Spikes

[AnnS]

I often find it difficult to remember to take my QA insulin (Fiasp) at least 15mins before meal. Is this the reason I seem to spike a lot? Also morning glucose before breakfast is high. Take 10 units levemir at bedtime. I was on 12 but had hypos in night. Not always a saint when it comes to eating. Count carbs and avoid between meal snacks.

 

[trophywench]

So - only ONE jab of Levemir?

And - why Fiasp? What else have you tried?

 

[Inka]

Hi @AnnS Yes, ideally you should take your bolus insulin at the appropriate time to avoid a spike. Do you take Levemir in the morning too? For your nighttime Levemir, if 12 units made you hypo and 10 makes you high in the morning, have you tried 11units? Also, what time do you take your evening Levemir?

 

[helli]

@AnnS do you know if your levels continuously rise throughout the night or start to rise in the early hour?
The reason I ask is "Dawn Phenomenon" - our livers helpfully dump glucose into our blood to give us energy to start the day.
If this is the reason for your high waking level, increasing your basal insulin will be less helpful - you are more likely to hypo before the liver dump.
Unfortunately, the only way to tell is to set an alarm at around 2 or 3 o'clock to check your levels ... unless you have a CGM or Libre
It could be worthwhile applying for the Libre trial of you don't have one. Checkout their website, if I remember correctly, the free trial is pretty obvious.


With regards to your Fiasp timing, when you say you "spike slot" does your level return to normal levels after the spike? And how high do you spike?
Even people without diabetes will spike when they eat. Depending upon the meal, they can spike to around 9mmil/l. If this is what you are are seeing, I would not stress. Our levels are not supposed to be flat all the time.

 

[trophywench]

I used to hypo during the night at first with Levemir - then someone told me to try taking it earlier so from then I did that and brill - so I took it when I got up for work - around 7 to 7.30am and approx 9.30 to 10pm instead of bedtime at 11-11.30pm.

 

[rebrascora]

I take my Levemir 7am and anywhere between 10.30pm and 1am. I need much less at night. Currently 22 units in the morning and 8 in the evening and that is balancing me really nicely just now. It is bliss when you get your basal doses right! It takes a bit of trial and error to find what works for you, but absolutely worth the effort.
They officially advise that you split it 12 hours apart but it works better for me when I wake up and go to bed, both balance wise for my basal needs and logistically.

 

[AnnS]

So - only ONE jab of Levemir?

And - why Fiasp? What

Hi @AnnS Yes, ideally you should take your bolus insulin at the appropriate time to avoid a spike. Do you take Levemir in the morning too? For your nighttime Levemir, if 12 units made you hypo and 10 makes you high in the morning, have you tried 11units? Also, what time do you take your evening Levemir?

Tend to take when I go to bed anytime between 10.30 and 12

 

[AnnS]

So - only ONE jab of Levemir?

And - why Fiasp? What

@AnnS do you know if your levels continuously rise throughout the night or start to rise in the early hour?
The reason I ask is "Dawn Phenomenon" - our livers helpfully dump glucose into our blood to give us energy to start the day.
If this is the reason for your high waking level, increasing your basal insulin will be less helpful - you are more likely to hypo before the liver dump.
Unfortunately, the only way to tell is to set an alarm at around 2 or 3 o'clock to check your levels ... unless you have a CGM or Libre
It could be worthwhile applying for the Libre trial of you don't have one. Checkout their website, if I remember correctly, the free trial is pretty obvious.


With regards to your Fiasp timing, when you say you "spike slot" does your level return to normal levels after the spike? And how high do you spike?
Even people without diabetes will spike when they eat. Depending upon the meal, they can spike to around 9mmil/l. If this is what you are are seeing, I would not stress. Our levels are not supposed to be flat all the time.

No my levels spike early morning. My levels after meals can spike higher than 9 then drop sometimes dramatically.

 

[helli]

No my levels spike early morning. My levels after meals can spike higher than 9 then drop sometimes dramatically.

I wonder if Fiasp is related to your spikes and drops.
I find the speed at which it works depends on my starting levels.
If my levels are in the 4s or 5s, Fiasp works very fast. i do not need to pre-bolus.
if my levels are in double numbers, Fiasp can take over an hour to work and then suddenly plummets.

 

[trophywench]

Levemir was never designed to be 'one jab and it lasts all day and night' - always supposed to be 2 jabs - the dosage of it and how long it lasts depends on how much of it your TDD works out at, per kilo.

Time active is usually between 12 and 18 hours, ish.

In any event - waste of time fiddling about with bolus insulin unless your basal insulin dose(s) is as **** on over the 24hrs as it possibly can be. Fiasp isn't usually tried until people have had some trouble with eg Novorapid or Humalog. Hence why I asked.

Do a basal test - which will take you a week or so if you do it properly, 6-ish hrs at a one day, miss a day, 6-ish different hours the next day, etc.

 

[Inka]

Tend to take when I go to bed anytime between 10.30 and 12

So can you confirm you’re only taken Levemir ONCE a day? If so, that’s probably part of your problem. It’s a twice daily insulin.

If you are taking it twice a day, then I’d try experimenting with taking it earlier. I’m on a pump but when I have a pump break I use a twice-daily basal and take it around 9/9.30pm. I had to experiment a bit, but you’d be surprised how much of a difference an hour or two or so can make.

 

[helli]

Levemir was never designed to be 'one jab and it lasts all day and night' - always supposed to be 2 jabs - the dosage of it and how long it lasts depends on how much of it your TDD works out at, per kilo.

What's TDD?

Fiasp isn't usually tried until people have had some trouble with eg Novorapid or Humalog.

Are you sure of that?
Why would someone newly diagnosed not be offered the benefits of faster acting insulin from the start?
It's not as if we have to go through the full insulin back catalogue to get to the one most suited to us.

 

[Inka]

TDD= total daily dose, I assume @helli

 

[helli]

TDD= total daily dose, I assume @helli

@trophywench comment made me think it was something you calculate and input into some algorithm to work out how long Levemir will last.

 

[Inka]

@trophywench comment made me think it was something you calculate and input into some algorithm to work out how long Levemir will last.

Yes, there’s a graph somewhere online (sorry, googled, but couldn’t find it) that shows how Levemir lasts, depending on the dose you take (low dose lasts a shorter time) and the dose in relation to body weight too, if I’m remembering correctly.

 

[SB2015]

I certainly find that if my levels are higher I need more bolus insulin to do the same work.
I found it worked for me with two markers in my Bg, above which I increased my
bolus by 20% or by 40%.

In the sick day rules or high BG rules this is also reflected in the instructions
to increase basal and bolus.

 

[Robin]

@trophywench comment made me think it was something you calculate and input into some algorithm to work out how long Levemir will last.

Yes, there’s a graph somewhere online (sorry, googled, but couldn’t find it) that shows how Levemir lasts, depending on the dose you take (low dose lasts a shorter time) and the dose in relation to body weight too, if I’m remembering correctly.

This one, I think.

Levemir – detail « Diabetes Support Information Exchange

www.diabetes-support.org.uk

 

[Inka]

This one, I think.

Levemir – detail « Diabetes Support Information Exchange

www.diabetes-support.org.uk

Thanks @Robin That’s the one 🙂

 

[PattiEvans]

This one, I think.

Levemir – detail « Diabetes Support Information Exchange

www.diabetes-support.org.uk

It looks a bit daunting, but in fact it’s fairly easy. You divide the number of units of Levemir you take by your weight in kilos. Then look along the lines to see how many hours it will last.

 

[helli]

It looks a bit daunting, but in fact it’s fairly easy. You divide the number of units of Levemir you take by your weight in kilos. Then look along the lines to see how many hours it will last.

Just to clarify: it is only the basal insulin that needs to be considered?
The comments above suggested that it was the total daily insulin (including bolus).