needs to be looked at, you might find that helps before you put the insulin up. However, levemir can be split 2x though your 'best' readings seem to be at night so if you do, its likely you'll need a higher proportion of it in the morning.

However, if you intend on putting it up at all, always do it by a unit at a time, I wouldnt jump 4u-just adjust slowly.

There are billions onf T2s on here who can help but I would consider

Diet first
Then metformin
Then insulin

I happily stand to be corrected/contradicted by our fab T2s

L

 

[Trinkwasser]

You're starting off high in the morning (possibly Dawn Phenomenon) then your breakfast is shooting you higher. Later in the day you are getting better numbers.

How much metformin are you on? - this may need increasing

When are you taking the Levemir? It doesn't usually last 24 hours and may need two shots per day, and the dose tweaking (someone I know elsewhere gets a mere 7 hours out of Levemir, usually it lasts longer than that but seldom for 24 hours)

I'd go back to your nurse and discuss. Also see if you can drop some of the carbs out of that breakfast. Unlike Lantus Levemir seems to respond fairly quickly to dose adjustments so with some tweaking I'm optimistic you will get sorted.

 

[johnforster]

Thanks so much [both] for you help.

As regards Metformin I am on the maximum of 850mg three times a day. I have been looking at the daily profile for levimir and its effect starts to decrease after 10-12hrs so I think I could [with the help of the DN] either change the daily injection to late evening or as you suggest have two injections a day. I will sort out the carbs and then let other members know how I got on.

Kind regards - John

ps: My Before Breakfast today was 8.6 and I had two weetabix and two hours latter it was 13mmols.
mmmm. :|

 

[Dennis]

Hi John,

All breakfast cereals are very high in carbohydrate and will send your blood sugar high and, as Lilibet said, at the time of day when most people's bodies are least able to cope with a sudden carb overload. Try having a non-cereal breakfast, maybe something egg based (boiled, scrambled, fried, poached, omelette, and with bacon or tomatoes, or mushrooms, or all of them if you like!) plus a slice of toast. A single slice of even plain white bread toast will be less than a third of the carbs you are having with a cereal breakfast.

 

[johnforster]

Many thanks everyone.

I shall cut out the breakfast cereals then and am working on how to change my Once a day Levemir from taking it in the morning [at 6am] and moving it to 6pm. when I look at the graph over the last two weeks [since starting the Insulin] all my readings are high except between 2pm - 6pm. This is also a time I walk the dog.

I think by moving it to the evening [as NovoNordisk recommend] things will be much better. I do check my sugars at least every three hours at the moment so if there were lows in the night hopefully I'll know about it.

I shan't do anything without telling the DN.

All the best - John

 

[Trinkwasser]

Breakfasts

http://loraldiabetes.blogspot.com/2006/ ... fasts.html

mine are usually low carb high protein moderate fat, usually fish or meat with lashings of salad and a couple of buttered oatcakes

Levemir graph

http://wiki.diabetesdaily.com/wiki/Leve ... ersus_Dose

from which you'll see it is unlikely to last a day except at low doses

 

[johnforster]

Fantastic. What great sites.

Alan your site is great and prompts me to write my own. It has been really helpful and I printed off TEST TEST TEST etc. I've registered with the other forum too.

I have to say in all the time I have been T2 [10yrs or so] I have tried to eat healthily but since being put on insulin I have really looked hard at my old diet and decided it was rubbish.

SO, the NEW John is about to emerge.

I will keep this forum posted. Regards John

 

[Trinkwasser]

SO, the NEW John is about to emerge.

I will keep this forum posted. Regards John

That's the way to do it!

Have a look through the Stickies and Success Stories for more useful sources of information

(I'm not Alan, he's an old friend who put together a lot of advice that helped him, me and others too numerous to mention, he's dropped in occasionally but spends most of his time elsewhere)