A Question

[allisonb]

I'm sure that with some of the knowledge that you all have someone will be able to answer this for me...........

I have been having lots of problems with high morning blood sugars in the last few months. Today is a prime example, went to bed at 7.2 and woke up at 14.7. I've fiddled with my bolus and basal and have recently changed from insulatard to levemir to avoid a spike. I am now thinking that, as I usually eat quite late, 9pm sometimes, when I go to bed and take my levemir there is obviously still some fast acting in my system (I have novorapid) and the two combined are dropping my BS and making me hypo which is leading to highs in a morning? I am wondering if anyone knows of another quick acting insulin that spikes earlier than novorapid and perhaps doesn't hang around as long?

Any suggestions would be appreciated.

 

[Steff]

hi alison i cant answer the insulin question as im not on it , but i have the same prob i also eat a snack about 9.30 and im wondering if im eating to late

 

[Copepod]

Have you considered splitting your long acting into 2 doses, morning and evening? Might be worth asking your diabetes team about this.

 

[Caroline]

Can't advise on the insulin, but might be worth checking carb content of your late meal and adjust accordingly.

 

[Tezzz]

Can't advise on the insulin, but might be worth checking carb content of your late meal and adjust accordingly.

I agree with Caroline. If I have too many carbs in my evening meal my morning blood glucose is a lot higher than the trend.

 

[aymes]

I don't know of a quicker insulin, novorapid is pretty quick acting really.

In theory the novorapid should have finished doing what it should do in 5 hours so if it was me and I was eating at 9pm I'd set an alarm to do a blood test at about 2am for a few nights to get a good reading of where you are following your evening meal. If it's high at that stage and stays so through to the morning it's likely your basal is right and maybe you need to look at your ratios in the evening. If you're at a good level at 5 hours post meal but rising by morning you'd need to investigate a bit more, could be basal is too low, too high (causing hypos and a rebound) or the dawn phenomenon.

 

[Northerner]

I sometimes eat later than normal and have NR in my blood still when I go to bed. I think you need to be confident that you are dosing correctly for the meal and learn what level you can go to bed on - for example, it might be 8.5, but still falling back to 6-ish. If you were 5.5 at bedtime, then you'd need a snack to avoid the risk of hypo. After many months I have also managed to get my basal at the right level - it's lantus and shouldn't spike, but I reckon in me it does, a couple of hours after taking it. I've had hypos in the night, but never woken with high sugars - I've been low sometimes, but never above 7.

 

[bev]

Alexwasthe same as you - waking up really high after going to bed one a good level - 8mmols - waking up 20!!!!!!!

So we tested through the night for a week (3am) and found that he was just steadily rising - no hypo's. So we split his dose of levemir as we think it was running out before the 24 hours and also the dawn phenomenon!
So far it has brought him down from 22 to 13 - so we still have a way to go - but we are doing it very slowly - half a unit every couple of nights - until we reach anything under 10!
But dont change anything yourself unless you have spoken with your dsn.🙂Bev

 

[allisonb]

I'm already on a split dose of Levemir so maybe some regular testing during the night is the answer to see what is happening and if I'm going low and bouncing back up, which would mean less quick acting at tea time, or just steadily going up, which would mean more Levemir before bed. Just finding it very frustrating!

 

[randomange]

I was told that humalog is slighly faster thatn novorapid, and apidra is slightly faster again.

I agree with aymes, I think it would be a good idea to check at about 2-3 am. That way you'd have more of an idea as to what is happening.

Do you feel like you've gone low in the night? I usually find that I wake with a headache and feeling a bit rubbish if it's happened, and I know some people get the same thing.

 

[Adrienne]

Hi

Have you thought about changing the levemir to Lantus. They are both long acting but the reason you have split the levemir is because it only lasts about 16 odd hours in reality. Lantus lasts longer and works differently in different people. It can last up to 22 hours. My daughter had Lantus and that worked for her. Other people I know swapped from levemir to Lantus and that worked but on the flip side some people don't like Lantus and swap to levemir.

Sounds like the dawn phenomenen is kicking in where you go high in the morning. Have you thought about a pump, it would solve that problem.

I agree with the others and look at what sort of food you are having as a snack that late at night. Could be that you need non carb foods instead. Worth a try.

 

[NiVZ]

Hello,

Everyone else has already given you plenty of good tips, but also wanted to add that you might want to try eating a bit earlier a couple of nights to try and get a better picture of whats happening and also 3am testing will help.

Ideally you should have eaten and taken fast insulin 4 hours before you check your bedtime BG reading to ensure all your fast insulin is out of your system. That way it's only the slow insulin thats active. Then compare your bedtimg BG to your morning reading which should hopefully only be +/- 2 mmol.

It's not easy, I know. I often eat after 7pm and have also had to do 3am tests to see whats going on with slow insulin

Let us know how you get on.

NiVZ

 

[allisonb]

Well my theory has been proved right. I've had several carb free evening meals in the last week and have been fine overnight and woken with good levels but when I have novorapid I seem to hypo overnight, even when I have less than I need for the carbs I eat. This is also happening during the day, my BS is good two hours after a meal but drops steadily over the next few hours which is leading to several hypos. So, have been to see my DSN this morning and have changed from Novorapid to Humalog. Will see how it goes. Have also got a memoir pen that I've seen mentioned on here before, which tells you the last time you had insulin. Should solve those blonde moments when I can't remember if I injected or not.