Night time basal/DP

[samantha13]

I go to bed at around 7-7.5mmols and my DP starts around 3am and I wake up 14-18mmols. Now my DSN just tells me to increase my night time basal. Over the past 12 months it's gone from 16u to now 24u of levimer. I only take 6u in the morning. I feel compared to my morning dose this is a massive amount and I wonder how much more I'm going to have to increase it by to see results? I try to wake around 4 or 5am and inject a correction but I'm already exhausted with other issues atm so some mornings I just can't find the energy. Any advice? Should I just keep increasing?

 

[GrantGam]

You need to watch with dialling up your evening Levemir dose. Although it doesn't claim to have a peak, Levemir definitely does! Usually somewhere between 5-8 hours for me. Initially, I tried increasing my evening Levemir to combat DP and all that happened was I'd hypo in the wee hours and end up with a combination of a rebound high coupled with the already present effects of DP. The end result was worse than DP by itself...

There seems to be no way (personally speaking) for basal insulin to offset the effects of DP. The mechanics behind the way that basal insulin works backs that up too. Some people try to time their evening dose so that the peak occurs around the same time as DP starts to set in and have semi decent results. That may work in very mild forms of DP but isn't an option for me. The only way I can get round it is to either never lie in and bolus on waking - or wake up, bolus and go back to sleep. Both are a total pain but the only real way to work around DP whilst on MDI...

I don't know if you're using or have ever tried the Libre system, but it's really handy for monitoring your overnight BG trends. It helped me set my basal correctly and most importantly, find out that simply dialling up my evening basal dose was causing severe rebound highs. It's not cheap but can really help you work out the best doses and timings for your basal.

 

[eventhorizon]

I have similar. I found moving my nighttime basal shot to the last thing before bed 2330 to 2400 ish seemed to work. And taking a small bolus first thing on waking helped smooth things.

 

[Kristin251]

I find the same. Taking more basal just makes me go hypo. I dose for bf right after getting up, wait 10 min to eat, eat no carbs at bf then take a small bolus one hour later to stop any further rise. If I take it all at bf I go low then pop up. It's my version of a pump haha. But it works.

 

[samantha13]

You need to watch with dialling up your evening Levemir dose. Although it doesn't claim to have a peak, Levemir definitely does! Usually somewhere between 5-8 hours for me. Initially, I tried increasing my evening Levemir to combat DP and all that happened was I'd hypo in the wee hours and end up with a combination of a rebound high coupled with the already present effects of DP. The end result was worse than DP by itself...

There seems to be no way (personally speaking) for basal insulin to offset the effects of DP. The mechanics behind the way that basal insulin works backs that up too. Some people try to time their evening dose so that the peak occurs around the same time as DP starts to set in and have semi decent results. That may work in very mild forms of DP but isn't an option for me. The only way I can get round it is to either never lie in and bolus on waking - or wake up, bolus and go back to sleep. Both are a total pain but the only real way to work around DP whilst on MDI...

I don't know if you're using or have ever tried the Libre system, but it's really handy for monitoring your overnight BG trends. It helped me set my basal correctly and most importantly, find out that simply dialling up my evening basal dose was causing severe rebound highs. It's not cheap but can really help you work out the best doses and timings for your basal.

Yeah that scares me so each time I ring my dsn to discuss it she tells me to go up another 2u. I'm scared to go up anymore. I've my consultant app on Tues I'll see what he advises but looks like it'll just be early starts for me unless I get the pump. I love my sleep is the problem lol

 

[GrantGam]

Yeah that scares me so each time I ring my dsn to discuss it she tells me to go up another 2u. I'm scared to go up anymore. I've my consultant app on Tues I'll see what he advises but looks like it'll just be early starts for me unless I get the pump. I love my sleep is the problem lol

There is always the possibility that you simply need a lot more basal overnight than during the day, a lot of us do. However, unless you use some form of CGM or FGM, it's very hard to monitor your overnight BG readings wrt your increased basal dose. But from what you've described, it sounds very much like DP.

Sure you can overnight basal rate test with a conventional BG meter, but my BG rises when I wake up so that method of testing has never been conclusive for me... You may be different though so it's always worth a go!

By the sounds of things, we're in an identical situation. If I get up really early (6am for example), I can catch my BG anywhere between 5-9mmol/l and bolus for the rise which I experience once I jump out of bed. If I have even a small lie in, I can be up around 15+mmol/l. I then have to correct the high and apply a bolus for the inevitable rise which I'll get as soon as I start moving around. I just can't seem to find the energy to do a 4/5am bolus, and for that reason I don't. You're not alone @samantha13 - my DP has completely destroyed my HbA1c. I've gone from 39mmol/mol to an estimated 51mmol/mol in less than a year...

 

[samantha13]

This was last night but woke to correct around 5am and had a lie in. I might try and increase by 2u tonight. It just seems an awful lot in comparison to my daytime dose but hey I'll try anything! Thanks for your replies.

 

[GrantGam]

This was last night but woke to correct around 5am and had a lie in. I might try and increase by 2u tonight. It just seems an awful lot in comparison to my daytime dose but hey I'll try anything! Thanks for your replies.

What time do you take your evening Levemir? Looks like classic DP as far as I can see, so I'd imagine even altering your basal injection times probably won't help unfortunately...

 

[jonniey]

Use lantus is better than levemir. I use 13 lantus morning and 6 lantus evening ....so that's a ratio of 2:1 or a fraction of 2/3 and 1/3 lower dose at night.

 

[jonniey]

I used levemir lantus and protaphane.....and lantus is the best it's peakless and it has a better effect than levemir..... ALWAYS mix your lantus never SHAKE though.

 

[jonniey]

When I used to use 1 dose of lantus in the morning, at about 2am the next morning my levels started to go up.... meaning if you use it at night levels will start to rise 6 or 4 hours before the time you usually inject.....well depending on the duration lantus lasts for I even think its just 18 hours.