Diabetes Talking

Question:

Patrick I started the evening dose of Levemir a month ago, and now he wants me to do a daytime one, which is fine, as my afternoon BG was starting to rise. But my main problem is and always has been high FBG’s and they are pretty high. I see what you mean by testing every hour or so, yes it would disturb my pattern, but i’m not sure if i am low at night or just rising. I will keep trying. I have also just given up smoking ( after reading your previous posts )  ) , and am now giving up drinking Stella and switching to Red Wine. I low carb / Excersie / the bloody lot ! But still have high FBG’s. I will start on a lower dose of levemir for the day and check whats happening at night. Thank You Su

– Hide quoted text — Show quoted text – I don’t know whther anyone remembers but I moved from Lantus onto Levemir 1 month ago, to try to reduce my FBG which can vary frp, 13.0-20.0. Since starting the Levemir I FEEL better, but have found that it runs out after 11 hrs as opposed to the 19hrs that Lantus gave me. Saw my consultant today –  he told me to take 2 doses of Levemir AM/PM and to keep increasing my night time dose until my morning sugars come down. I asked him if that was safe- considering may be hypoing at night… What I will do is wake up every 2hrs to check my night time sugars to see what is going on, but I am just SO fed up of it now. The hospital have also mentioned the pump, but want to try the levemir first. I asked about animal insulin as advised on this NG, but was told that it was a "retrograde" step. Also since changing to Lantus and then Levemir my Hba1C has gone from 5.2 to 7.1 – 8.1. Just wanted to offload really. Su With specific regards to morning Bgs … once you get the evening levemir dose right, you won’t need to worry about hypos – unless you have varying nights of sleep activity and sleep walk or something like that. I take lantus in one dose of 28u. If i go to bed at 12:00am with a reading of 5 to 6 mmol/l i will wake up with a reading of between 4 and 5 mmol/l. The day my FBG starts to worsen is the day i will adjust the dose of the lantus. How much levemir are you taking? You might find you set your alarm for odd times in the night during the first week, or what you could do is start on a very low evening dose and increase it 2 u at a time until you get an acceptable morning reading … but your best friend here is your meter and your alarm clock. Bearing in mind you only need to drop 3 mmol or so you won’t need much levemir for that. I don’t know if you’ve calculated how much levemir you need whilst sleeping to drop yourself around 3mmol/l  Maybe start with 2u before bed and take it from there. One thing that has been said before is that with any adjustment, don’t adjust too much too fast and only adjust one thing at once until you understand exactly what is going on. What i would NOT do is simply inject the same dose of levemir for the night that you take for the day time, i think that would result in you waking up with a hypo or worse. I would also suspect that if you tested every 2 hours during the night,. you’d not get a decent sleep and your morning readings may well be affected by that and when you return to a normal sleep pattern they might change again. However one night where you test every 3 or 4 hours would at least tell you what pattern your night time bgs follow. I am surprised your consultant didn’t give you a starting injection amount though ….. Patrick.

Response:

– Hide quoted text — Show quoted text -I don’t know whther anyone remembers but I moved from Lantus onto Levemir 1 month ago, to try to reduce my FBG which can vary frp, 13.0-20.0. Since starting the Levemir I FEEL better, but have found that it runs out after 11 hrs as opposed to the 19hrs that Lantus gave me. Saw my consultant today –  he told me to take 2 doses of Levemir AM/PM and to keep increasing my night time dose until my morning sugars come down. I asked him if that was safe- considering may be hypoing at night… What I will do is wake up every 2hrs to check my night time sugars to see what is going on, but I am just SO fed up of it now. The hospital have also mentioned the pump, but want to try the levemir first. I asked about animal insulin as advised on this NG, but was told that it was a "retrograde" step. Also since changing to Lantus and then Levemir my Hba1C has gone from 5.2 to 7.1 – 8.1. Just wanted to offload really. Su

With specific regards to morning Bgs … once you get the evening levemir dose right, you won’t need to worry about hypos – unless you have varying nights of sleep activity and sleep walk or something like that. I take lantus in one dose of 28u. If i go to bed at 12:00am with a reading of 5 to 6 mmol/l i will wake up with a reading of between 4 and 5 mmol/l. The day my FBG starts to worsen is the day i will adjust the dose of the lantus. How much levemir are you taking? You might find you set your alarm for odd times in the night during the first week, or what you could do is start on a very low evening dose and increase it 2 u at a time until you get an acceptable morning reading … but your best friend here is your meter and your alarm clock. Bearing in mind you only need to drop 3 mmol or so you won’t need much levemir for that. I don’t know if you’ve calculated how much levemir you need whilst sleeping to drop yourself around 3mmol/l  Maybe start with 2u before bed and take it from there. One thing that has been said before is that with any adjustment, don’t adjust too much too fast and only adjust one thing at once until you understand exactly what is going on. What i would NOT do is simply inject the same dose of levemir for the night that you take for the day time, i think that would result in you waking up with a hypo or worse. I would also suspect that if you tested every 2 hours during the night,. you’d not get a decent sleep and your morning readings may well be affected by that and when you return to a normal sleep pattern they might change again. However one night where you test every 3 or 4 hours would at least tell you what pattern your night time bgs follow. I am surprised your consultant didn’t give you a starting injection amount though ….. Patrick.

Response:

I don’t know whther anyone remembers but I moved from Lantus onto Levemir 1 – Hide quoted text — Show quoted text – month ago, to try to reduce my FBG which can vary frp, 13.0-20.0. Since starting the Levemir I FEEL better, but have found that it runs out after 11 hrs as opposed to the 19hrs that Lantus gave me. Saw my consultant today –  he told me to take 2 doses of Levemir AM/PM and to keep increasing my night time dose until my morning sugars come down. I asked him if that was safe- considering may be hypoing at night… What I will do is wake up every 2hrs to check my night time sugars to see what is going on, but I am just SO fed up of it now. The hospital have also mentioned the pump, but want to try the levemir first. I asked about animal insulin as advised on this NG, but was told that it was a "retrograde" step. Also since changing to Lantus and then Levemir my Hba1C has gone from 5.2 to 7.1 – 8.1. Just wanted to offload really. Su

Response:

– Hide quoted text — Show quoted text – Patrick I started the evening dose of Levemir a month ago, and now he wants me to do a daytime one, which is fine, as my afternoon BG was starting to rise. But my main problem is and always has been high FBG’s and they are pretty high. I see what you mean by testing every hour or so, yes it would disturb my pattern, but i’m not sure if i am low at night or just rising. I will keep trying. I have also just given up smoking ( after reading your previous osts )  ) , and am now giving up drinking Stella and switching to Red Wine. I low carb / Excersie / the bloody lot ! But still have high FBG’s. I will start on a lower dose of levemir for the day and check whats happening at night. Thank You

I’d keep the daytime levemir the same and take a smaller night time dosage. Start small though …and test regularly the first night to see what happens. I’d say every 3 or 4 hours would be frequent enough. What you could also do is set your alarm for random times of the night for a week before you change anything so you get a good idea of exactly where your blood sugar rises and by how much. As for swapping stella for red wine that’s a great idea. However when drinking wine there are some kinds that are sweetened and some that are not. I find hardys, jacobs creek to be ok for that, your experience may differ. Have you tried one glass of red wine before you go to bed? If your day time numbers are fine i would leave them alone and concentrate on the night time ones. What reading do you get before you go to bed? I’m assuming that with your previous Hba1c that your general control is very good? Giving up smoking may also cause a rise in BGs as well as a desire to eat like a starved goat :p

Response:

Patrick….. i’m confused….. why do you want to DROP 3mmol over night with the Levemir i would have thought you want to remain at the same reading you had BEFORE you went to bed…… or am i reading something wrong here?? kate — Join us in the Diabetic-Talk Chatroom on UnderNet /server irc.undernet.org — /join #Diabetic-Talk More info: http://www.diabetic-talk.org/ I have no medical qualifications beyond my own experience. Choose your advisers carefully, because experience can be an expensive teacher.

– Hide quoted text — Show quoted text – Patrick I started the evening dose of Levemir a month ago, and now he wants me to do a daytime one, which is fine, as my afternoon BG was starting to rise. But my main problem is and always has been high FBG’s and they are pretty high. I see what you mean by testing every hour or so, yes it would disturb my pattern, but i’m not sure if i am low at night or just rising. I will keep trying. I have also just given up smoking ( after reading your previous posts )  ) , and am now giving up drinking Stella and switching to Red Wine. I low carb / Excersie / the bloody lot ! But still have high FBG’s. I will start on a lower dose of levemir for the day and check whats happening at night. Thank You Su I don’t know whther anyone remembers but I moved from Lantus onto Levemir 1 month ago, to try to reduce my FBG which can vary frp, 13.0-20.0. Since starting the Levemir I FEEL better, but have found that it runs out after 11 hrs as opposed to the 19hrs that Lantus gave me. Saw my consultant today –  he told me to take 2 doses of Levemir AM/PM and to keep increasing my night time dose until my morning sugars come down. I asked him if that was safe- considering may be hypoing at night… What I will do is wake up every 2hrs to check my night time sugars to see what is going on, but I am just SO fed up of it now. The hospital have also mentioned the pump, but want to try the levemir first. I asked about animal insulin as advised on this NG, but was told that it was a "retrograde" step. Also since changing to Lantus and then Levemir my Hba1C has gone from 5.2 to 7.1 – 8.1. Just wanted to offload really. Su With specific regards to morning Bgs … once you get the evening levemir dose right, you won’t need to worry about hypos – unless you have varying nights of sleep activity and sleep walk or something like that. I take lantus in one dose of 28u. If i go to bed at 12:00am with a reading of 5 to 6 mmol/l i will wake up with a reading of between 4 and 5 mmol/l. The day my FBG starts to worsen is the day i will adjust the dose of the lantus. How much levemir are you taking? You might find you set your alarm for odd times in the night during the first week, or what you could do is start on a very low evening dose and increase it 2 u at a time until you get an acceptable morning reading … but your best friend here is your meter and your alarm clock. Bearing in mind you only need to drop 3 mmol or so you won’t need much levemir for that. I don’t know if you’ve calculated how much levemir you need whilst sleeping to drop yourself around 3mmol/l  Maybe start with 2u before bed and take it from there. One thing that has been said before is that with any adjustment, don’t adjust too much too fast and only adjust one thing at once until you understand exactly what is going on. What i would NOT do is simply inject the same dose of levemir for the night that you take for the day time, i think that would result in you waking up with a hypo or worse. I would also suspect that if you tested every 2 hours during the night,. you’d not get a decent sleep and your morning readings may well be affected by that and when you return to a normal sleep pattern they might change again. However one night where you test every 3 or 4 hours would at least tell you what pattern your night time bgs follow. I am surprised your consultant didn’t give you a starting injection amount though ….. Patrick.

Response:

Hello su I remember you were struggling on the Levemir the same as I am. My sugars are better than they were on Lantus,that stuff was lethal for me. I am struggling to balance the Levemir along side my NovoRapid, I have been told to inject some more Levemir in the morning which I do but still struggle. For some reason last night my BG was23.4 before bed. I took 40 units of Levemir and by 9.00 am it had only dropped to 18.2, so I had a lousy no energy morning until the Novorapid kicked in. I am waiting to hear from Hope hospital about my pump very soon as I have managed to get a 3 month free trial. Will let you all know how it goes. All the Best Carl Type 1 for 21 years (18 of them fine, 2 Not Bad and 1 bloody awful)

– Hide quoted text — Show quoted text – I don’t know whther anyone remembers but I moved from Lantus onto Levemir 1 month ago, to try to reduce my FBG which can vary frp, 13.0-20.0. Since starting the Levemir I FEEL better, but have found that it runs out after 11 hrs as opposed to the 19hrs that Lantus gave me. Saw my consultant today –  he told me to take 2 doses of Levemir AM/PM and to keep increasing my night time dose until my morning sugars come down. I asked him if that was safe- considering may be hypoing at night… What I will do is wake up every 2hrs to check my night time sugars to see what is going on, but I am just SO fed up of it now. The hospital have also mentioned the pump, but want to try the levemir first. I asked about animal insulin as advised on this NG, but was told that it was a "retrograde" step. Also since changing to Lantus and then Levemir my Hba1C has gone from 5.2 to 7.1 – 8.1. Just wanted to offload really. Su

Response:

I’m not being clear am i I meant to say that you should leave the daytime levemir alone and ADD 2 units at night and increase it in 2u steps until you get a satisfactory FBG. I.e. TWO injections. one daytime that she’s currently already doing and one MORE at night  ;) I’ve had a long day … sorry if i’m not being clear

Response:

ahhhh ok makes more sense the only other part of this equation that i would question is what is the pre=bed bg reading…… if that is high then the levemir might be holding Su steady thru the night…. and that would indicate that the evening meals’ insulin needs to be kate — Join us in the Diabetic-Talk Chatroom on UnderNet /server irc.undernet.org — /join #Diabetic-Talk More info: http://www.diabetic-talk.org/ I have no medical qualifications beyond my own experience. Choose your advisers carefully, because experience can be an expensive teacher.

– Hide quoted text — Show quoted text – I’m not being clear am i I meant to say that you should leave the daytime levemir alone and ADD 2 units at night and increase it in 2u steps until you get a satisfactory FBG. I.e. TWO injections. one daytime that she’s currently already doing and one MORE at night  ;) I’ve had a long day … sorry if i’m not being clear

Response:

Hello su I remember you were struggling on the Levemir the same as I am. My sugars are better than they were on Lantus,that stuff was lethal for me. I am struggling to balance the Levemir along side my NovoRapid, I have been told to inject some more Levemir in the morning which I do but still struggle. For some reason last night my BG was23.4 before bed. I took 40 units of Levemir and by 9.00 am it had only dropped to 18.2, so I had a lousy no energy morning until the Novorapid kicked in. All the Best Carl"

". . .. For some reason last night my BG was 23.4 before bed. I took 40 units of Levemir and by 9.00 am it had only dropped to 18.2, so I had a lousy no energy morning until the Novorapid kicked in. . ."    I find that when,  for any reason,  my sugar ends up much higher than 9 or so,  I need proportionally more insulin to control it than when at lower sugars,  i.e.  any given amount of insulin has less effect.   In my case, a sugar near 11 requires twice as much insulin to move my sugar some fixed amount when compared to the effects of insulin when I am closer to 5 or 6. The medical sites comment on this effect.  They say that high blood sugar produces a temporary increase in Insulin Resistance for everybody,  Type 1, Type 2  or whatever.    My experience supports that statement. Therefore,  if I were to go to bed at 23,   I would expect my standard dose of basal to have scant chance of doing anything all all to my FbG.    I solve that problem by taking extra Humalog and staying up until I have normalized.   IOW,  I will not go to bed at anything above 9. If I am near 9 at bedtime,  I will shoot a "supplemental bolus"**  of Humalog then go to bed trusting the Humalog to knock my sugar to reasonable levels while I sleep.      I don’t go to bed "on faith" at 12 or higher since  I can’t be sure how low I will drop when I shoot enough Humalog to defeat the ultra-high bG. (** "supplemental bolus" is the name that technique is given on the medical sites.) Regards   Old Al

Response:

i just want to confirm OldAl’s experience here for a bg level of 24 i have to take 15 units of insulin for a bg level of 9 i have to take 1 unit of insulin the amount of Humalog i take varies WIDELY based on my bg reading i would NEVER use Levemir or Lantus to ‘bring down my bg levels’ that’s the job of Humalog and a Levemir adjustment has a far longer impact than a Humalog adjustment has kate — Join us in the Diabetic-Talk Chatroom on UnderNet /server irc.undernet.org — /join #Diabetic-Talk More info: http://www.diabetic-talk.org/ I have no medical qualifications beyond my own experience. Choose your advisers carefully, because experience can be an expensive teacher.

– Hide quoted text — Show quoted text – Hello su I remember you were struggling on the Levemir the same as I am. My sugars are better than they were on Lantus,that stuff was lethal for me. I am struggling to balance the Levemir along side my NovoRapid, I have been told to inject some more Levemir in the morning which I do but still struggle. For some reason last night my BG was23.4 before bed. I took 40 units of Levemir and by 9.00 am it had only dropped to 18.2, so I had a lousy no energy morning until the Novorapid kicked in. All the Best Carl" ". . .. For some reason last night my BG was 23.4 before bed. I took 40 units of Levemir and by 9.00 am it had only dropped to 18.2, so I had a lousy no energy morning until the Novorapid kicked in. . ."    I find that when,  for any reason,  my sugar ends up much higher than 9 or so,  I need proportionally more insulin to control it than when at lower sugars,  i.e.  any given amount of insulin has less effect.   In my case, a sugar near 11 requires twice as much insulin to move my sugar some fixed amount when compared to the effects of insulin when I am closer to 5 or 6. The medical sites comment on this effect.  They say that high blood sugar produces a temporary increase in Insulin Resistance for everybody,  Type 1, Type 2  or whatever.    My experience supports that statement. Therefore,  if I were to go to bed at 23,   I would expect my standard dose of basal to have scant chance of doing anything all all to my FbG.    I solve that problem by taking extra Humalog and staying up until I have normalized.   IOW,  I will not go to bed at anything above 9. If I am near 9 at bedtime,  I will shoot a "supplemental bolus"**  of Humalog then go to bed trusting the Humalog to knock my sugar to reasonable levels while I sleep.      I don’t go to bed "on faith" at 12 or higher since  I can’t be sure how low I will drop when I shoot enough Humalog to defeat the ultra-high bG. (** "supplemental bolus" is the name that technique is given on the medical sites.) Regards   Old Al

Response:

Patrick Before bed my numbers are 5.0 -7.0 but on waking they are ALWAYS above 13.0 and upto 20.0 I have tried a the usual things and looked at the dawn effect etc and had a snack / no snack / red wine /cheese /peanut butter etc etc. I have been lurking a while. Daytime I have always been fine its while I am asleep that the problem occurs. And yes my previous Hba1c’s have been fine. It all went to pot when I started Lantus, and now that I am on levemir I FEEL better but it has not solved the problem. Today I have taken my 1st daytime shot of Levemir. See how it goes. Red Wine: Jacobs Creek / Hardy’s / Rioja a good one ! Thanks Su

– Hide quoted text — Show quoted text – Patrick I started the evening dose of Levemir a month ago, and now he wants me to do a daytime one, which is fine, as my afternoon BG was starting to rise. But my main problem is and always has been high FBG’s and they are pretty high. I see what you mean by testing every hour or so, yes it would disturb my pattern, but i’m not sure if i am low at night or just rising. I will keep trying. I have also just given up smoking ( after reading your previous osts )  ) , and am now giving up drinking Stella and switching to Red Wine. I low carb / Excersie / the bloody lot ! But still have high FBG’s. I will start on a lower dose of levemir for the day and check whats happening at night. Thank You I’d keep the daytime levemir the same and take a smaller night time dosage. Start small though …and test regularly the first night to see what happens. I’d say every 3 or 4 hours would be frequent enough. What you could also do is set your alarm for random times of the night for a week before you change anything so you get a good idea of exactly where your blood sugar rises and by how much. As for swapping stella for red wine that’s a great idea. However when drinking wine there are some kinds that are sweetened and some that are not. I find hardys, jacobs creek to be ok for that, your experience may differ. Have you tried one glass of red wine before you go to bed? If your day time numbers are fine i would leave them alone and concentrate on the night time ones. What reading do you get before you go to bed? I’m assuming that with your previous Hba1c that your general control is very good? Giving up smoking may also cause a rise in BGs as well as a desire to eat like a starved goat :p

Response:

question – No – i haven;t a clue what its doing. Funnily enough I have taken my 1st daytime shot today at 10:00AM , 10units as opposed to the 31 I take at night, and it has made my BG drop from 11.1 is happening in the night, I think I may be dropping . Will continue to moniter. Su

– Hide quoted text — Show quoted text – Do you know how long levemir takes to work for you? If you inject it .. how long does it take before that injection starts to work. I found that for me and lantus i needed to inject it at teatime ( about 6.00pm) so that it was starting to work overnight and was working as i get up. I found that my bolus ( when shot correctly) covered my daytime needs with no problem. As with anything, always  test when you change something and don’t change too much or too quickly as there are a lot of variables to take into account. What time have you been injecting levemir up till now?

Response:

Patrick Before bed my numbers are 5.0 -7.0 but on waking they are ALWAYS above 13.0 and upto 20.0 I have tried a the usual things and looked at the dawn effect etc and had a snack / no snack / red wine /cheese /peanut butter etc etc. I have been lurking a while.

It might be Somogyi effect rather than dawn effect, DP isn’t characteristically a large jump. Somogyi is more common in insulin users. A miscalculated evening insulin dose cause a low in the early hours and a rebound high, sometimes very high. Maybe your night dosage needs adjusting.

Response:

Do you know how long levemir takes to work for you? If you inject it .. how long does it take before that injection starts to work. I found that for me and lantus i needed to inject it at teatime ( about 6.00pm) so that it was starting to work overnight and was working as i get up. I found that my bolus ( when shot correctly) covered my daytime needs with no problem. As with anything, always  test when you change something and don’t change too much or too quickly as there are a lot of variables to take into account. What time have you been injecting levemir up till now?

Response:

question – No – i haven;t a clue what its doing. Funnily enough I have taken my 1st daytime shot today at 10:00AM , 10units as opposed to the 31 I take at night, and it has made my BG drop from 11.1 what is happening in the night, I think I may be dropping . Will continue to moniter. Su

*snip* What you need to establish above all else is how fast the levemir starts to work and when it’s working at its hardest. What you do NOT want is to find the levemir kicking in at 4.00am when you’re soundly asleep. If you can pinpoint the time of your morning Bg rise, and you can work out how long the levemir takes to become active then you can better time the amount and time of injection. You obviously know how to test etc etc, and if you can find Oldal he’s also worth discussing this as he’s far more technically clued up about most of the modern insulins and how they work. If you’ve taken 10u this morning, are you going to take the remaining 21 at the usual time? There is a figure that gives you a good indication of how much basal insulin you need correlated to your weight and age etc, again Oldal had a lot of information about this. Oddly enough i found that lantus was quite sensitive, if i take 2u too much or 2u too little then my numbers defnitely suffer …. can’t comment on levemir as i’m not using it. In answer to your first sentence, i really would invest some time and effort in working out exactly what your body is doing overnight, without that information it’s going to prove difficult to make relevant changes to your insulin regieme. Break things down, get your daytime readings back to where you want them OR sort out your nighttime readings. What you can’t do is both at once, there’s just too many variables involved. http://medweb.bham.ac.uk/easdec/prevention/lantusnotes.htm This might give you some more information about how things are meant to work, i know the page says lantus but it also discusses levemir too. Cheers, Patrick

Response:

Yeh, have read about the somogyi effect, just couldn’t remember how to spell it. OldAl mentioned it to me ages ago. thanks

– Hide quoted text — Show quoted text – Patrick Before bed my numbers are 5.0 -7.0 but on waking they are ALWAYS above 13.0 and upto 20.0 I have tried a the usual things and looked at the dawn effect etc and had a snack / no snack / red wine /cheese /peanut butter etc etc. I have been lurking a while. It might be Somogyi effect rather than dawn effect, DP isn’t characteristically a large jump. Somogyi is more common in insulin users. A miscalculated evening insulin dose cause a low in the early hours and a rebound high, sometimes very high. Maybe your night dosage needs adjusting.

Response:

That is very interesting, the fact that you have to use differing amounts of insulin dependant upon your numbers. In fact it also answers some of my questions. All this info is very valuable, and in actaul fact i am strtaing to make a bit more sense of what could be happening. You know when you get yourself into the situation "wood for the trees", I think thats where I have been. I never imagined that I would need more insulin at a higher BG of say 19.8 than I would at 8.2 but it makes sense. Cheers Su

– Hide quoted text — Show quoted text -i just want to confirm OldAl’s experience here for a bg level of 24 i have to take 15 units of insulin for a bg level of 9 i have to take 1 unit of insulin the amount of Humalog i take varies WIDELY based on my bg reading i would NEVER use Levemir or Lantus to ‘bring down my bg levels’ that’s the job of Humalog and a Levemir adjustment has a far longer impact than a Humalog adjustment has kate — Join us in the Diabetic-Talk Chatroom on UnderNet /server irc.undernet.org — /join #Diabetic-Talk More info: http://www.diabetic-talk.org/ I have no medical qualifications beyond my own experience. Choose your advisers carefully, because experience can be an expensive teacher. Hello su I remember you were struggling on the Levemir the same as I am. My sugars are better than they were on Lantus,that stuff was lethal for me. I am struggling to balance the Levemir along side my NovoRapid, I have been told to inject some more Levemir in the morning which I do but still struggle. For some reason last night my BG was23.4 before bed. I took 40 units of Levemir and by 9.00 am it had only dropped to 18.2, so I had a lousy no energy morning until the Novorapid kicked in. All the Best Carl" ". . .. For some reason last night my BG was 23.4 before bed. I took 40 units of Levemir and by 9.00 am it had only dropped to 18.2, so I had a lousy no energy morning until the Novorapid kicked in. . ."    I find that when,  for any reason,  my sugar ends up much higher than 9 or so,  I need proportionally more insulin to control it than when at lower sugars,  i.e.  any given amount of insulin has less effect.   In my case, a sugar near 11 requires twice as much insulin to move my sugar some fixed amount when compared to the effects of insulin when I am closer to 5 or 6. The medical sites comment on this effect.  They say that high blood sugar produces a temporary increase in Insulin Resistance for everybody,  Type 1, Type 2  or whatever.    My experience supports that statement. Therefore,  if I were to go to bed at 23,   I would expect my standard dose of basal to have scant chance of doing anything all all to my FbG.    I solve that problem by taking extra Humalog and staying up until I have normalized.   IOW,  I will not go to bed at anything above 9. If I am near 9 at bedtime,  I will shoot a "supplemental bolus"**  of Humalog then go to bed trusting the Humalog to knock my sugar to reasonable levels while I sleep.      I don’t go to bed "on faith" at 12 or higher since  I can’t be sure how low I will drop when I shoot enough Humalog to defeat the ultra-high bG. (** "supplemental bolus" is the name that technique is given on the medical sites.) Regards   Old Al

Response:

– Hide quoted text — Show quoted text -I don’t know whther anyone remembers but I moved from Lantus onto Levemir 1 month ago, to try to reduce my FBG which can vary frp, 13.0-20.0. Since starting the Levemir I FEEL better, but have found that it runs out after 11 hrs as opposed to the 19hrs that Lantus gave me. Saw my consultant today –  he told me to take 2 doses of Levemir AM/PM and to keep increasing my night time dose until my morning sugars come down. I asked him if that was safe- considering may be hypoing at night… What I will do is wake up every 2hrs to check my night time sugars to see what is going on, but I am just SO fed up of it now. The hospital have also mentioned the pump, but want to try the levemir first. I asked about animal insulin as advised on this NG, but was told that it was a "retrograde" step.

Shows how much he "kows" then doesn’t it? It’s only retrograde if it didn’t work and it did. And it still does. TELL him you want to try beef, don’t ask. Beav

Response:

Carl my consultant wants me to give the levemir "a good go", anmd I will certainly try. My exp. on Lantus was horrific, I too feel better on Levemir, but my numbers are wackier. Today is my 1st day of split doses, so #I will see how it goes. Good luck with the pump trial, how does the funding work..? Is it the primary care trust that pays or do you have to supplement it..? Su Type1 since 2001. Levemir & Novorapid 37yr

– Hide quoted text — Show quoted text – Hello su I remember you were struggling on the Levemir the same as I am. My sugars are better than they were on Lantus,that stuff was lethal for me. I am struggling to balance the Levemir along side my NovoRapid, I have been told to inject some more Levemir in the morning which I do but still struggle. For some reason last night my BG was23.4 before bed. I took 40 units of Levemir and by 9.00 am it had only dropped to 18.2, so I had a lousy no energy morning until the Novorapid kicked in. I am waiting to hear from Hope hospital about my pump very soon as I have managed to get a 3 month free trial. Will let you all know how it goes. All the Best Carl Type 1 for 21 years (18 of them fine, 2 Not Bad and 1 bloody awful) I don’t know whther anyone remembers but I moved from Lantus onto Levemir 1 month ago, to try to reduce my FBG which can vary frp, 13.0-20.0. Since starting the Levemir I FEEL better, but have found that it runs out after 11 hrs as opposed to the 19hrs that Lantus gave me. Saw my consultant today –  he told me to take 2 doses of Levemir AM/PM and to keep increasing my night time dose until my morning sugars come down. I asked him if that was safe- considering may be hypoing at night… What I will do is wake up every 2hrs to check my night time sugars to see what is going on, but I am just SO fed up of it now. The hospital have also mentioned the pump, but want to try the levemir first. I asked about animal insulin as advised on this NG, but was told that it was a "retrograde" step. Also since changing to Lantus and then Levemir my Hba1C has gone from 5.2 to 7.1 – 8.1. Just wanted to offload really. Su

Response:

It’s Primary Care Trust as far as I know. Haven’t heard anything as yet, so trying to keep faith with levemir. Carl

– Hide quoted text — Show quoted text – Carl my consultant wants me to give the levemir "a good go", anmd I will certainly try. My exp. on Lantus was horrific, I too feel better on Levemir, but my numbers are wackier. Today is my 1st day of split doses, so #I will see how it goes. Good luck with the pump trial, how does the funding work..? Is it the primary care trust that pays or do you have to supplement it..? Su Type1 since 2001. Levemir & Novorapid 37yr Hello su I remember you were struggling on the Levemir the same as I am. My sugars are better than they were on Lantus,that stuff was lethal for me. I am struggling to balance the Levemir along side my NovoRapid, I have been told to inject some more Levemir in the morning which I do but still struggle. For some reason last night my BG was23.4 before bed. I took 40 units of Levemir and by 9.00 am it had only dropped to 18.2, so I had a lousy no energy morning until the Novorapid kicked in. I am waiting to hear from Hope hospital about my pump very soon as I have managed to get a 3 month free trial. Will let you all know how it goes. All the Best Carl Type 1 for 21 years (18 of them fine, 2 Not Bad and 1 bloody awful) I don’t know whther anyone remembers but I moved from Lantus onto Levemir 1 month ago, to try to reduce my FBG which can vary frp, 13.0-20.0. Since starting the Levemir I FEEL better, but have found that it runs out after 11 hrs as opposed to the 19hrs that Lantus gave me. Saw my consultant today –  he told me to take 2 doses of Levemir AM/PM and to keep increasing my night time dose until my morning sugars come down. I asked him if that was safe- considering may be hypoing at night… What I will do is wake up every 2hrs to check my night time sugars to see what is going on, but I am just SO fed up of it now. The hospital have also mentioned the pump, but want to try the levemir first. I asked about animal insulin as advised on this NG, but was told that it was a "retrograde" step. Also since changing to Lantus and then Levemir my Hba1C has gone from 5.2 to 7.1 – 8.1. Just wanted to offload really. Su

Response:

– Hide quoted text — Show quoted text – Patrick Before bed my numbers are 5.0 -7.0 but on waking they are ALWAYS above 13.0 and upto 20.0 I have tried a the usual things and looked at the dawn effect etc and had a snack / no snack / red wine /cheese /peanut butter etc etc. I have been lurking a while. It might be Somogyi effect rather than dawn effect, DP isn’t characteristically a large jump. Somogyi is more common in insulin users. A miscalculated evening insulin dose cause a low in the early hours and a rebound high, sometimes very high. Maybe your night dosage needs adjusting.

If it was Somogyi, I would’ve thought a nighttime snack would’ve addressed it, or at least given a clue. Maybe a snack wouldn’t have stopped it dead, but it would’ve slowed the drop to the point where she *may* have not gone so low she got a massive re-bound. It IS something to consider though. Beav

Response:

That is very interesting, the fact that you have to use differing amounts of insulin dependant upon your numbers. In fact it also answers some of my questions. All this info is very valuable, and in actaul fact i am strtaing to make a bit more sense of what could be happening. You know when you get yourself into the situation "wood for the trees", I think thats where I have been.

Su, I’m interested in your comment there. It seems that you haven’t used different amounts of insulin to do "different things" I look on insulin shots like I look at food. If I’m only a little hungry, I only eat a little, and if my sugars are only a little high, I only use a little insulin and vice-versa. If I’m high, then the insulin dose is adjusted upwards to speed things up. Of course, if you go daft, then you’ve got to be prepared to catch any "incoming" that may arrive and this can lead very quickly to massive weight gains as you subsequently need to feed the insulin to fight the incoming hypo. I never imagined that I would need more insulin at a higher BG of say 19.8 than I would at 8.2 but it makes sense.

It makes perfect sense BUT…. only if you make sure you record the numbers and the effect of the insulin doses. We begin by guessing how much we need, but eventually it becomes less guesswork and more experience. Like Kate knows how many units to shoot for a particular BG number and how much to shoot for another BG number. These doses are learned through trial and (hopefully not many) error(s). Recording the numbers and the doses makes life SO much easier and safer, so it’s not something that shouldn’t be done. Nowadays the medical community call this approach "Dafne" which stands for "Dosing as for normal eating" (there are courses for it now too!!) This approach where each insulin shot is DIRECTLY related to what you’re about to eat/have eaten and your blood glucose level at the time. Adjustments can be made later on too, if your BG isn’t where it should be. Lots of us have been doing it for years, but we didn’t/don’t call it "Dafne", we simply call it MDI (Multiple Daily Injections) because that’s about all it really boils down to. Beav

Response:

Hello su I remember you were struggling on the Levemir the same as I am. My sugars are better than they were on Lantus,that stuff was lethal for me. I am struggling to balance the Levemir along side my NovoRapid, I have been told to inject some more Levemir in the morning which I do but still struggle. For some reason last night my BG was23.4 before bed. I took 40 units of Levemir and by 9.00 am it had only dropped to 18.2, so I had a lousy no energy morning until the Novorapid kicked in.

Whenever I have trouble bringing down a high, I’ve found that not only do I need the insulin, but food too. Not a lot of food, but without it, the high resists lowering attempts more. Food seems to act as a trigger to get "everything " working as it should. Now this might not work for everyone, but it’s not a killer to try it. Beav

Response:

|

|

|Hello su |I remember you were struggling on the Levemir the same as I am. | |My sugars are better than they were on Lantus,that stuff was lethal for |me. |I am struggling to balance the Levemir along side my NovoRapid, I have |been |told to inject some more Levemir in the morning which I do but still |struggle. For some reason last night my BG was23.4 before bed. I took 40 |units of Levemir and by 9.00 am it had only dropped to 18.2, so I had a |lousy no energy morning until the Novorapid kicked in. | |Whenever I have trouble bringing down a high, I’ve found that not only do I |need the insulin, but food too. Not a lot of food, but without it, the high |resists lowering attempts more. Food seems to act as a trigger to get |"everything " working as it should. | |Now this might not work for everyone, but it’s not a killer to try it. | |Beav | Hi Beav That comment triggered a memory of an article published recently on HISS. I’ve not seen much discussion on it, and I’ve no idea if it’s being accepted by other scientists, but the basic logic was as follows: HISS stands for "hepatic insulin sensitizing substance". What it means is that when non-diabetics eat, the insulin which is released also triggers the release by the liver of HISS. The presence of HISS then effectively doubles the effectiveness of that insulin on our blood glucose. Thus, the act of eating leads to both insulin and HISS as part of the insulin/glucose system in a normal person. In a significant number of type 2 diabetics, the release of HISS is impaired or absent. This leads to HDIR or "HISS-dependent insulin resistance". I don’t remember type 1 being mentioned, but if his logic is correct, then you would be producing the HISS but not the insulin when you eat, thus increasing the effect of the insulin you inject. The url is http://www.jstage.jst.go.jp/article/jphs/95/1/9/_pdf I posted some comments on it on asd/mhd at http://tinyurl.com/4k8wp . In fairness, if you read the replies on the thread, Frank and Jefferson weren’t over-enthused with the researcher. Maybe some food for thought though. Cheers, Alan, T2 d&e, Australia. Remove weight and carbs to email. — Everything in Moderation – Except Laughter.

Response:

– Hide quoted text — Show quoted text – | | |Hello su |I remember you were struggling on the Levemir the same as I am. | |My sugars are better than they were on Lantus,that stuff was lethal for |me. |I am struggling to balance the Levemir along side my NovoRapid, I have |been |told to inject some more Levemir in the morning which I do but still |struggle. For some reason last night my BG was23.4 before bed. I took 40 |units of Levemir and by 9.00 am it had only dropped to 18.2, so I had a |lousy no energy morning until the Novorapid kicked in. | |Whenever I have trouble bringing down a high, I’ve found that not only do I |need the insulin, but food too. Not a lot of food, but without it, the high |resists lowering attempts more. Food seems to act as a trigger to get |"everything " working as it should. | |Now this might not work for everyone, but it’s not a killer to try it. | |Beav | Hi Beav That comment triggered a memory of an article published recently on HISS. I’ve not seen much discussion on it, and I’ve no idea if it’s being accepted by other scientists, but the basic logic was as follows: HISS stands for "hepatic insulin sensitizing substance". What it means is that when non-diabetics eat, the insulin which is released also triggers the release by the liver of HISS. The presence of HISS then effectively doubles the effectiveness of that insulin on our blood glucose. Thus, the act of eating leads to both insulin and HISS as part of the insulin/glucose system in a normal person.

Very interesting Al, cheers for that. It’s something I’ve not seen before, but although I don’t know the mechanics of it, I do know (for me) it’s a fact of life. In a significant number of type 2 diabetics, the release of HISS is impaired or absent. This leads to HDIR or "HISS-dependent insulin resistance". I don’t remember type 1 being mentioned, but if his logic is correct, then you would be producing the HISS but not the insulin when you eat, thus increasing the effect of the insulin you inject.

Seems so, and of course, as a T1 I don’t suppose I produce much insulin anyway. Maybe some, but certainly not enough to have any effect on my BG. I rather like this idea of having it’s effectiveness doubled by scoffing though )) The url is http://www.jstage.jst.go.jp/article/jphs/95/1/9/_pdf

I’ll give that a serious perusing. I posted some comments on it on asd/mhd at http://tinyurl.com/4k8wp . In fairness, if you read the replies on the thread, Frank and Jefferson weren’t over-enthused with the researcher.

I’ve not "MHD’d" for a while. Maybe some food for thought though.

And talking of food, I had pancakes for tea tonight. 5 of them, with lemon and SUGAR. One hour after eating them, my BG was 1 point below what it was before I started. I never even topped 8mmol/l. Started at 7.5, an hour later, 6.5. Beav

Response: