Hi this is my first post - I was diagnosed in March and over the months my basal needs decreased . Till I was 2 levemir morning and night . However I started experiencing crazy insulin sensitivity at random moments so I started eating a cracker or something before I bolused but didn’t include in my carb count so my control Went out the window . contacted my nurse for help and all she asked me to to is increase levemir . I’ve just had a horrible night and could feel the levemir drag levemir drag me down . - I only increased my day time . I’ve taken the dose again this morning - after all it was medical advice but am already stressing about tonight . Are you suppose the feel the insulin dragging you from the inside ? I honestly don’t know what to do . She told me not to correct any highs just increase levemir . This is going to be a long day and night
-
Please Remember: Members are only permitted to share their own experiences. Members are not qualified to give medical advice. Additionally, everyone manages their health differently. Please be respectful of other people's opinions about their own diabetes management.
-
Learn more about joining the Diabetes UK Support Forum team here: https://forum.diabetes.org.uk/boards/threads/volunteering-opportunities-why-dont-you-join-us.112862/
Stressed by my diabetes
- Thread starter ellevee
- Start date
rebrascora
Well-Known Member
- Relationship to Diabetes
- Type 1
- Pronouns
- She/Her
Are you having nocturnal hypos? Is that what you mean by the Levemir dragging you down at night? If so, in your position I would skip my evening Levemir dose tonight and see how that works out. In fact that is what I am currently doing and only having a morning dose of Levemir which I have also reduced and none at night but still battling lows through the night.... I needed 6 jelly babies through the night last night to prevent dropping into the red. 🙄 Do you have Libre or other CGM to monitor your levels and if so, can you post a screen shots of your graphs from yesterday and overnight?
trophywench
Well-Known Member
- Relationship to Diabetes
- Type 1
I'm wondering whether you're having false hypos? - that's a symptom of blood glucose dropping lower that your own body has become used to.
Please tell us how you came to be diagnosed with Type 1 diabetes in the first place, and which mealtime (bolus) insulin you use as well as the Levemir background (basal) one, plus your testing regime and whether you do also have a Libre?
Please tell us how you came to be diagnosed with Type 1 diabetes in the first place, and which mealtime (bolus) insulin you use as well as the Levemir background (basal) one, plus your testing regime and whether you do also have a Libre?
Thank you . Not hypoing as such but waking up to dropping levels and eating them to prevent a low . I’m so new to this but isn’t it bad to skip a levemir dose ? I think the problem started when I went back to work in August after being at home all
Summer and walking the dog more in the mornings must have been keeping the blood sugar rise in the morning at bay .now I think the answer might be a correction dose because even with the higher dose my levels still rise in the morning . She’s put daytime my levemir up three units in a week and she’s not listening when I say it’s bringing me down at night my previous dose
kept me consistently steady at the place where my bolus wore off . I just lost the nerve to correct after the sensitivity issues my bolus should have worn off around 2 at 8mmol thank goodness and woke up around 5 dropping at 5.9 so I ate something lol . Then the previous night I at an Indian and completely miscalculated and bolus wore off around 12 mmol I didn’t correct and still wok up at 7 mmol it’s obviously too high but I feel I’m too new to go against medical expert advice . I know how my body feels and it feels overloaded
Summer and walking the dog more in the mornings must have been keeping the blood sugar rise in the morning at bay .now I think the answer might be a correction dose because even with the higher dose my levels still rise in the morning . She’s put daytime my levemir up three units in a week and she’s not listening when I say it’s bringing me down at night my previous dose
kept me consistently steady at the place where my bolus wore off . I just lost the nerve to correct after the sensitivity issues my bolus should have worn off around 2 at 8mmol thank goodness and woke up around 5 dropping at 5.9 so I ate something lol . Then the previous night I at an Indian and completely miscalculated and bolus wore off around 12 mmol I didn’t correct and still wok up at 7 mmol it’s obviously too high but I feel I’m too new to go against medical expert advice . I know how my body feels and it feels overloaded
Attachments
Mmm maybe but I’m fairly used to being between 5 and six overnight steadily . There is now a definite drop during the night and it makes me fearful I think my levels now sit higher as I be never nailed the morning correction factor or just been too cautious (ie correcting the. Eating the correction )
In answer to you questions I was diagnosed in March after I lost 2 stone in the space of two months out of nowhere . I had all the antibody tests etc done and it was confirmed my hba1c at diagnosis was 15.5 and fortunately no dka but was starting to feel fairly rough . I use novorapid which seems to work at snails pace(but I think my carb ratios need fixed ) and levemir twice daily . I have a libre and have tried to educate myself on the condition . I tried to do basal test by fasting . On 2 and 2 my my line stayed level where ever my bolus lands . I have a feeling if I tested today I’d drop if I didn’t eat . The extra levemir make me feel tight across the chest . I was told this was anxiety but I don’t feel
It on the lower dose . What do you mean by testing regime ?
trophywench
Well-Known Member
- Relationship to Diabetes
- Type 1
Well if you're a normal human being, your blood glucose does drop in the middle of the night, roughly 2.30 ~ 3 am - ish. Then nearer the time you usually wake up, it increases.
Well apart from before and after meals (to see whether your bolus dose is dealing with the carbs) when you feel this tightness across your chest, since you can't rely on Libre either when your BG is getting down towards 4 or heading up to 10+ - you MUST always fingerprick if you feel anything other than normal. Abbott do at least tell you this now - they hadn't used to so us lot had to find out for ourselves. Libre can very easily suffer from compression lows (ie false ones!) and during the night when we're in bed, that can be fairly common.
Well apart from before and after meals (to see whether your bolus dose is dealing with the carbs) when you feel this tightness across your chest, since you can't rely on Libre either when your BG is getting down towards 4 or heading up to 10+ - you MUST always fingerprick if you feel anything other than normal. Abbott do at least tell you this now - they hadn't used to so us lot had to find out for ourselves. Libre can very easily suffer from compression lows (ie false ones!) and during the night when we're in bed, that can be fairly common.
Thanks for your reply Yes I’ve had a few compression lows and always finger prick . The issue is my numbers sitting higher during the day but changing my basal isn’t sorting this because my blood sugar still come up in morning no matter what and now I feel like Im being pulled down I just wondered the feeling of having something working in you was normal With insulin or should it feel like it just isn’t there like it does when I’m in my regular dose .thank you
rebrascora
Well-Known Member
- Relationship to Diabetes
- Type 1
- Pronouns
- She/Her
Do you mean that you feel your levels dropping as yes, that is normal if they are dropping fast due to too much insulin. If there is no active NovoRapid in your system at the time like during the night, then it can only be the Levemir.
I absolutely love Levemir because it is so flexible, but you have to learn how to adjust it to suit your body and the only way to do that is through careful experimentation. The most important thing is to prevent nocturnal hypos and if you are doing that by either going to bed with higher levels in order to prevent a hypo or eating something at bedtime to push your levels up, so that the Levemir doesn't take you too low, or you are having to eat through the night to prevent hypos, then the most obvious thing to do is to reduce your nighttime dose. If I have had a very active day, I often need to reduce my evening Levemir dose to 0 otherwise I would hypo and as I said, the last few days, even with no evening dose I am still either having hypos or heading them off, so then all I can do is start reducing my morning Levemir dose.
It is important to understand that we all need very different doses but if it helps to compare notes, I need anywhere from 16-24 units of Levemir on a morning as soon as I wake up and before I get out of bed. I also jab 1-2 units of my fast acting insulin (Fiasp) at the same time (before I get out of bed) to deal with the surge of glucose that my liver releases as soon as I get up (often referred to as Foot on the Floor Syndrome) If I am going to have breakfast, then I also add my breakfast bolus insulin and any correction if I wake up above target. So if I wake up and my levels are 9mmols, I inject 2 units for "Foot on the Floor" and 3.5units for breakfast plus a correction of 1.5 units, so I jab a total of 7 units and then I get up and washed and dressed and have a coffee and then I have my breakfast and that works out about right for me. The rest of the day, I don't need that foot on the floor extra insulin because it just happens in the morning and my levels will rise by about 6mmols in the space of an hour if I don't hit it with some fast acting insulin and the Levemir doesn't work fast enough to cover that. In the evening at bedtime, I inject however many units of Levemir I feel I will need from experience and what has happened overnight the last few nights. So I have currently been dropping low through the night and needing jelly babies with no evening Levemir, so it would be crazy to inject some and make that worse. There is clearly enough insulin in my system to keep my levels low, so there is no problem not having an evening dose. What would be dangerous is to inject it when my levels are already dropping low. Levemir can be injected just once a day and many people, myself included, were started off on a single dose. It wasn't split into a morning and evening dose until just before my DAFNE course about 8 months after I was diagnosed and then it was split into an even 7 in the morning and 7 at night which soon became clear was too much at night and I gradually adjusted it so that I inject much more in the morning and just a little or none at night. Since then my honeymoon period saw steady increases in the daytime dose, but my nighttime needs have remained very low and I am still very prone to nocturnal hypos but if I didn't adjust my Levemir it would be almost every night, which is clearly not good for anyone.
Who is advising you on adjusting your doses? Is it a nurse at the GP practice or a specialist DSN at the diabetes clinic? That graph shows a significant drop from being in the 12s after your Indian takeaway, so if you didn't do a correction in the night then that is an indication that your evening Levemir is too much, although generally you look for patterns before you make a change rather than just one instance, but if you were eating to prevent hypos the previous night too, then that suggests you have too much insulin in your system during the night and you need to inject less. It may be that your body is able to cover you overnight needs without any additional Levemir, but needs more during the day when there is greater demand. Your remaining beta cells can also have a resurgence after you start injecting insulin, which gives then a bit of respite and they suddenly fire up again and insulin doses need to be dialed right back or indeed some people have to stop all insulin for a while during their honeymoon period, but then gradually reintroduce it as more beta cells are killed off. I didn't experience that but certainly there are people on the forum who have and we have one member who doesn't need any basal insulin at all, but just fast acting insulin for meals and he has been diagnosed over a decade.
We have a saying here on the forum that "You need what you need!" with regard to insulin doses but it is dangerous to keep injecting more than you need, so if you feel that your night time Levemir is too much then it would be wise to reduce it. If you are not comfortable not taking any, then consider a compromise and just reduce it by 1unit.
Do you have a half unit pen? 2 units is a very small dose so you should have a half unit pen so that you can adjust it more finely. The NovoPen Echo Plus is the half unit pen for Levemir and NovoRapid. They are really nice quality reusable pens so better for the environment as well as giving you that half unit option of adjusting doses and the cartridges for them take up much less space in the fridge than a box of pens. Ask your nurse to prescribe them as you will really benefit from being able to make half dose adjustments. They come in red and blue so make sure to ask for one of each because you don't want two pens the same colour for your different insulins, plus ask for a spare. The pens usually last at least 5 years and they show you what the last dose was that you injected and how long ago, which is really helpful for those "did I" or "didn't I" moments, we all have from time to time when injecting just becomes so automatic, you can't remember if you actually did it.
Sorry for writing "war and peace" but hopefully some of it will be useful.
I absolutely love Levemir because it is so flexible, but you have to learn how to adjust it to suit your body and the only way to do that is through careful experimentation. The most important thing is to prevent nocturnal hypos and if you are doing that by either going to bed with higher levels in order to prevent a hypo or eating something at bedtime to push your levels up, so that the Levemir doesn't take you too low, or you are having to eat through the night to prevent hypos, then the most obvious thing to do is to reduce your nighttime dose. If I have had a very active day, I often need to reduce my evening Levemir dose to 0 otherwise I would hypo and as I said, the last few days, even with no evening dose I am still either having hypos or heading them off, so then all I can do is start reducing my morning Levemir dose.
It is important to understand that we all need very different doses but if it helps to compare notes, I need anywhere from 16-24 units of Levemir on a morning as soon as I wake up and before I get out of bed. I also jab 1-2 units of my fast acting insulin (Fiasp) at the same time (before I get out of bed) to deal with the surge of glucose that my liver releases as soon as I get up (often referred to as Foot on the Floor Syndrome) If I am going to have breakfast, then I also add my breakfast bolus insulin and any correction if I wake up above target. So if I wake up and my levels are 9mmols, I inject 2 units for "Foot on the Floor" and 3.5units for breakfast plus a correction of 1.5 units, so I jab a total of 7 units and then I get up and washed and dressed and have a coffee and then I have my breakfast and that works out about right for me. The rest of the day, I don't need that foot on the floor extra insulin because it just happens in the morning and my levels will rise by about 6mmols in the space of an hour if I don't hit it with some fast acting insulin and the Levemir doesn't work fast enough to cover that. In the evening at bedtime, I inject however many units of Levemir I feel I will need from experience and what has happened overnight the last few nights. So I have currently been dropping low through the night and needing jelly babies with no evening Levemir, so it would be crazy to inject some and make that worse. There is clearly enough insulin in my system to keep my levels low, so there is no problem not having an evening dose. What would be dangerous is to inject it when my levels are already dropping low. Levemir can be injected just once a day and many people, myself included, were started off on a single dose. It wasn't split into a morning and evening dose until just before my DAFNE course about 8 months after I was diagnosed and then it was split into an even 7 in the morning and 7 at night which soon became clear was too much at night and I gradually adjusted it so that I inject much more in the morning and just a little or none at night. Since then my honeymoon period saw steady increases in the daytime dose, but my nighttime needs have remained very low and I am still very prone to nocturnal hypos but if I didn't adjust my Levemir it would be almost every night, which is clearly not good for anyone.
Who is advising you on adjusting your doses? Is it a nurse at the GP practice or a specialist DSN at the diabetes clinic? That graph shows a significant drop from being in the 12s after your Indian takeaway, so if you didn't do a correction in the night then that is an indication that your evening Levemir is too much, although generally you look for patterns before you make a change rather than just one instance, but if you were eating to prevent hypos the previous night too, then that suggests you have too much insulin in your system during the night and you need to inject less. It may be that your body is able to cover you overnight needs without any additional Levemir, but needs more during the day when there is greater demand. Your remaining beta cells can also have a resurgence after you start injecting insulin, which gives then a bit of respite and they suddenly fire up again and insulin doses need to be dialed right back or indeed some people have to stop all insulin for a while during their honeymoon period, but then gradually reintroduce it as more beta cells are killed off. I didn't experience that but certainly there are people on the forum who have and we have one member who doesn't need any basal insulin at all, but just fast acting insulin for meals and he has been diagnosed over a decade.
We have a saying here on the forum that "You need what you need!" with regard to insulin doses but it is dangerous to keep injecting more than you need, so if you feel that your night time Levemir is too much then it would be wise to reduce it. If you are not comfortable not taking any, then consider a compromise and just reduce it by 1unit.
Do you have a half unit pen? 2 units is a very small dose so you should have a half unit pen so that you can adjust it more finely. The NovoPen Echo Plus is the half unit pen for Levemir and NovoRapid. They are really nice quality reusable pens so better for the environment as well as giving you that half unit option of adjusting doses and the cartridges for them take up much less space in the fridge than a box of pens. Ask your nurse to prescribe them as you will really benefit from being able to make half dose adjustments. They come in red and blue so make sure to ask for one of each because you don't want two pens the same colour for your different insulins, plus ask for a spare. The pens usually last at least 5 years and they show you what the last dose was that you injected and how long ago, which is really helpful for those "did I" or "didn't I" moments, we all have from time to time when injecting just becomes so automatic, you can't remember if you actually did it.
Sorry for writing "war and peace" but hopefully some of it will be useful.
Thank you Barbara that was a very comprehensive reply . And very useful . I did ask for a half unit pen but was told they were for children . I was having hypos on my 2 and 2 after activity so to increase by three units in one week seems mental . I will ask about the novopens but was also told there was no money for anything other than the basic . I was losing a bit of weight that I couldn’t afford to lose and was trying to up my carbs I think between that and not being entirely sure of my carb ratio and the foot in the floor it all went a wee bit pear shaped . Tonight I’ll eat some extra carbs before bed and then tomorrow I’ll go back to the start . Thank you for your supportive reply . I really appreciate your time - being newly diagnosed is very overwhelming and diabetes team don’t have the time to give newbies the help they need.
Bruce Stephens
Well-Known Member
- Relationship to Diabetes
- Type 1
That's just nonsense! They're for anyone who takes a suitably low volume, i.e., for someone like you, who could usefully use half units. (Not that useful for me because I'm rarely injecting less than 10 units, so half a unit here or there doesn't matter much.)
Also silly. They cost ~£50 each and last for a few years. And Novo Nordisk no longer make reusable pens other than the Novopen 6/Novopen Echo Plus. And while the disposable pens might work out cheaper, I rather doubt it. (Even if there is a difference I doubt there's much in it either way.) When I asked to switch over a couple of years ago there was no quibbling: we just discussed whether I wanted the half unit pens or not, and she made sure to prescribe different colour pens.
Inka
Well-Known Member
- Relationship to Diabetes
- Type 1
- Relationship to Diabetes
- Type 1
- Pronouns
- He/Him
Welcome to the forum @ellevee
NotVeryRapid and Levemir are great insulins, so you are on a pretty good combo there. Levemir is likes by forum members because it’s flexible and responsive. And because running 2 doses a day means you have the ability to have more or less basal active daytime/nighttime to suit you.
I think perhaps your nurse is trying to simplify things for you, but reading between the lines of your post I wonder whether that simplification has left you feeling a bit weird, and like you don’t really trust your doses?
Would it help to check things over in a slightly more systematic way? You could run some basal tests, to see if your basal doses are holding your BGs steady in the absence of rapid/food. It’s a bit of a faff, but it’s a technique that really helped me understand what the insulins were supposed to be doing and how to balance them better. And it was based on experimentation and observable evidence, rather than just plucking a dose out of the air(!).
There’s a write-up of basal testing here which you can adapt to your situation:
https://www.mysugr.com/en/blog/basal-rate-testing/
Once my basal is set right, and doing its hob properly I find it much easier to adjust my meal ratios and correction factors with confidence that I’m building off a firm foundation.
NotVeryRapid and Levemir are great insulins, so you are on a pretty good combo there. Levemir is likes by forum members because it’s flexible and responsive. And because running 2 doses a day means you have the ability to have more or less basal active daytime/nighttime to suit you.
I think perhaps your nurse is trying to simplify things for you, but reading between the lines of your post I wonder whether that simplification has left you feeling a bit weird, and like you don’t really trust your doses?
Would it help to check things over in a slightly more systematic way? You could run some basal tests, to see if your basal doses are holding your BGs steady in the absence of rapid/food. It’s a bit of a faff, but it’s a technique that really helped me understand what the insulins were supposed to be doing and how to balance them better. And it was based on experimentation and observable evidence, rather than just plucking a dose out of the air(!).
There’s a write-up of basal testing here which you can adapt to your situation:
https://www.mysugr.com/en/blog/basal-rate-testing/
Once my basal is set right, and doing its hob properly I find it much easier to adjust my meal ratios and correction factors with confidence that I’m building off a firm foundation.