Question re Levemir & Actrapid timings

[ShandyT]

Question about going low around 9-10 pm most nights.
Started taking 15 ui of Levemir around 6 pm and having evening meals between 6-7 pm so dosage of Actrapid varies depending on what I eat, at the moment trying 3 to 1 ratio, anyone got any ideas why I'm dropping so low late in the evening?

Used to be on Prednisalone steroids, which I'd completed the course on the 6th on Dec. due too getting Crohn's in May last year, then I seemed to be steady on 4 to 1 ratio.

It was the Diabetic nurse who advised to switch the Levemir to 6 pm, before that I used to take it around 11 pm.

 

[HOBIE]

Hi Shandy T. Someone on Levemir will prob be along & be able to answer. Good luck🙂

 

[grainger]

When I was on levemir I was advised to take morning and night doses about 12 hours apart - is this what you are doing?

It’s worth doing a carb free dinner so you can rule out it being your fast acting dinner ratio that’s dropping you and see what’s going on.

 

[ShandyT]

Only once a day for the Levemir,, used to be on 20 ui when I first started, but now down to 15 ui, but it's never been like this, I'm wondering if the Levemir and the Actrapid are causing the low around 9pm,
What I forgot to mention, in the mornings when I do my test around 6ish I'm around 12, which I've never had before, even if I leave my blood sugar to be around 6ish overnight, I know I'm not going hypo overnight as I'm up most of the night going to the loo (effects of the Crohn's, causes constant loo runs through the night) some time maybe 3 - 4 times through the night, and I keep a check on the bs, and it seems to stay around 6- - 7, but come 6am, bang - it's around 11 - 12 !!! weird.

 

[mikeyB]

If you went back to taking the Levemir at 11pm that morning rise should disappear. I split my Levemir 20 morning and 10 bedtime, and that keeps the morning or “dawn effect” as it’s called under control. It’s just your liver releasing glucose to prepare for the exertions of the morning. (In my case, getting out of bed, going to bathroom, going to coffee machine). So it’s not weird, it’s normal, if a little exaggerated.

 

[everydayupsanddowns]

Levemir usually works best at 2x a day from what I’ve seen. It has a slightly shorter action than Lantus and 2 doses allow you to have less or more insulin active at night vs during the day, depending on what you need.

Not quite sure what you mean by 3:1 ratio and which of those relates to insulin and food. Do you mean 3u to 10g carbs or 30g carbs to 1u insulin?

Another couple of things to bear in mind - steroids usually mean people need a lot more insulin, so if you have stopped steroids you will probably need less now than you did.

Actrapid is a slower acting mealtime insulin which gets going later and lasts much longer. It might be that this is propping up your levemir later on, but it also means you might need to be careful in working out which insulin is causing which as it could still be working 6-8 hours after injecting.

Hope you find a new set of doses that work well for you.

 

[everydayupsanddowns]

Incidentally... if I were changing basal insulin, one of the things I'd want to do would be to undertake a full 24 hours-worth of basal tests in sections (possibly a couple of times) to gradually adjust the dose so that the new basal was doing its job properly.

Sometimes HCPs seem to ignore basal testing for people on injections, but it is every bit as important as fro those on a pump in my opinion. A bit of a faff to do, but unless my basal is set right (and then adjusted when my needs change through the year) I never get any reliability in the action of food doses and/or corrections.

There's a write-up of how you can check that your Levemir is set right here: http://www.diabetes-support.org.uk/info/?page_id=120

 

[trophywench]

.... and also from the same website, a lovely graph showing you the action of Levemir and how long it is active for. You need to know your weight in kilos and I suggest increasing your screen resolution too otherwise the lines will be very hard to follow.
http://www.diabetes-support.org.uk/info/?page_id=428

 

[ShandyT]

Get up, test your BS, take any medications you require including basal insulin if that’s when you normally take it. Do not take any fast-acting insulin. Do not eat breakfast. Test mid-morning and prior to lunch.
If your basal dose is correct, your BS by lunchtime should be within approx.10% of what it was when you got up.
If not take more or less basal insulin – never adjust by more than 2 units up or down.
Repeat the ‘miss breakfast’ test at least 3 days hence, to see if it’s right. Keep repeating this until it is more or less right!
Make sure you are happy that that bit is right, then next do the same again but miss lunch. Your pre-lunch and pre-dinner readings should be similar now.
Then do exactly the same pre-dinner, missing dinner – and pre-bed.
Then move on to overnight.

What happens when you get up you find your bs is around 12, then how much fast acting insulin do you give in this scenario, also conversely what do you do if your bs is around 3.4 and you have to walk to the station which is 15 min walk away.
These suggestions are great if you don't have to work and can just stay at home playing out these ideas.

 

[trophywench]

First scenario depends on your Correction ratio, second one requires you to eat breakfast and take less insulin for it having taken into account the low starting BG and the exercise after eating it. haven't you done a proper carb counting and dose adjustment course? - doesn't sound like it to me! better ask to go on one asap then you'll know what to do yourself!

 

[everydayupsanddowns]

Postpone the test until a day when you wake in range?

 

[ShandyT]

@trophywench I'll ask about this "carb counting and dose adjustment course" when I finally get a chance to speak to my DN at the Swindon GWH - never heard of this, been type 1 since Feb 1972. Since they started looking at HBA1C the doctors/nurses have left me to carry on pretty much with what I was doing as it was always between 6-8.

Is everyone on this site on pumps? I've asked about it, but the nurses/doctors never recommended it to me, and a friend at work is on the pump, and he said he'd been put on it cause his BS were more up then normal, and I've always managed to keep a check on my BS until I got diagnosed with Crohn's in May last year, then it all went to pot due to the steroids (prednisolone). Made an appeal on the Crohn's site for any Type1's, but got no response on that query.

 

[khskel]

Hi There, I'm a type 1 with ulcerative colitis and I know what you mean about the steroids. Luckily I've only had two short courses of them.

My basal requirements have varied greatly during the 3 years or so since I was diagnosed with Diabetes. Having done basal testing and referring to the chart
@trophywench mentioned I've arrived at a split dose of levemir, 3 units @ 7pm and 3 @ 7am and that keeps me pretty level overnight and during the day.

Are you in a position to be able to afford a freestyle libre or see if your clinic can give you a trial. Personally I found that invaluable.

Best of luck to you.

 

[everydayupsanddowns]

Is everyone on this site on pumps? I've asked about it, but the nurses/doctors never recommended it to me, and a friend at work is on the pump, and he said he'd been put on it cause his BS were more up then normal, and I've always managed to keep a check on my BS until I got diagnosed with Crohn's in May last year,

Not all on pumps no - There are all types of treatment here, from different types of injections and insulins through to insulin pumps - and all sorts of meds (or not!) on the T2 side too. All learning from each other.

There are two criteria for insulin pump therapy in the UK - the first relates to hypoglycemia or fear of hypoglycaemia ‘interfering with daily life’, the second to elevated HbA1c (above 8.5%).

Hope you manage to get on a course and find it helpful. DAFNE and BERTIE are well thought of by members here, though different places have their own variants.

 

[ShandyT]

@khskel Thanks for that, what's your daily Carb intake, mine's around 200 per day.

Thanks to everyone for the suggestions, seems I have a lot to talk about with my DN when I get to see them later this year, as they're too busy to answer emails or take phone calls (when I'm free).

 

[khskel]

@khskel Thanks for that, what's your daily Carb intake, mine's around 200 per day.

Thanks to everyone for the suggestions, seems I have a lot to talk about with my DN when I get to see them later this year, as they're too busy to answer emails or take phone calls (when I'm free).

Usually about 150

 

[ShandyT]

Thanks, I'm trying 7 @6pm and 8 @6-7am to see how it goes (started that last night), except this morning my BS was 12 - which is very high for my liking, but I'll stay with the 7 & 8 for a week and see how it works out.