Insulin levels

[Colt]

Just to add my agreement to others who’ve suggested you’d be best splitting the Levemir. It’s usually taken twice daily. The split doesn’t have to be equal.

Do you have a minimum glucose level to aim for before you go to bed? 8mmol is common but others aim for 10mmol. Do you have a bedtime snack? Could your lows be connected to poor absorption of your food?

For instance last night when going to bed my level was greater than 12 woke up 3.30am and it was 2.3….??

 

[trophywench]

So - how long is it now? - cos doses don't stay the same for ever anyway - you get em right now, then life happens, so the body's needs change.

 

[rebrascora]

For instance last night when going to bed my level was greater than 12 woke up 3.30am and it was 2.3….??

That doesn't surprise me at all, taking all your Levemir at night. Just amazed you haven't had problems before now.

 

[trophywench]

Approx 2-30 to 3-30am is when the human body experiences its lowest natural BG (in the past, not for nothing did med students doing night shifts in A&E during their usual rotation always dub it the suicide hour ...) so if that happens to coincide with the time the infused basal insulin reaches its peak that = trouble, stands to reason and QED. Just what I was scared of .....

Far be it from me - BUT try even less ..... but STILL try and get expert advice on splitting it before you're very much older.

Please!

 

[Colt]

My op was in 2003….

 

[Colt]

I am 62 years old and weigh 72kg

 

[helli]

It is never a great idea to change insulin doses by more than 10% at a time

I have never heard this - I was advised to reduce my basal by 20% following exercise and have been doing so for years to avoid night time hypos after sport. I now have a post-exercise basal rate on my pump at this level.
I wonder what is the reason for the 10% advice?

 

[Inka]

For instance last night when going to bed my level was greater than 12 woke up 3.30am and it was 2.3….??

Probably because you’d just taken a big dose of Levemir. I’d advise you to discuss splitting it, but for now I’d reduce your one dose even more. You can’t risk nocturnal hypos like that.

 

[PattiEvans]

Hi @Colt I think I can see what's happening. It would appear that you are taking approx .69u of Levemir per kilo of weight (going on the 50 units you originally mentioned), the higher the dosage per kilo the longer Levemir will last (as you can see from the graph below). It looks as though the Levemir could be lasting over 24 hours for you and therefore it could well be overlapping with the next dose just when that is at it's peak, thus the hypo in the night.

As the others have said, basal doses aren't set in stone. I have to adjust mine at least once every 3 months if not more often. Also as the others have already said, Levemir is recommended by the manufacturers to be administered in two doses... though many in the medical profession (especially at GP level) don't seem aware of this.

Are you aware of how to do a basal test to see what your basal insulin is actually doing throughout the day? Trouble is a lot of us are initially told what doses to take and no one tells us they need adjusting nor how to do it. I found a couple of books really helpful. One was "Think like a Pancreas" by Gary Scheiner, the other (somewhat more dense) was "Using Insulin" by John Walsh. I know members on here recommend a book by Ragnar Hanas called "Type 1 in Children, adolescents and young adults". I know you don't fall into that category but I believe the book is excellent. Now you are retired hopefully you will find the time to read them 😉.

 

[Colt]

Hi @Colt I think I can see what's happening. It would appear that you are taking approx .69u of Levemir per kilo of weight (going on the 50 units you originally mentioned), the higher the dosage per kilo the longer Levemir will last (as you can see from the graph below). It looks as though the Levemir could be lasting over 24 hours for you and therefore it could well be overlapping with the next dose just when that is at it's peak, thus the hypo in the night.

As the others have said, basal doses aren't set in stone. I have to adjust mine at least once every 3 months if not more often. Also as the others have already said, Levemir is recommended by the manufacturers to be administered in two doses... though many in the medical profession (especially at GP level) don't seem aware of this.

Are you aware of how to do a basal test to see what your basal insulin is actually doing throughout the day? Trouble is a lot of us are initially told what doses to take and no one tells us they need adjusting nor how to do it. I found a couple of books really helpful. One was "Think like a Pancreas" by Gary Scheiner, the other (somewhat more dense) was "Using Insulin" by John Walsh. I know members on here recommend a book by Ragnar Hanas called "Type 1 in Children, adolescents and young adults". I know you don't fall into that category but I believe the book is excellent. Now you are retired hopefully you will find the time to read them 😉.

View attachment 19301

Many thanks for the advice and will look at the books

 

[Colt]

Many thanks for the advice and will look at the books

I don’t know how to do a basal test, will these books point me in the right direction

 

[rebrascora]

You also might benefit from dropping your Levemir injection back to bedtime rather than 6pm. It is currently peaking at 8-10 hours in, on the dosage you are taking, which means you get the most insulin release from it between 2 and 4am ie. the time most people need the least amount of insulin, so if you took it at 10-11pm, even continuing with a single dose, that would push the peak of insulin release and mean that it was giving it's peak of activity at 8-9am in the morning when people tend to need it more.

I appreciate we might be overloading you with info at the moment and some of it may not make sense to you yet, but your insulin regime needs a major overhaul and not just reducing the dose, so if that review is not with a hospital team, please do push for a referral and ask about an education course like DAFNE.

You can however learn a massive amount from the forum and from books in the mean time, but to me your current situation is dangerous and needs input from a specialist, not your GP. I hope the reduction improves things but I would agree with the others that a bigger reduction might be wise.

 

[Colt]

You also might benefit from dropping your Levemir injection back to bedtime rather than 6pm. It is currently peaking at 8-10 hours in, on the dosage you are taking, which means you get the most insulin release from it between 2 and 4am ie. the time most people need the least amount of insulin, so if you took it at 10-11pm, even continuing with a single dose, that would push the peak of insulin release and mean that it was giving it's peak of activity at 8-9am in the morning when people tend to need it more.

I appreciate we might be overloading you with info at the moment and some of it may not make sense to you yet, but your insulin regime needs a major overhaul and not just reducing the dose, so if that review is not with a hospital team, please do push for a referral and ask about an education course like DAFNE.

You can however learn a massive amount from the forum and from books in the mean time, but to me your current situation is dangerous and needs input from a specialist, not your GP. I hope the reduction improves things but I would agree with the others that a bigger reduction might be wise.

Thankyou

 

[PattiEvans]

I don’t know how to do a basal test, will these books point me in the right direction

See the .pdf on my previous post Colt. Instructions there.

 

[trophywench]

I don’t know how to do a basal test, will these books point me in the right direction

The pdf which Patti put at the end of her reply, gives the method.

I have never heard this - I was advised to reduce my basal by 20% following exercise and have been doing so for years to avoid night time hypos after sport. I now have a post-exercise basal rate on my pump at this level.
I wonder what is the reason for the 10% advice?

That advice you had was specifically for post exercise. When we need to adjust dosages for either fast or long acting insulins for any of the other many random reasons we may need to do so, like Colt right now, 10% max at a time. If it ain't enough, do it again. If it's too much give it a couple of days for the body to calm down again, then try less.

 

[Colt]

See the .pdf on my previous post Colt. Instructions there.

saw it

 

[Colt]

Hi had a couple of bad overnights and spoke to GP again yesterday and agreed splitting the dose 50/50 was best way forward so took 50%last night and had no issues and then 50% this morning but whilst I did go low late morning I have been so much better. He did think I may have an issue so will continue with this strategy over next couple of days and possibly tweak the dose levels as I monitor the data.

 

[Inka]

Great news @Colt ! Not only will this help you reduce hypos, you’ll find it more flexible to be able to adjust each dose to your needs. Many people find they need a split that’s 60/40 or 40/60 or 70/30 or other variations too.

Here’s to less hypos 🙂

 

[everydayupsanddowns]

Glad the split dose has worked well for you so far @Colt

You can adjust your daytime and nighttime doses independently from now on, which should really help.

Additionally levermir is quite responsive to dose change (unlike some other basal analogues that can take a few days to settle into a new dose) so if you know you have a particularly active day ahead, you can experiment with slightly reducing your morning levemir dose to help prevent hypos. 🙂

 

[Colt]

Yes still getting used to it but so much better, I have noticed that I will need to tweak the daily dose down when I am playing golf as I do dip towards end of round. Also need to be better at taking in some food whilst playing