2 questions about dosing

I’m not sure if I might be fighting a cold or something because my #'s keep going up to around 260 for no apparent reason. So when this happens, I hesitate to keep up-ing my levemir dose because when my body gets back to normal, suddenly I’ll have too much insulin in my system. Is it better to just keep correcting with the fast-acting insulin?

The other question I have is about shots throughout the day. There are 2 levemir drops that I notice----2 and 1/2 hours after my shot, then 2 hrs after that. If I was going to have lunch around 12, and my levemir peak is going to happen around 1:00, then which is better—to have only a few carbs with lunch and no shot, or a shot, but less of it? Does the levemir peak make up for not having rapid for 5 or 6 hrs?

I don’t know about the levemir because I’ve never used it. However, with the high numbers, I would keep trying to bring it down with your fast acting, being sure to keep in mind how much you’ve given and how long it takes to peak. I had to do this when I had surgery, so I just set an alarm to check every couple of hours.
I would suggest calling your Endo though. Maybe you will need to split your levemir dose?

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This is all unique to your body. You need to discover what you need by doing some experimentation. It can be trial and error but at least you’ll hone in on some useful info. Write stuff down, keep some records, hypothesize and test again. It’s time well spent. You have a lifetime to do the study.

I would probably be tempted to use the short acting corrections at first but then move it over to your basal dose if it appears to be needed on a regular basis. The job of your basal is to keep your BG flat if you don’t eat. And that number will change.

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Thank you both for your helpful responses :slight_smile:

I would correct with fast acting.

That’s what it’s designed for: to deal with spikes by getting in, doing its job, and going away. The action profile of a basal insulin like Levemir simply can’t deal with a spike effectively. It takes too long to ramp up and become effective, and then hangs around long after the problem is solved.

Basal insulins are intended and designed to provide a stable base of BG control throughout the day, not to deal with fluctuations. That said, it’s important to have your basal set correctly before you can hope to achieve good control with or without fast acting, but that’s a much larger topic for another time.

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If I’m sick enough that even my fasting blood sugars have skyrocketed, I add a bit of basal, but not a lot (even as a T2). But as Terry said, that’s something I’ve figured out over the course of years with trial and error. I can kind of judge when to start and stop based on where my BGs are in the morning and how cruddy I feel symptom-wise as to if I think I’m still going to be sick or not. If I’m optimistic that things are clearing up, I’ll dial back on the basal to (hopefully) avoid lows. I’d wager that’s probably a bit harder of a target to figure out as a T1.

I tend to cover more sick-day issues with my bolus insulin.

I can’t really say too much to your question about your basal-bolus timing.

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Sure. Pump users do the same thing by adjusting basal rates and then setting them back when things return to normal. Fasting is what basal is for, generally speaking. Pumpers have a big advantage that way; they can change a basal rate for a short time.

Just to throw it out there, by any chance did you recently start taking any steroidal meds or injection (e.g. cortisone, prednisone, etc.)? I ask because that can cause your BG’s to shoot up for weeks on end and stubbornly stay there for a few weeks until after the meds are out of your system.

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A perennial hazard, and one of which orthopedists are frequently unaware or underestimate the effect. Always worth mentioning when these “why am I running so high if I’m not sick?” queries come up.

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No I didn’t but this is good for me to know in case I should be taking any of those in the future. I’m not sure what it was but its gone now. Hopefully I won’t be seeing a lot more of those days. Thank you for responding :slight_smile:

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I usually get unexplained high when I have cold or any hidden infection like tooth or so.
I would correct with fast insulin.
Basal is not for covering food, as you may know, it is for stabilise your BS while you are not eating, if you using it to cover food even low carb that means the dose is higher than it should be

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I had a hard time years ago when I was on Levemir. Are you on 1 or 2 shots a day of the long acting? I was originally on 1 but then was switched to 2. The 2 shots helped a lot but I still couldn’t get it under good control. At the time I didn’t realize everything that could affect your blood sugar as a woman. I get stressed out easily and it seems to mess up my blood sugar a lot too. But anyways my point is different times of the month I have to switch my basal setting on my insulin pump up or down I guess the hormones in my body fluctuate back and forth.

I would definitely recommend talking to your doctor to see if changes are needed.

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I am back to having one shot a day (in the morning). I’ve tried different ways and it seems there are pro’s and con’s to every approach. My #s start climbing early in the morning because of having no lev at night, but then I don’t have to worry about dropping as much during the night.
LOL my doctor! I’m actually seeing her today, and it never fails. Every time I make an appointment with her about something, by the time the day comes for my appointment, I have another more urgent problem to talk to her about. I think I better ask her for some anti-anxiety meds while I’m there. by the time my appointment is over, she might need some herself.

My Endo said for Type 1 diabetics it’s common to need 2 shots of the long acting insulin. I guess mine wasn’t lasting 24 hours. So no matter what I would do my blood sugar would shoot up to 400’because I had no insulin in my body. Your body needs insulin constantly so I’m lucky I didn’t end up in the hospital. It’s easy to develop DKA if you don’t have any long acting insulin in your body when not on an insulin pump.

I was so upset when finding that out. My other Endo didn’t have a clue about that and just kept increasing my dose. He had me on such a nightmare of a ride. Shortly after I developed several diabetic complications. I’m just glad that the new doctor started helping and giving me a lot of info.

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That’s terrible. I’m glad you’re on the right path now! How in the world do some of these endo’s keep their jobs?! Same here, my endo used to insist that my long-acting insulin lasts 24 hours, and to keep increasing the dose. But I’ve found that it lasts more like around 20 hours. Some times I go back to having a couple of units at night, and I’ve also considered just setting my alarm to ring every morning around when it starts to go up to have a correction shot. If I choose the first option, then I worry that I might some day get my dosages mixed up and accidentally have the morning dose (22 units) at night. (I had asked my pharmacist about “timesulin” a few wks ago after learning about it on here, but he didn’t know what I was talking about. That would be the best!) And of course the 2nd option is okay at the times when i easily fall asleep after. It’s just that I’m not always able to get back to sleep. I tried also splitting the 2 doses equally, but for me it made my bg more unpredictable and I kept dropping at night…I’m not sure what options are left but I’ll have to think of something.

you can order Timesulin here


Thank you Marie! :slight_smile: I am currently using metal pens and found out that for me to use timesulin, that I have to use flex-pens…I’m going to ask my pharmacists if they have those. That would be a great thing to have!

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I have a Timesulin that I no longer use. Maybe I just got a lemon, but I found that the time it said wasn’t reliable. Oh, it might have been correct 80 or 90% of the time, but there were other times when I noticed that it was an hour off, or a dozen or more hours off. I decided not to continue using it at all since I couldn’t count on its being correct.

By the way, one of the things that I found helped to curb my DP was when I had to get up in the night for a bladder call anyway, if I’d take the time to go into the kitchen and find an ounce or two of cheese (without taking bolus) that that reduced my DP a lot. In fact, my BG when I finally arose wouldn’t be a lot higher than what I’d expect from just the cheese without bolus. It was as if the cheese fooled my liver into thinking I was already up and had had breakfast.

Some people seem to be able to cut down on the DP with a low carb snack before bed, but that never worked for me. It had to be after midnight, which would be within three or four hours of when my DP starts. Of course, you are a lot younger than I am, so you might not often have to get up in the night the way many of us old timers do.

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Thanks, I’m going to try that with the cheese because I usually get up once or twice at some point during the night.