Hi I am a type 1diabetic and over the last couple of years have struggled with setting my rapid insulin levels. Lifestyle completely changed as have retired from a very intensive job. I inject with each meal, novorapid, and once a day with levermir. Over the last few weeks I have gone very low thru the night. As a result am trying to get advice thru my Doctors but at present not quite sure what to do. My evening dose is over half what it used to be when I was working.
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Insulin levels
- Thread starter Colt
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If you are going low overnight, that suggests your slow acting insulin (Levemir) needs to be adjusted.
A basal test would be helpful to work out how much to adjust this.
It is always recommended to fix your basal insulin first. Otherwise, you will be using your fast acting (and hypo treatment) to correct it - get your Levemir foundation correct and then build your NovoRapid house on top of it.
(Sorry, I get a bit carried away with analogies sometimes.)
A basal test would be helpful to work out how much to adjust this.
It is always recommended to fix your basal insulin first. Otherwise, you will be using your fast acting (and hypo treatment) to correct it - get your Levemir foundation correct and then build your NovoRapid house on top of it.
(Sorry, I get a bit carried away with analogies sometimes.)
rebrascora
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Hi and welcome.
If you are going low through the night then it is more likely to be your long acting (basal) insulin .... in your case Levemir which is causing the problem. When do you take your Levemir and do you adjust the dose of it yourself? Have you always taken it as a single dose? Most of us on Levemir find it is best to take it as a split dose.... so much in the morning and some in the evening. The doses can then be adjusted independently, so that if you need more through the day, you take more in the morning and if you are having nocturnal hypos, then you reduce your evening dose. As an example, I need a lot more Levemir during the day so I am currently taking 24 units on a morning as soon as I wake up but just 4 units at night. A week ago when I was doing a lot of exercise I had to reduce my evening dose down to 0 because I was going low through the night even on just 4 units.
I wonder if you might benefit from a DAFNE intensive education course or whatever your local equivalent is. The course is actually Dose Adjustment For Normal Eating but it is about so much more that carb counting and one of the big benefits for me was learning how to spot when my basal insulin dose needed adjusting and giving me the confidence to make those adjustments safely for a whole variety of reasons.... lifestyle changes.... your retirement is certainly likely to have impacted your basal needs, hormones affect it, the change of the seasons affect it, ambient temperature as well as more or less physical activity, more or probably less stress could well be contributing to a change if you have retired.
There were newly diagnosed people on my course as well as people with 15 and 50 years of diabetes and all learned something from the course, but one of the main benefits is spending a week in the classroom with other Type 1s and learning from them as much as from the educators. It really can make a huge difference to how you manage your diabetes and can be a door opener for other tech to help you manage your diabetes... things like Freestyle Libre or even a pump in some cases.
Anyway, those would be my thoughts on your situation.... ie that it is a basal insulin dose adjustment which is needed and probably a whole new approach to your basal insulin by splitting the dose, rather than a quick acting, meal time (bolus) insulin issue.
If you are going low through the night then it is more likely to be your long acting (basal) insulin .... in your case Levemir which is causing the problem. When do you take your Levemir and do you adjust the dose of it yourself? Have you always taken it as a single dose? Most of us on Levemir find it is best to take it as a split dose.... so much in the morning and some in the evening. The doses can then be adjusted independently, so that if you need more through the day, you take more in the morning and if you are having nocturnal hypos, then you reduce your evening dose. As an example, I need a lot more Levemir during the day so I am currently taking 24 units on a morning as soon as I wake up but just 4 units at night. A week ago when I was doing a lot of exercise I had to reduce my evening dose down to 0 because I was going low through the night even on just 4 units.
I wonder if you might benefit from a DAFNE intensive education course or whatever your local equivalent is. The course is actually Dose Adjustment For Normal Eating but it is about so much more that carb counting and one of the big benefits for me was learning how to spot when my basal insulin dose needed adjusting and giving me the confidence to make those adjustments safely for a whole variety of reasons.... lifestyle changes.... your retirement is certainly likely to have impacted your basal needs, hormones affect it, the change of the seasons affect it, ambient temperature as well as more or less physical activity, more or probably less stress could well be contributing to a change if you have retired.
There were newly diagnosed people on my course as well as people with 15 and 50 years of diabetes and all learned something from the course, but one of the main benefits is spending a week in the classroom with other Type 1s and learning from them as much as from the educators. It really can make a huge difference to how you manage your diabetes and can be a door opener for other tech to help you manage your diabetes... things like Freestyle Libre or even a pump in some cases.
Anyway, those would be my thoughts on your situation.... ie that it is a basal insulin dose adjustment which is needed and probably a whole new approach to your basal insulin by splitting the dose, rather than a quick acting, meal time (bolus) insulin issue.
Thankyou, I have been told by GP yesterday to adjust my levermir dose down from 50 to 46. I currently do 1 dose a day at 6pm. The timing was chosen as when I was working I was travelling to the US quite a lot and needed to ensure the time worked in various time zones. I am awaiting a diabetic review which hopefully will be in the next couple of weeks. Thru COVID situation I haven’t had a face to face review for over 2 years…
Leadinglights
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I think people underestimate just how much a change of lifestyle such as retirement has on various aspects of your metabolism so it is understandable that something that worked before now needs adjustment.
rebrascora
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My guess is that you would benefit hugely from a DAFNE course and prior to that an appointment at the specialist diabetes clinic.... Hopefully that is where your review will be. Most GPs have not got a clue about Type 1 insulin management. You really need to be seeing a consultant or DSN to get your insulin regime better sorted to your current lifestyle.
rebrascora
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It doesn't surprise me at all that you are hypoing through the night with that Levemir regime. The insulin will be peaking in activity in the middle of the night when you would normally need the least amount. How bad are the hypos you are getting?
Thankyou, I have yesterday adjusted my levemir dose down from 50 to 46 following discussion with GP yesterday . I take this at 6pm everyday
Night before last my wife had to call 999 which is the first time ever…. I have been a diabetic for 15years following a major operation
rebrascora
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Very sorry to hear that you needed medical assistance for it. It must have been scary for you both!
When you say a major operation.....Not meaning to be nosey but did that involve your pancreas? Just wondering if you are actually Type 3c rather than Type 1. It doesn't really make much difference treatment wise but gives people a bit better understanding of your situation and it can be helpful to compare notes with other Type 3c members.
When you say a major operation.....Not meaning to be nosey but did that involve your pancreas? Just wondering if you are actually Type 3c rather than Type 1. It doesn't really make much difference treatment wise but gives people a bit better understanding of your situation and it can be helpful to compare notes with other Type 3c members.
rebrascora
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Well that is a lot better than being put in the Type 2 category as some Type 3c members were and then had to battle hard to get access to appropriate insulin treatment and constant confusion about their situation with other medical professionals. It may seem a bit arbitrary but it can make the world of difference to have the correct diagnosis and treatment.
rebrascora
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Do you need to take Creon, or did your operation not affect that part of your pancreas?
rebrascora
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I know that @eggyg is very busy at the moment preparing to go on holiday, but she is our most prolific Type 3c member, so perhaps she may bookmark this post and come back to you when she has more time to swap notes and experiences.
Does that Creon dose work for all meals for you? As I understood it, Creon doses can vary a bit like insulin doses depending upon the content of the meal.... but I may have picked that up wrong. I'm no expert.
Does that Creon dose work for all meals for you? As I understood it, Creon doses can vary a bit like insulin doses depending upon the content of the meal.... but I may have picked that up wrong. I'm no expert.
It seems to, again have had very little advice over the years, I tend to stick to a regular diet and avoid really fatty food
nonethewiser
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Pancreatic challenged & also take Creon with food. Eat regular healthy diet myself, find with fatty foods it does make insulin dosing complicated & requires more Creon, but dont avoid such foods just learnt how to cope with it over time.
I've found as got older need less insulin than did at beginning, no idea why just do, basal at one point was 40u now 20u, only thing changed is using pump now.
Inka
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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?
trophywench
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Blimey @Colt ! Excuse my language but Levemir was never intended to be delivered once a day - always in two doses a day, though to be fair, the greater the amount of insulin per kilo of body weight, the longer it remains effective for. It ramps up to a peak within a couple of hours usually - but who knows when the body has eg a cancerous pancreas (or indeed any of the other bodily bits and pieces close by) and it isn't working efficiently.
For your own sake, get your GP to refer you to a hospital diabetes centre ASAP - I'm 'lucky' in that respect since Coventry hospital, being a Teaching Hospital, has an excellent D Centre fully manned by expert staff - but I know all hospital Trusts are not so well furnished - although most of em still have expert staff, they may not be available every day.
It is never a great idea to change insulin doses by more than 10% at a time so yes, ok - but, if the Levemir is still active after 24 hours, the 4u reduction might not be sufficient, is my concern. (cos repeated hypos ain't nice)
For your own sake, get your GP to refer you to a hospital diabetes centre ASAP - I'm 'lucky' in that respect since Coventry hospital, being a Teaching Hospital, has an excellent D Centre fully manned by expert staff - but I know all hospital Trusts are not so well furnished - although most of em still have expert staff, they may not be available every day.
It is never a great idea to change insulin doses by more than 10% at a time so yes, ok - but, if the Levemir is still active after 24 hours, the 4u reduction might not be sufficient, is my concern. (cos repeated hypos ain't nice)
Thanks, I have been on a single dose of levemir since being diagnosed following my op……even yesterday I queried it with my GP but was given the advice to reduce from 50 to 46….my op involved gall bladder, pancreas, and some of my intestines
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