Morning levemir?

[Lion2012]

Good evening guys i hope all is well.
Leo had a great day today (well, much better day anyway) re his range of levels.
Well, right up until now anyway lol
I have attached today's libre graph. A massive and sudden spike... Rocketed and kept going.
Lunch carb counting spot on... After lunch hypod a little.. Leo has taken the advice of others on the forum and doing the wait 15 minutes and only use the accu metre machine for lows.... Then had a glucose tablet. After 15 mins he was back up so had a biscuit.
This method works a treat... But having just got him home! Wow... Climbed and climbed for no reason at all!!!!!

I would like to ask.. Could this be the levemir in the morning? I reduced only by 0.5 due to slightly lower this am and a heavy football sesh last night.

Many thanks in advance

 

[rebrascora]

Hi.

Looks like he managed the hypo really well.
I can't see that spike being from his morning Levemir running out. The rise is too dramatic.
I assume he hadn't had his evening meal at that stage?? I dread to think how high he went after tea if that was his before tea reading! Yikes! Definitely a day for a low carb meal like an omelette.

What was the biscuit he had? Some people don't seem to need follow up slow acting carbs. I am one of them. My levels would go into orbit if I had a biscuit after I had treated a hypo with fast acting carbs and often just one jelly baby is enough to treat my hypos, but many people need a full 15g fast acting plus 10-15g slow carbs every time. We are all different so you have to experiment to see what works for you the majority of the time.

My other thought is that his liver is kicking in late with a liver dump of glucose in response to the hypo. I do wonder if his CF has any impact on his liver function and that may be an aggravating factor for his levels shooting up so high after hypos, as this does seem to happen often from the graphs you have posted. I really don't know anything about CF to know if it could have an impact like that but certainly the liver can kick out a load of glucose in response to a hypo. This may settle down with time once his levels become more stable in the longer term.

First part of the graph is absolutely brill though.... eventually you will find that you get more times like that and less of the big peaks and troughs, it just takes time to figure out how his body works and how best to manage it.... and just when you do, it will change and you have to scratch your head and start figuring out a new game plan..... but with all the experience you gain each day you start winning more.

 

[Inka]

I don’t think that big sudden spike looks like the Levemir wearing off. Too big, too quick, and a bit too early (depending on when he had the Levemir in the morning). But well done on the earlier part of the graph - excellent 🙂 Next time something similar happens, do the same but maybe try half of the same biscuit and watch his levels carefully.

My other thought is where did he inject for lunch. Sometimes I’ve found certain sites cause the insulin to all work at once almost, causing a low after the meal, but then a spike later. And - apologies for forgetting - what bolus insulin is he using?

 

[Lion2012]

I don’t think that big sudden spike looks like the Levemir wearing off. Too big, too quick, and a bit too early (depending on when he had the Levemir in the morning). But well done on the earlier part of the graph - excellent 🙂 Next time something similar happens, do the same but maybe try half of the same biscuit and watch his levels carefully.

My other thought is where did he inject for lunch. Sometimes I’ve found certain sites cause the insulin to all work at once almost, causing a low after the meal, but then a spike later. And - apologies for forgetting - what bolus insulin is he using?

Thank you very much for that. I did myself think of reducing the slow carbs to maybe half.. Or even none at all as previous posts suggests.
He is on fiasp at the moment. He Was on novo rapid....

 

[Lion2012]

Hi.

Looks like he managed the hypo really well.
I can't see that spike being from his morning Levemir running out. The rise is too dramatic.
I assume he hadn't had his evening meal at that stage?? I dread to think how high he went after tea if that was his before tea reading! Yikes! Definitely a day for a low carb meal like an omelette.

What was the biscuit he had? Some people don't seem to need follow up slow acting carbs. I am one of them. My levels would go into orbit if I had a biscuit after I had treated a hypo with fast acting carbs and often just one jelly baby is enough to treat my hypos, but many people need a full 15g fast acting plus 10-15g slow carbs every time. We are all different so you have to experiment to see what works for you the majority of the time.

My other thought is that his liver is kicking in late with a liver dump of glucose in response to the hypo. I do wonder if his CF has any impact on his liver function and that may be an aggravating factor for his levels shooting up so high after hypos, as this does seem to happen often from the graphs you have posted. I really don't know anything about CF to know if it could have an impact like that but certainly the liver can kick out a load of glucose in response to a hypo. This may settle down with time once his levels become more stable in the longer term.

First part of the graph is absolutely brill though.... eventually you will find that you get more times like that and less of the big peaks and troughs, it just takes time to figure out how his body works and how best to manage it.... and just when you do, it will change and you have to scratch your head and start figuring out a new game plan..... but with all the experience you gain each day you start winning more.

Once again the information and advice given is very much appreciated thank you
I will ask the question re the liver to his CF team, msy not be anything that can be done but it is well worth asking them. I am going to try the no slow carbing and also the half a biscuit too just to trial the two scenarios.
I can't lie in order to keep him in the green for a new day i do have to correct in the night etc.... He is never high high but in the 12s.. 13s.....at times.
Thank you again

 

[Leadinglights]

Are you able to relate the lows to when he takes the CF medication as some do cause low blood glucose, which means you then may be over correcting so level shoots up.

 

[Inka]

Thank you very much for that. I did myself think of reducing the slow carbs to maybe half.. Or even none at all as previous posts suggests.
He is on fiasp at the moment. He Was on novo rapid....

I would have guessed Fiasp… I know it’s beloved of some, but it might be worth trying a different bolus insulin.

Personally I’d go the cautious route and reduce the carbs gradually. Better safe than sorry 🙂

 

[Lion2012]

I would have guessed Fiasp… I know it’s beloved of some, but it might be worth trying a different bolus insulin.

Personally I’d go the cautious route and reduce the carbs gradually. Better safe than sorry 🙂

Hi there.. Forgive me for asking but what do you mean reduce the carbs slightly in what scenario.. Sorry

 

[Lion2012]

Are you able to relate the lows to when he takes the CF medication as some do cause low blood glucose, which means you then may be over correcting so level shoots up.

Hey there.
Not really sorry as he had 2 x kaftrio tablets in the morning with breakfast and 12 hours later at night 1 more kaftrio tablet.

 

[rebrascora]

I have mentioned on other posts that Fiasp may be part of the problems Leo is experiencing. It isn't the easiest quick acting insulin to get along with for some people and whilst I use it and now wouldn't go back to NR it has been a bumpy road getting along with it. It can be an "all or nothing" effect with it. Sometimes it seems incredibly effective and other times it is like water. I can now mostly predict how it will respond in different circumstances like high levels and exercise but it has taken a long time to get to grips with it and I wouldn't necessarily recommend it to someone who is relatively inexperienced. It seems weird that a simple change from NR to Fiasp can cause BG havoc but in my experience it can and you have to learn how it works in different circumstances in your body..... it isn't a simple straight swap.

Hi there.. Forgive me for asking but what do you mean reduce the carbs slightly in what scenario.. Sorry

I am guessing Inka is suggesting to try just half a biscuit after a hypo has been treated first to see how that works a few times before dropping the biscuit altogether if a half biscuit still sends him high..

 

[Lion2012]

I have mentioned on other posts that Fiasp may be part of the problems Leo is experiencing. It isn't the easiest quick acting insulin to get along with for some people and whilst I use it and now wouldn't go back to NR it has been a bumpy road getting along with it. It can be an "all or nothing" effect with it. Sometimes it seems incredibly effective and other times it is like water. I can now mostly predict how it will respond in different circumstances like high levels and exercise but it has taken a long time to get to grips with it and I wouldn't necessarily recommend it to someone who is relatively inexperienced. It seems weird that a simple change from NR to Fiasp can cause BG havoc but in my experience it can and you have to learn how it works in different circumstances in your body..... it isn't a simple straight swap.


I am guessing Inka is suggesting to try just half a biscuit after a hypo has been treated first to see how that works a few times before dropping the biscuit altogether.

Thank you .
Sadly these things still happened with novo rapid.. Hence the initial change.
I still have plenty of novo rapid left so i guess i could revert back once this runs out just to see (along with the tweeks from his team) if this has a positive effect once more. Can you change insulin without any precautionary measures?? The last change was easy enough as his team just prescribed and let us go

 

[rebrascora]

Can you change insulin without any precautionary measures?? The last change was easy enough as his team just prescribed and let us go

Not sure what you mean about precautionary measures?
How long have you been using the Fiasp?
As I have mentioned before, I tried it for 3 months and gave up and went back to NR and then a year later I tried again and stuck at it the second time and had another 3 months of frustration with it before I eventually got to grips with it at about 4 months. I don't love it but I can make it work for me most of the time now. I don't think that anything else on the market would be any better for me and the consultant is of the same opinion and I am consistently getting about 90% TIR over 90 days so it is working for me but I do have to be quite proactive with it and inject corrections before my levels get above 10 otherwise I have a battle on my hands....

.... So if you have been using Fiasp for a couple of months it might be worth sticking with it now rather than switch back. If it is only a couple of weeks I might be inclined to go back to NR and see how you manage. There was no problem me giving Fiasp another go after my initial trial of it was abandoned but it usually needs the consultant or a DSN to write to your GP to change your prescription.

 

[Leadinglights]

Hey there.
Not really sorry as he had 2 x kaftrio tablets in the morning with breakfast and 12 hours later at night 1 more kaftrio tablet.

I wonder if it is an effect of having to take the tablets with fatty foods that is affecting how effective the bolus insulin is and how quickly the carbs are metabolised. Just a theory.
The product info does say low blood glucose is a possible side effect in a small number of people.

 

[Lion2012]

Thank you
Awaiting a response back from the CF team and the diabetes team
about his football and huge rising levels during game time also ⚽

 

[Inka]

Hi there.. Forgive me for asking but what do you mean reduce the carbs slightly in what scenario.. Sorry

Sorry @Lion2012 I wasn’t clear. I meant reduce his longer-acting carbs (ie the biscuit) after his hypo gradually. That is, don’t jump from one biscuit to no biscuit. Try half a biscuit, then reduce or increase if necessary. It’s better to take small careful steps than risk a hypo.

To come back to Fiasp, I remember now and I think I might have asked you on your earlier thread when he started the Fiasp. If you answered, I missed it. I’m wondering if these sudden spikes are caused by the Fiasp.

 

[Lion2012]

Sorry @Lion2012 I wasn’t clear. I meant reduce his longer-acting carbs (ie the biscuit) after his hypo gradually. That is, don’t jump from one biscuit to no biscuit. Try half a biscuit, then reduce or increase if necessary. It’s better to take small careful steps than risk a hypo.

To come back to Fiasp, I remember now and I think I might have asked you on your earlier thread when he started the Fiasp. If you answered, I missed it. I’m wondering if these sudden spikes are caused by the Fiasp.

Yes i think i may swap back to novo rapid afyer this current cartridge runs out. Try the novo rapid once more. I take it its OK to just revert back?... Thank you

 

[Inka]

Yes i think i may swap back to novo rapid afyer this current cartridge runs out. Try the novo rapid once more. I take it its OK to just revert back?... Thank you

You could go back to Novorapid or try a more reliable/predictable bolus insulin eg Humalog. Personally, I’d try going back to NR first and making tweaks eg bolusing more in advance, checking ratios or whatever. If there were still issues, I’d try Humalog or something similar.

 

[rebrascora]

Yes i think i may swap back to novo rapid afyer this current cartridge runs out. Try the novo rapid once more. I take it its OK to just revert back?... Thank you

Yes, that's what I did.

 

[Lion2012]

Just an update for everyone.. Better day today. In comparison.
But once again an out of the blue spike rocket for bed .... Up to 15 and rising nothing to eat nothing to cause this. Just boom.
Let's see what happens.
Ps.... Also just after 2pm another spike which i was forced to give 1 unit so caught it on time otherwise would had been another rocket . Out of the blue. Lunch was at 1230.

 

[rebrascora]

That could just be a late glucose release from his evening meal. What did he have? Do you keep a food diary to check back on to see if the same meal gave similar results last time he ate it. It looks like he had a small rise and drop after his evening meal and then that sudden surge starting about 8pm.