Insulin question for type 1's

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Insulin question for type 1's


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Old 04-14-2012, 19:07   #1
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Hi all!

I'm a newb here (and have recently moved... no specialist set up yet, but hopefully soon)... I'm having some problems with my morning bg's, and was wondering if anyone had any advice.

For my insulin regime, I do the following:
- Morning basal: 12 Levemir
- Evening basal: 6 Levemir
- 1 unit of Humalog per 10 g carbohydrate
- Insulin correction equation: ( [high blood glucose] - 5 ) / 3.3 = units of Humalog needed.

Anyways, with my evening insulin, I go to bed around 8 or 9 pm (my man wakes up at 3:30 am to get ready for work, and I usually wake with him too--get his lunch ready and have coffee together--and so go to bed with him pretty early), and my blood sugars stay very steady throughout the night all the way until I test them at 4 am. I usually have my basals at 7 am and 7 pm respectively, and my afternoon blood sugars tend to drop, and I have trouble keeping them up. However, between the hours of 4 am and 10 am, my blood sugars like to rise... today I had to have a grand total of 7.5 extra units of Humalog to keep them down (I tested every half hour from 4 am to 7 am... lots of pokes, lots of corrections, but a good idea of what my blood sugars are doing).

Does anyone know why my blood sugars rise and I need this much insulin between 4 am and 10 am? By the afternoon/evening, I will have a whole lot of lows (which, ironically, will result in a necessary 75g extra carbohydrate... the amount that the 7.5 units of Humalog would cover were I to just snack on this). Is this just the way Levemir works in my body? Or is there something I should be looking out for? I'm sick right now (this is day 4 of a terrible flu), but they were doing this before too.

I'm so frustrated, and have no hope of seeing a specialist for a long time, but I need to make some changes to my insulins before my HbA1c goes all wonky. I don't think my evening basal needs to change (I'll have night lows if I increase, or worse morning highs if I decrease), or my morning basal (that would mean even more and worse lows in the afternoon/evening), and so was thinking about giving myself an extra dose of Humalog at 4 am to prevent the highs before they happen... except it's fast acting, and I don't want to go through a rollercoaster ride before even starting my day (of course, that's pretty much what's happening anyways).

So far, the Humalog is my only option, and all I can think of doing is pre-treat the highs before they happen, slowly... meaning lots of injections between 4 am and 10 am, and I'm pretty sure this isn't a normal way of treating this. I even considered the possibility that it was the coffee increasing the blood sugars, but after removing it, they still went up. If I sleep in to 7 am when I have my basal, I wake with a high.

Any suggestions?

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Old 04-14-2012, 19:35   #2
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Your BGs are following a very common pattern. In fact, they mirror mine quite closely.

The morning highs are commonly called the "dawn phenomenon" and you should be able to find a lot of posts here about it.

My afternoons can have a lot of lows, too, so I compensate by using a lower carb ratio for lunch and a lower basal rate until dinner.
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Old 04-14-2012, 19:39   #3
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To treat the morning highs, I increase my basal rate to compensate. For yourself you may want to ask your doctor about increasing your long acting overnight insulin. You'll need to monitor this very carefully, however, because you don't want to have a low while you are sleeping.

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Old 04-14-2012, 20:34   #4
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I was leaning towards this, but having just moved and not having any Dr other than to go to a regular walk-in Dr (I had finally gotten a family Dr and a diabetic specialist lined up, and had to move again ), I was afraid of being wrong and treating it incorrectly (oh man!) I'm not going to increase my overnight basal (I tried this, and had a snack before bed to prevent a low... but my blood sugars weren't as steady as I wanted them to be), so I'm going to become my own insulin pump of a sort (I can't afford one right now, and our medical insurance doesn't cover one). Since I wake most days around 4 am anyways, I think I'll just make this my routine, and give myself a dose of Humalog to prevent the highs from happening.

Once I figure out the hours that I go low, I was thinking of just eating a snack to prevent the low from happening all together... this would be an OK idea, right?

Thank you so much for your post too... it really helps to have someone else confirm the problem, and I found it helpful hearing how you treat yours too . I feel much more optimistic about resolving this on my own now, and have hope that I can have this figured out before going in to see anyone about it (I shouldn't have to move for another year, and hopefully it will be longer, but that's enough time to at least get a team back in place... fingers crossed it won't take half a year to get in to see someone again).

That said, thank you again!!!!

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Old 04-14-2012, 20:45   #5
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I have to change the dose of Lantus sometimes, because my need for insuline changes.
For me, I will typically have a FBG between 4 and 5,5, and then I have very few carbs (my max limit is 5 carbs), but in the afternoon my BG often wants to drop, so I eat more frequently in the afternoon (but never more than 5 carbs), and by doing this my BG is between 4,0 and 6,4 during the day.
I take 8 i.e.h Lantus in the morning and 4 i.e.h. Lantus in the night, and dont use any rapid insuline unless I max once a month want to eat something more than 5 carbs for a meal. In that case I use Humalog.
Earlier, before I fully started to eat LCHF, my BG would act like a crazy dog, and I would have a BG jumping between 2 and 17 several times during the day.

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Old 04-15-2012, 01:51   #6
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Sorry, but I don't think I can help. Your question involve insulin I don't use and I've only been at this 6 months. I don't think I have enough knowledge to really help.

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Old 04-15-2012, 04:46   #7
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Your basal rate of 12 units am/5 units pm seems a little out of wack to me. I take about the same amount, but I split it evenly 9 units am and 9 units pm. I was doing 11/7, but I kept getting mixed up by taking the wrong dose. So for the past week or so I am doing the new rate with no issues.

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Old 04-15-2012, 04:56   #8
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I would say that your basal load is out of balance. I would switch a couple of units from morning dose to the evening dose. But that's just me.

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Old 04-15-2012, 16:10   #9
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I agree with adjitater and frankly. I would adjust my basal doses. When doing MDIs my basal rate was 15u am and 15u pm.

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Old 05-03-2012, 00:03   #10
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I would concur with what most people here are suggesting. If your glucose levels are fluctuating for reasons other than a recent meal, then you need to adjust the timing of or the number of units you take of basal insulin.

Although at first it doesn't sound like a bad idea to pre-treat your highs with Humalog, the problem with that would be the times that you take an injection of fast-acting insulin and then you don't have the corresponding glucose spike you were expecting. You're likely to experience an episode of hypoglycemia which you'd have to correct by taking carbs.

That was one of my problems when I first began insulin therapy and I was only using Lantus. I would be fine 50% of the time, the other 30% of the time my post-prandal glucose would go too high, so I'd try to correct this by increasing my basal insulin. That resulted in the remaining 20% of the time being me going hypo and then having to eat two or three bags of gummy bears to get back to normal. I'd eat too many (because they are delicious) and then I'd be too high.

The lesson I learned was to change my mindset to focus on the long game. Although frequent blood glucose monitoring is important and it's good to correct highs when they occur, in the long-run we are better off to maintain a blood glucose that is a steady 120 mg/dL rather than one that fluctuates between 60 mg/dL and 180 mg/dL.

So my advice is to make some slow changes to your basal insulin, by taking a couple units away from the morning and adding them to the evening injection. Try that for a few days and see if it makes an improvement. If your daytime and evening readings don't suffer, but your morning ones are still high, take a few more units away from the morning dose and add them to the evening. I'd continue to make this change every few days until the amounts were balanced, until my morning highs were eliminated, or until my other readings started to go high.

Just keep in mind, being a little high for a few weeks while you adjust your insulin is not going to cause you harm. To put it into perspective, think how much better off you are now, being high for a few hours a day for a few weeks, than of you were high all of the time without relief, as so many unaware of their diabetes are.

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