How long does it keep working, in the past I was getting hypos between 1 and 4 during the night, mentioned it to to my DN where she cut my lantus down by two units, this I take before breakfast, have been making changes to my novorapid and finding that my readings before bed are around 8..9 so having a biscuit just incase of hypo through the night, should I be taking less novorapid with my evening meal so my readings would be a bit higher or will there not be much change, my rapid is taken around 6.30....7.00....Thanks
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Novorapid
- Thread starter Charl
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NovoRapid typically last for 4 or 5 hours after taking.
I am not a doctor but my suspicion would be the Lantus. Its profile is not as flat as one would hope and may have a peak a few hours after taking.
When I was injecting (NovoRapid and Lantus like you), I changed my Lantus dose to take it with my evening meal rather than just before bed so I was awake for the peak and able to handle it if necessary.
Alternatively, you could request a different basal insulin such as Tresiba which is very flat over 3 days (but you have to take it daily) or Levemir which lasts about 12 hours which gives you more flexibility if your basal needs vary.
I am not a doctor but my suspicion would be the Lantus. Its profile is not as flat as one would hope and may have a peak a few hours after taking.
When I was injecting (NovoRapid and Lantus like you), I changed my Lantus dose to take it with my evening meal rather than just before bed so I was awake for the peak and able to handle it if necessary.
Alternatively, you could request a different basal insulin such as Tresiba which is very flat over 3 days (but you have to take it daily) or Levemir which lasts about 12 hours which gives you more flexibility if your basal needs vary.
rebrascora
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I would say 5 hours max for NovoRapid.
What BG level have you been advised to aim for at bedtime? Having a biscuit when you are 8-9 seems like overkill especially if your Lantus has been reduced, so it may be that you need another reduction. I constantly need to tweak my basal insulin because my needs change depending upon what I have been doing during the day and how warm or cold it is (or I am).
What sort of levels are you waking up to in the morning?
How low are the hypos you are experiencing during the night?
What BG level have you been advised to aim for at bedtime? Having a biscuit when you are 8-9 seems like overkill especially if your Lantus has been reduced, so it may be that you need another reduction. I constantly need to tweak my basal insulin because my needs change depending upon what I have been doing during the day and how warm or cold it is (or I am).
What sort of levels are you waking up to in the morning?
How low are the hypos you are experiencing during the night?
What are your sugar levels like during the day? Do you get hypos between meals? You might need to reduce your Lantus a little bit more if you're having to eat before bed. Has your nurse ever asked you to do a basal test?
Here's a comparison of insulin profiles (NovoRapid at the top).
Here's a comparison of insulin profiles (NovoRapid at the top).
Are these finger prick readings or are they Libre readings?
I ask because Libre can report compression lows (false lows when you lie on the sensor) and are also less accurate when in double figures so both your night time hypos and your morning highs may not be as bad as you think and should be double checked with a finger prick (you may need to set an alarm to check the night time lows).
However, it is also worth considering your morning readings as being caused by Dawn Phenomenon
rebrascora
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I also wondered if you were using Libre as compression lows can create a lot of confusion.
The other thing I would ask is .... When do you take your morning reading? Is it as soon as you wake up before you get out of bed or after you have got up and perhaps gone to the loo and showered and dressed and sitting with a coffee etc?
That can make a significant difference to your morning reading. My BG can rise by 6 whole units in the morning due to Dawn Phenomenon or what we refer to as Foot on the Floor syndrome here on the forum. This is where the liver pumps out extra glucose to give us energy for the day ahead, but we don't have any insulin production to deal with it. I inject my basal insulin an hour before I get up to give it a chance to get going and I inject my breakfast bolus before I get out of bed and then potter on with my morning routine before I have breakfast. This all helps to control that morning rise.
Did you say that you take your Lantus on a morning? If so it is likely that this is responsible for your high levels on a morning, but unlikely to be causing you hypos at night.
The other possibility is that you are having hypos at night and it isn't the Libre telling porkies and either over treating them or your liver reacting to them and dumping glucose in response to the lows and that is why your waking readings are high.
Knowing more about your situation Libre use, when exactly you take your Lantus and when you take your morning readings will help us to understand your situation better and what may be happening.
The other thing I would ask is .... When do you take your morning reading? Is it as soon as you wake up before you get out of bed or after you have got up and perhaps gone to the loo and showered and dressed and sitting with a coffee etc?
That can make a significant difference to your morning reading. My BG can rise by 6 whole units in the morning due to Dawn Phenomenon or what we refer to as Foot on the Floor syndrome here on the forum. This is where the liver pumps out extra glucose to give us energy for the day ahead, but we don't have any insulin production to deal with it. I inject my basal insulin an hour before I get up to give it a chance to get going and I inject my breakfast bolus before I get out of bed and then potter on with my morning routine before I have breakfast. This all helps to control that morning rise.
Did you say that you take your Lantus on a morning? If so it is likely that this is responsible for your high levels on a morning, but unlikely to be causing you hypos at night.
The other possibility is that you are having hypos at night and it isn't the Libre telling porkies and either over treating them or your liver reacting to them and dumping glucose in response to the lows and that is why your waking readings are high.
Knowing more about your situation Libre use, when exactly you take your Lantus and when you take your morning readings will help us to understand your situation better and what may be happening.
rebrascora
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Ok, so the hypos are real.... Sorry if it looked like we were doubting you but Libre can confuse this issue. That suggests the Lantus is responsible for your hypos. You could try taking the Lantus earlier like me, say an hour before you get up if that isn't too much of an imposition. I have it off to a fine art and don't even put the light on, just wake up, inject and drop back off to sleep for an hour..... depends how early your start to the day normally is. I inject about 6.30am and get up about 7.30am. That hour gives the Lantus time to start working before you get up which can be a bonus for DP/FOTF and will mean that it has tailed off a bit more by the time you hit the witching hour at night when your body needs very little insulin.
Another alternative is to ask for Levemir as your basal. This is what I have and means that I can adjust my daytime and night time doses independently. I need far more during the day than at night so I currently inject 24 units in the morning and just 3 or 4 units at night, sometimes dropping to 0 at night if I have had a particularly active day. Levemir gives you much more scope to fine tune your basal insulin to suit your body's needs. You can also adjust the time you take each dose to further improve things. So normally I inject at bedtime, but just recently my evening levels have started to climb, so I have been injecting the evening dose earlier to tackle this. It takes a bit more thought but enables you to find a better balance than a once a day basal insulin.
Another alternative is to ask for Levemir as your basal. This is what I have and means that I can adjust my daytime and night time doses independently. I need far more during the day than at night so I currently inject 24 units in the morning and just 3 or 4 units at night, sometimes dropping to 0 at night if I have had a particularly active day. Levemir gives you much more scope to fine tune your basal insulin to suit your body's needs. You can also adjust the time you take each dose to further improve things. So normally I inject at bedtime, but just recently my evening levels have started to climb, so I have been injecting the evening dose earlier to tackle this. It takes a bit more thought but enables you to find a better balance than a once a day basal insulin.
trophywench
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Fancy that Leicester hospital thing saying that Lantus has no peak! What a fib.
rebrascora
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I find the Levemir profile graph on that chart quite funny as well and certainly not reliable portrayed. It just suddenly shuts off at 24hrs instead of tailing off. I have seen that quoted about Lantus before having no peak and some people even believe it! 🙄
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