I am fairly new to insulin and am still trying to figure out my proper basal dose (as well as my carb ratio, but I want to get THIS straight first!) Following the instructions in Think Like a Pancreas, I found that my blood sugar dropped from 145 to 88, for a total of 60 points or so overnight (this is without eating or bolus before bedtime; something I usually do). I had a 77 in the middle of the night and was very uncomfortable (still have pretty good hypo awareness most of the time). Anyway, according to “Pancreas” I should lower my basal dose 10% or more. BUT, my daytime BGs are averaging more in the 160s range (after bolus has worn off, for example), making me think that the basal is not high enough. Should I split the dosage? I have been doing 20 units Levemir about 10 pm. I am 5’2" about 140 lbs, and old (51)
In my opinion as a professional UDE (Uncertified Diabetes Educator), there are 2 options:
- Move to your Levermir shot. Both Lantus and Levemir are stronger at the beginning, not the end of the shot, so if you take Levmir at 10 pm, it’s strength is going to be at night, and slowly wane through the day (not until about 18 hrs in, however, so you should be pretty good for most of the day.). This could partially explain why you drop at night, after you take your shot, and then start to go up during the day.
Also, your body doesn’t naturally produce the same amount of insulin for 24 hrs, which is why a 1 shot a day basal doesn’t always cut it. It’s okay, but having 3-4 or more basal rates will often match up with your body a lot better.
That said, option #2 is splitting the dose. Take slightly less at around 9 or 10 p.m., and then take the bulk of the rest at 9 or 10 a.m. You’re not getting as much insulin overnight, but you’re still covered 24 hours.
Again, I’m NOT a CDE, so who knows if I’m right, but these are 2 options to bring up with your CDE or your doctor.
Hi Rebecca,
I’m Type 1, take injections & use Levemir.
What are your morning fasting readings? Were your numbers before taking insulin very high? Asking because 77 isn’t low for it to feel this uncomfortable to you.
What I’ve experienced & many others here have experienced the same. Despite what our doctors say & the pharm info, basal insulin does not last 24 hours for most people. I’ve discussed this with several endos, one who also had a Ph.D. & with Dr. Bernstein. While the biochem explanation was too complicated for me to understand, basal taken at night lasts about 8 hours. For some reason it just gets used up faster while we’re sleeping.
My first endo was adamant about me taking basal first thing in the morning. I had good daytime numbers, but my fasting morning numbers were high. If I took higher basal doses, I’d have lows during the day, but my morning numbers the next day were still high. Opposite of what’s happening to you. I learned that many people took basal in two doses–right before bed & then first thing in the morning. Not that I’m recommending this, but I just went ahead & gave two doses against what my first endo said because the morning highs were killing me. Thankfully, I have a better endo now!
It wasn’t a matter of splitting the basal dose in half for me because the basal was used up overnight with my bad dawn phenonmenon. I take relatively small doses of Levemir because I’m thin.
Does sound like taking two separate doses would help you because taking it in the evening is not helping your between meal BG.
Update- well yesterday was one of my best days yet on the insulin. I took part of my Levemir at night (15u), woke up with a 104 that I was happy with, then took more Levemir (10u) in the mid-morning and stayed much more level all day. Thanks for the advice! Had lots more energy too!