help!

[bev]

HI all,
The other day i decided to split the levemir because Alex was having high levels from early evening right through until morning. Waking on awful numbers like 18 and 22!

I did this because i had asked his team weeks and weeks ago about what to do and they didnt bother getting back to me so i took the decision myself that the levemir was running out and causing the highs.

Anyway, this lunchtime he was 2.9 - and i am wondering whether you think this is anything to do with me changing the levemir? Of course it could be coincidence - but his DSN is off on fridays right through until mondays - so i cant get any help there!

He was having 7.5 units at 9pm at night. I have changed it to 4 units at 8.30pm and 3.5 units at 8.30am. Any advice would be appreciated thankyou. 🙂Bev

 

[Patricia]

Bev, you may need to lower his breakfast ratio a little ultimately, but if I were you I'd see what level he is at 3am ish and keep track of waking levels to see if the evening/morning split is right? You may find that he needs more in the evening dose, which may take just enough off the morning dose to avoid a lunch hypo.

I am pretty sure we did adjust ratios slightly when we split though. It makes sense.

As for general proportions evening/morning, we ended up on 9 units morning, 12 units evening -- though when we first split, they were virtually even (maybe one more on evening). I've heard though of people almost reversing the proportion for some reason, with more given in the day, less at night.

I'm sorry you seem to have such a struggle with your team sometimes. Makes me feel very lucky!

 

[Mand]

Perhpas it was just coincidence and not the split of Levemir. My son's dsn always recommends three consecutive readings before making any changes. So in your case she would recommend giving it another morning or two to see if there is a pattern because one off readings cannot be trusted as so many factors come in to making their levels too high or too low.

We have never done the split dose of long acting so cannot advice you further but do let us know how things go. 🙂

 

[sofaraway]

remember one reading isn't a pattern,

has the split helped with the high's from evening and fasting readings?

 

[bev]

Morning all!

Alex's levels on waking are still crazy - this morning he was 19.2!!!!!!!
He was 8 last night at 12 o clock - so it doesnt look as if this has helped with the night time rise. However, it has helped with the late afternoon early evening high levels - so there has been some benefit.

Anyone who has the ragnar hanas book, could you please have a look and see what it says about the levemir split? Sorry to ask but we have only just ordered ours and it wont be here until monday probably.Thanks.🙂 Bev

 

[insulinaddict09]

Hi Bev has Alex hypoed in the night and thats why he was high first thing ? I know that has been my problem quite often ? I hope things settle down for you both soon xx🙂

 

[bev]

Hi A.M. - I dont think it is hypo's he is having as we spent a week testing him through the night - he just seems to be steadily rising. I am thinking it is the 'dawn phenomenon' - and if it is i am not sure how on earth we can sort that out as i would be worried to correct him just in case that particular night it doesnt happen! Flippin diabetes.Bev

 

[mikep1979]

hi bev just a thought but is it the levemir not working for him???? i know before i got changed onto the lantus i was constantly getting bad morning readings. since i got changed it is a load better. maybe it is worth looking into it being his insulin and not the doses. but as some have said you need to give it 3 days to work into his system before seeing the reall results

mike

 

[insulinaddict09]

Hi A.M. - I dont think it is hypo's he is having as we spent a week testing him through the night - he just seems to be steadily rising. I am thinking it is the 'dawn phenomenon' - and if it is i am not sure how on earth we can sort that out as i would be worried to correct him just in case that particular night it doesnt happen! Flippin diabetes.Bev

Ah poor Alex , I do know the feeling though !!! Sometimes we all get rogue highs for seemingly no reason. I went to bed last night in 11.0 and woke to a 21.9 😱 I am assuming that Ive hypoed in the night and kicked out some Glucose !!! I hate high morning readings they mess you up for the whole day. Have you discussed this with Alex's DSN ? How long ago is it now since you swapped to a split dose Levemir ? Ive not long split my dose as it was only lasting 18ish hours , It took about a week and I've noticed a big difference in levels. I do think I still need to higher my Basal though but will do that 2 units at a time . What sort of levels does Alex go to bed at ? When I first went on Levemir if I went to bed under 9.0 I would be hypo by 3-6 am every morning .I hope things get back to normal for you soon xx🙂

 

[bev]

He normally goes to bed on 7 or 8 - then when we check at 12ish he is approx 12 or 13 - then he rises until waking on high levels!

I split the dose on wednesday - but we havent had a good mornng level since then - it is the same as it was before.

Our dsn takes weeks to get back to us so i decided to just go ahead and do it myself. She had mentioned about lantus - but someone has told me that it can sting and also that your more prone to hypo's in the night - i am not sure if this is true or not? I just wasnt keen to swop one set of problems for another!Bev

 

[insulinaddict09]

He normally goes to bed on 7 or 8 - then when we check at 12ish he is approx 12 or 13 - then he rises until waking on high levels!

I split the dose on wednesday - but we havent had a good mornng level since then - it is the same as it was before.

Our dsn takes weeks to get back to us so i decided to just go ahead and do it myself. She had mentioned about lantus - but someone has told me that it can sting and also that your more prone to hypo's in the night - i am not sure if this is true or not? I just wasnt keen to swop one set of problems for another!Bev

Hi Bev , I had a problem with Lantus , my levels were rising even when my dose had nearly been doubled . Maybe as Mike says the Levemir is just not working for Alex ? I swapped from Lantus to Levemir with no ill effects at all , apart from a smaller dose [half] I think Levemir tends to sting more than Lantus did , also Lantus tends to last the full 24 hours without a peak . Maybe it is worth looking in to if things dont improve with the levels. Is Alex worried or stressed over anything at the moment ? that can cause a lot of rises in levels , I on the otherhand tend to burn glucose with nervous energy and end up hypo.

 

[bev]

Thanks A.M.,

I dont think he is worried about anything at the moment - his exams are finished and they are just winding down at school ready for the summer holidays!
Actually it could be that when he went to his new secondary school for the afternoon to meet with all the other new children - he was a bit dissapointed that there were no 'hotties'!!!!!!!!!He is only 11 and already checking out the girls! Bev

 

[insulinaddict09]

Thanks A.M.,

I dont think he is worried about anything at the moment - his exams are finished and they are just winding down at school ready for the summer holidays!
Actually it could be that when he went to his new secondary school for the afternoon to meet with all the other new children - he was a bit dissapointed that there were no 'hotties'!!!!!!!!!He is only 11 and already checking out the girls! Bev

He he he nice one Alex 🙂

 

[sasha1]

Hi Bev,

I had similar problems with Nathan when he was on Levemir..even after splitting the dose...He then required massive more amounts of long and short acting..He was then changed on to Latnus....It may be as Mike said..Levemir might not be suited to Alex.. But it could also be down to hormonal changes in Alex..Its a difficult one..when is Alex next due to see his consultant??? It may be that you need to address this with him rather than the DSN.. Also having just looked in my bible I'm going to type what it says about the Dawn and Somogyi Phenomenons...I am sure you are aware and well informed about them..but it might help you.

Dawn Phenomenon: Blood glucose levels rise early in the morning because of the so called dawn phenomenon which occurs in 80 - 100% of adults with type1 diabetes. This effect is caused by an increased secretion of growth hormone raising the blood glucose late in the night and early in the morning. The dawn phenomenon increases the bg by approx 1.5-2mmol/l (25-35 mg/dl) compared to the bg at midnight when adequate amounts of insulin are supplied throughout the night. A high morning bg is a common problem for growing children, especially during the later part of puberty when the growth spurt is at its peak. It may be difficult to tailor the insulin regimen to match the need of increasing levels in the morning. Lantus or an insulin pump can be good alternatives in this case. Younger children who go to bed early tend to their highest need for basal insulin earlier in the night (often before midnight).

Somogyi Phenomenon: If you bg is low at night, you are likely to sleep without noticing it. However, the secretion of counter-regulating hormones in your body can result in a rebound phenomenon with a rise in bg to high levels in the morning if the level of insulin in the blood is low. If you have'nt recorded low bg value in the middle of the night, you may believe that your bed time insulin needs to be increased. A higher dose of bedtime insulin the next night will give an even lower bg level and a more intense rebound effect, resulting in an even higher bg level the following morning. You can easily end up in a vicious cycle.
If your morning bg is sometimes low and sometimes high, it may be because you have problems with the somogyi phenomenon. Some nights your bg might be low enough to start the rebound phenomenon, causing the morning bg to be high. On other nights the bg will not be low enough to trigger the rebound phenomenon and the bg will subsequently lower.
The Somogyi phenomenon has been questioned over the years, but consensus today is that it is mainly seen in individuals using lee intermidate and lond acting insulins ( such as multiple injection therapy and insulin pumps) resulting in a lower level of insulin in the blood in the morning before waking. These people also have a higher than normal rise in the bg after breakfast following night time hypoglycaemia.

Note at bottom of Page: Different factors influence the bg level during the night and in the morning. The dawn phenomenon depends on the night time secretion of growth hormone and the somogyi phenomenon is a night time rebound phenomenon. The insulin waning effect depends on the pharmacological properties of the intermidate-acting insulins used for bed time injections. Long-acting insulins (Lantus, Ultratard, Humalin Zn) do not have this disadvantage. In one study looking at adolecents, the risk of night time hypoglcaemia decreased by 43% after switching to once-daily Lantus at bedtime.


Hope this helps
Heidi
🙂

 

[bev]

Wow thanks Heidi! That must have taken you ages to type! Thankyou so much - it does seem that changing to lantus may help to solve the problems.
He is due at clinic in a couple of weeks - but i think i will be ringing them tomorrow as he cant go on like this waking at 22!
I am wondering whether to increase his levemir tonight - and if so - by how much? He is only on 4 at night and 3.5 in the morning. Perhaps i could start by increasing by 1 unit? I wish the dsn had a 24 hour helpline!
Thanks again Heidi and all who have replied to this post!🙂Bev

 

[sasha1]

Wow thanks Heidi! That must have taken you ages to type! Thankyou so much - it does seem that changing to lantus may help to solve the problems.
He is due at clinic in a couple of weeks - but i think i will be ringing them tomorrow as he cant go on like this waking at 22!
I am wondering whether to increase his levemir tonight - and if so - by how much? He is only on 4 at night and 3.5 in the morning. Perhaps i could start by increasing by 1 unit? I wish the dsn had a 24 hour helpline!
Thanks again Heidi and all who have replied to this post!🙂Bev

Hi bev,

What is alex's reading when going to bed?

Heidi
🙂

 

[insulinaddict09]

Heid thanks for that post babe , you have answered a lot of my questions in one go thank you !!!!!!! 🙂🙂🙂🙂

 

[sasha1]

Heid thanks for that post babe , you have answered a lot of my questions in one go thank you !!!!!!! 🙂🙂

No worries hun...Just glad I've been able to help

Heidi
🙂

 

[bev]

Hi Heidi,
He is normally an ok level like 7 or 8 - but if he is lower like 5 or 6 he will have some milk and 1 x biscuit. But mostly he is 7 or 8 and doesnt have a snack.🙂Bev

 

[sasha1]

Hi Heidi,
He is normally an ok level like 7 or 8 - but if he is lower like 5 or 6 he will have some milk and 1 x biscuit. But mostly he is 7 or 8 and doesnt have a snack.🙂Bev

Hi bev..

This is what I would do if it were nathan, going to bed at 7 or 8 is perfect...
I always try to have nathan in that range...as studies have shown it decreases the risk of night time hypo's...I would let nathan have a small slice of toast..and increase by 1 or 2 units...when nathan was on levemir I would work in 2's...but since on lantus I tend to work in 1's.
This is only my opinion and what I would do bev...you need to do what you feel comfortable with...I would'nt increase the morning dose of levemir though..just for the mo..Hope this helps.
I also agree with you bev..If you can get Alex an earlier appointment with the consultant...not just for alex..but yourself..I understand how worried you must be...
Heidi
🙂