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Question

Abonimus

Member
Messages
5
Type of diabetes
Type 1
Treatment type
Insulin
Hello this is my first post

I have a strange problem with my diabetes. I take Levemir and Novorapid and the problem is in the morning my sugar level is around 10 and it doesnt matter how much i take before breakfast my sugar level will rise after i eat. W/e i eat and as much Novorapid as i take makes no difference what so ever because 2h after my breakfast my sugar level is bound to me around 15. I tried switching spots where i take my insulin both novorapid and levemir and the ammount of it. Tried going to my doctor but she has no clue whats going on or what tests she should run.

Now i have a problem with my thyroid gland for a year now and its pretty much gone undiagnosed since my doctor thinks its not important. Also i dont live in the UK in live in Serbia and ye ... doctors are kinda terrible here and hospitals even worse.

Any and all help about what i should try or what tests i should run would be greatly appreciated!
 
Could be your basal insulin (Levemir) is not set at the right dose or your insulin-to-carb ratio needs adjusting. As your English seems to be very good, see if the following is useful in getting your insulin doses right:

http://www.bdec-e-learning.com/
 
Google dawn phenomenon. Blood sugars tend to rise for a couple of hours after waking. It's not fully understood, but a generally accepted theory is that your liver gets paralysed while you sleep. When you wake, it overcompensates and raises your blood sugars more than necessary. I offset this with a small dose of short acting insulin part way through the night. Make sure to test carefully before trying this, a night time hypo is crucial to avoid. You could also try varying your breakfast, and particularly avoiding carbohydrates to limit the effect on your blood sugars.
 
here is a Basal testing
http://www.diabetes-support.org.uk/info/?page_id=120

This set of workbooks are worth reading and practising working examples only of carbs and doses
Don't change dose without nurse approval
Workbook 1http://www.diabetesinscotland.org.uk/Publications/9225 Carbohydrate Counting.pdf
Workbook 2http://www.diabetesinscotland.org.uk/Publications/9226 Carbohydrate Counting the Next Steps.pdf

Carb listhttp://www.diabetesinscotland.org.uk/Publications/9227 Carbohydrate Tables A6.pdf

Diaryhttp://www.diabetesinscotland.org.uk/Publications/9228 Free Diary Portrait A4.pdf

Sick day ruleshttp://www.diabetes-healthnet.ac.uk...flet_-_Sick_Day_Rules_for_Type_1_-_Nov_13.pdf
Sick day rules flowcharthttp://www.leicestershirediabetes.org.uk/uploads//documents/Type1 Sick_day_rules_InsulinV3.pdf


A workbook with USA numbers and math rules, but it has a good trouble shoot at the endhttp://www.bd.com/us/diabetes/download/insulin_adjustment_workbook_complete.pdf
 
Ye i read about the Dawn syndrom but the other one as well. The Somodoyi Phenomenon.

It may be that my basal insulin is set wrong so it tends to put me in a small hypoglicemia during the night so my breakfast insulin gets ignored ?

P.S strange as it may sound my Levemir dose last the full 24 hours.

P.S.S will do the basal insulin testing tonight and see how it goes.
 
Hi. I agree that you need to get your Basal right first. As you blood is 10 on waking you probably need to have more Levemir until your morning reading is somewhere between 5 and 7. You should only adjust by a shot or two each day and testing to avoid a hypo. If you can get this balanced then as other's have said changing the NovoRapid ratio in theory should help. Are you overweight? If so try to reduce the carbs as insulin can work erratically if you have insulin resistance due to excess weight.
 
I tried increasing it and it never went down switching between 24 and 30 units.

Actually my HBA1C was a lot better when the basal insulin was close to 24 then now at 27
 


There's an explanation about the Somogyi Effect in the following:

http://www.diabetes.co.uk/blood-glucose/somogyi-phenomenon.html

Do you split dose your levemir, most people that use this insulin find that it doesn't last much more than 18 hours so spit the dose in two, test your bg over the next few nights and report back.
 

The trouble with the Somogyi effect is that although many people including doctors talk about, there isn't any real evidence that it happens. Now we have had the means to test using continuous monitoring, they have found that people who have undetected lows overnight have low morning levels ie levels may rise a little but not to very high levels (I've found that happened to me when using a monitor) , high fasting levels are normally associated with rising levels overnight . They can't discount Somyogi but If it does exist then it can't happen very often.
This is one such study where they found that fasting levels of less than 5 were indicative of hypos at night rather than high glucose.
http://www.ncbi.nlm.nih.gov/pubmed/23672623

Basal testing is the way to find out. Do make sure that you don't start within 5 hours of your evening meal injection and that you are at a reasonable level when you go to bed. Test during the night.
 
Will do phoenix tnx!

I dont split my Levemir dosage as it indeed lasts 24 hours for me. I tried adding another small dosage but there was no point since my sugar levels are high in the morning and after breakfast but low after lunch and before dinner.

When i did try to overlap i had a very very bad hypoglicemia and i aint trying that again!
 
So my sugar levels are ok before bed, and during the night but in the morning it starts going up just before i wake up. I reduced the Levemir dosade i take at 23.00 hours and it seems better this morning it was 8 before and after breakfast which is a step up.

Should i try moving levemir to 22.00 hours maybe? Will it possibly help in some way ?
 

The morning rise in bg is called the Dawn Phenomenon, there's an explanation about it in the following:

http://www.diabetes.co.uk/blood-glucose/dawn-phenomenon.html

Personally I can't see how reducing your basal insulin helped with your postprandial bg levels, the only explanation being that you started off on a lower bg level than normal, reducing it too much could make your bg rise during the day and you'd need to take corrective doses with your Novorapid.

Leave it as it is for now and monitor your bg levels for a few mornings, if your basal insulin is set at the right dose then your fasting bg levels should fluctuate much more than 1.7mmol.
 
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