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Please help

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Aybrice (Blueduck)

Active Member
Relationship to Diabetes
Type 1
Have been having terrible trouble with bs levels which has a strange patten and any help would be appreciated
Have 10 units of levimir when I get up at 6.30 between getting up and having breakfast my bs is going up fast
I’ve tried injecting fast acting (fiasp) the minuet I get up with my back ground. This doesn’t work
Will often take up to 10oclock to come down then can go up again before lunch
At the other end, I have had to stop taking levimir before bed as I go hypo in the night

there is something I am not seeing and I want to sort this out it’s driving me crazy

I wonder if the morning levimir is running out, but then why would I go low over night? My bs starts to go up about 4am, slowly, then shots up from getting up to when I have my breakfast
1 was reading info about levimir and there was a suggestion, of injecting second dose 12 hours after first, or at dinner time

just wondered if any one could help, I have asked About going up before, so tried injecting the fiasp when I get up, but as I said this is not working
Thanks for reading
 
Have you basal tested to see if the dose is correct? Did you go low on every late night dose you tried? Did you cut it right back to 1 unit etc? (I'm not sure if you can do half units with Levimir) xx
 
Yes went low every time, started at 3, 2, 1.5, 1, none
I’m very insulin sensitive and have a half unit pen

I haven tested basal as after bs being crazy the morning g the rest of the day is perfect
 
Even more of a disaster today
Went to bed at 11.2
Decided not to do a correction as night before I was 10, corrected with 1 unit had to have jelly baby at 2.39 bs 4.8, but if I had not eaten I would have gone hypo
This morning 10.9 at 6.07
Fell back to sleep got up
6.42 13.7
2.5 fiasp 10 units levimir
3 units fiasp with bfast at 6.59 24 carbs
8.00. Up to 20! Ket 0.2. 2 units fiasp
 
Sorry to hear about the struggles you are having :(

You certainly seem to be caught between a rock and a hard place with your morning chaos and then the big drops overnight 😱

We can’t give you any medical advice here, of course, but what we can do is imagine ourselves in your shoes and what our experience of diabetes would make us think.

If those were my numbers, I would be wondering about the following

  • Liver dumps - not always easy to predict and not always consistent day to day, but the liver can ‘fire up the burners’ in the hours around dawn and/or on rising. Sometimes this is ‘switched off’ when we eat, even if we choose a low carb breakfast.
  • As @Kaylz suggests - what happens when you don’t eat breakfast/bolus? (but still bolus to cover what appears to be the liver dump)
  • Increased insulin resistance in the mornings can need more insulin for whatever carbs are eaten at breakfast - ratio tweak maybe?
  • Where are BGs approx 4-5 hours after all this insulin? If back in range (and not dropping into hypo territory) is there an argument for taking the doses, and subsequent corrections all ‘up front’ [and then keeping a careful eye on BGs!]
  • How much delay between bolus and any breakfast carbs? would a low carb breakfast be worth trying?
  • How healthy are sites? Proper rotation? Are fresh sites needed?
  • For the big drops overnight - basal testing again (skip evening meal). Are any remaining beta cells being triggered by high BG?
  • Could different evening meal choices result in a ‘smoother’ late evening BG outcome?
Just a few thoughts for you to stir into the mix 🙂
 
That’s lots of ideas everydayupsaand downs
Thank you
I write everything down so need to bolos test for a start and see how it goes
My dn made some suggestions but as that wasn’t working thought I’d see if any one had any ideas
Thank u for taking time
A comprehensive list to try
 
I'd be careful with all that corrections in such a short space of time, you haven't really given it much time to get to work before your putting more in and this could lead to a crash later when it does hit the system in 1 fell swoop xx
 
It also strikes me that part of your early morning rise may well be associated with the fact that you are only taking Lev once a day.

Levemir generally acts for 12-18 hours, so by the middle of the night you are running on no basal until you wake and jab (and that dose has had it’s onset time).

Or course you have that steep drop after bedtime, which rather mangles things.

Would be interested to know of that happens when you skip your eve meal, or if it might be bolus related?

A pump would allow you to keep very low basal from midnight, but then ramp it up in the early hours - I’m not sure if you have considered pump therapy?
 
Everydayupsanddowns
I was taking it twice a day, but was having hypos in middle of night so started to reduce and finally stop
I do think u are right and it’s to do with the basal, after bolus testing I am going to split the dose of basal to 6.30 and 22 hours after, I read that on a levimir site
My dn said going low in the night I needed to eat something b4 bed if I was below 8, but that has not been working
Yes I have considered a pump and if all else fails I’ll have to do that
Thank u
 
The 4am rise looks like Dawn Phenomenon. That’s about when my blood sugar starts to go up (but I have a pump to deal with that).

Then a possible Waking Rise (BS going up the moment you wake and get up). I have that and deal with it by eating breakfast ASAP or bolusing a small amount of insulin to help control the rise. But that’s not working for you - perhaps because you have no basal on board then which you need from early morning.

I’d be looking at a pump too. For me, I need very little insulin in the early night (practically zero for some hours) and much more from 4am onwards. My pump allows me to have basal exactly as needed. It could do that for you too. It would also allow you to give very small doses and be ideal as you’re insulin sensitive.
 
Thank u inka
I know we are all different but does it sound weird if I say that’s comforting that’s u have these issues
 
Not weird at all 🙂 That’s what the forum is about - support, advice and finding out you’re not alone and others have similar issues.

Trying the Levemir split first is a good idea. If it was me, I’d build up from a very small Levemir evening dose because of the risk of nocturnal hypos and see how it goes. I’d also set an alarm for the time I usually went hypo at night, so I could test and eat something if necessary.

If you can’t balance your basal needs with your basal insulin, then that would be the time to explore the possibility of a pump. I got mine because of nighttime hypos and the fact no basal insulin could provide the profile of insulin needs I have at night.
 
Hi. I started to split my Levemir a few months back which did smooth my BS thru 24 hours. It only lasts 12 to 18 hours depending on dose so splitting can make sense. One simple and rough way to get your Basal balanced is to not eat for a good few hours and see if you BS goes up or down. I accept that your BS changes are a bit strange.
 
Have you had a change of routine recently. I find that I hypo in the night if I have had a very active day and I reduce my evening Levemir to take that into consideration. If I have a series of very active days I have to reduce the Levemir by another unit each evening as the effect of the activity seems to stack up, so normally I need 16 units in the morning and 5 or 6 units at night but last week I had to gradually dial back the evening dose each night until I didn't need any for a couple of nights but then my routine changed and I wasn't so active for a few days and I have had to gradually dial the evening Levemir back up again. My daytime Levemir seems to be stable at 16 units but it is during the night when my day's activity has maximum impact.

With the "foot on the floor" liver dump, I incorporate that correction into my breakfast bolus and take it altogether the moment I get up but don't eat breakfast until my BG comes down into the 5s, which is usually 45 mins with Fiasp and can be over an hour with NovoRapid.... took an hour and a half the other day to have any effect. If my waking BG is high, it takes a lot longer to come into range for me to eat breakfast. Libre is great for watching to find the right moment to start eating. I tend to make my breakfast so it is ready to eat and then potter on doing little jobs around the house until the Libre shows my BG dropping and then I eat it.
 
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