Hi could someone please help me try to figure out my basal. Ok first night started out on levemir 6units went to bed at 181 woke up at 62. Second night lowered to 5u ate 2 things of protein was scared... went to bed at 140 woke up at 110. Third night took 5u, went to bed at 180 woke up 82. Fourth night which was last night took 5u of levemir ate 1 string cheese went to bed at 145 woke up at 65. I know some of you don't treat unless under 60, but i felt low when I woke up I was shaky and heart was pounding. So I took insulin Novolog anyway and ate right away instead of waiting. So my question is could someone please tell me what to do about the levemir, because I hate waking up low, and that was even an hour before I usually wake. Anyway I hate waking up low so I feel like I should lower the levemir, but I already feel like it doesn't work like it should in between meals because I still seem to go up between meals a lot. I don't know what to do?
My rule of thumb is that pre-meal BG show the basal rate accuracy and post meal show the bolus ratio accuracy. If you are running up after meals, perhaps you can try adjusting the ratio -1 or -2 G of carb/ unit to see if that fixes it? This is challenging as there can be "overlap" but most of the time, it works out ok. If the fasting, like the 65 in the AM, are too low to be comfortable, maybe a small adjustment, 1U at a time to see how it goes? I'd always try to guesstimate 1/2U by splitting in between the lines on syringes but insulin is strong stuff so be careful w/ any adjustments? Good luck!
I agree with acidrock that your between-meals numbers that are higher are more likely due to needing to tweak your novolog higher, not your levemir. You probably want to try lowering your levemir slowly over a couple of days. But keep in mind that perfection is a goal , not a true state of being. There are so many factors that can cause highs or lows that you'll have no control over, so just aim for the best you can do and look for the trends in your big picture. You've been doing really well so far, and I applaud how you've been working towards being healthy.
(Personally, I usually only need 3 units to have fasting numbers in range. Usually. Most of the time those 3 units will mean 85-105 when I wake up. Occasionally there will be a 70 or a 130. But as there's often no rhyme or reason it doesn't seem like a good idea to change that dosage only to be high or low for the 24 hours that follow. Hope the example helps.)
As a side note, if you find you're sensitive to the novolog and small amounts affect you a lot, you might consider something that does the 1/2 units. I use the novolog pen that's for kids specifically for that reason.
Good luck figuring it all out!
One thing to consider. You might still be "honeymooning" so this could potentially account for some unpredictable numbers.
http://en.wikipedia.org/wiki/Honeymoon_period_%28diabetes%29
I would think that at a year, the "homegrown" would be dropping off, which would lead to the higher than expected BG, perhaps more prominently in relation to food, or perhaps there's a "slow hand" operating, in that the food gets your own insulin fired up but it takes a while, leading to the fasting lows after the post-meal highs? I dunno that much about it as mine was a while ago and I don't have a big memory, other than that my numbers went up and I took more insulin and things smoothed out for a while.
I would just focus on balancing the numbers without worrying about honeymooning too much as the methodology would be the same? Which is, of course, easy for me to say as I'm honeymoonless!
LOL, at defering to flaky people named "acidrock23", hee hee. It may be more deferring to Medtronic? I can adjust mine 10% of 6U if I want to but it's hard to be that precise w/ 6U as the syringes/ pens don't have that sort of fineness but a lot of my "fiddling around" is very small increments. Re Denise's issue, maybe another "workaround" that many people have found useful is to split the Levemir into chunks? If you do that, it might produce a smoother curve or, more precisely, two smoother curves that would produce nicer ride?
I agree about splitting levemir into chunks, when I was using Lantus/ then Levemir I had to split my dose, I could not take it all at one time or it would drop me too low, but if I cut back I'd be running high all day, splitting my doses was an excellent way of getting around that and smoothing out that curve. I also think Denise's humalog needs some tweaking as well.
I agree with the others that the 5 units sounds about right, but I also agree you should split the dose to get better coverage. That is usually the norm with Levemir anyway. So I would take say 2 at night and 3 in the morning.
I did mine that way too, less at night, and slightly more in the morning. It really does help level out that curve. Despite what is said about insulins like Lantus and Levemir, there are some curves to them and they do seem to peak. I would agree as well and try 2 and night and 3 in the morning, and see how that works for you. It's amazing how it can still be the same amount of insulin, but given at different times can work so much better for you.
Thank you all so much for your helpful advice :)
does taking it in the morning interfere with the novolog though ? Like will be make it more likely for me to have a low in the morning hours? And do I take them the same time in the morning? Thanks
No, it doesn't matter if you take them at the same time (I did when I was on shots). The Levemir is long acting while the novolog is rapid acting. The Levemir affects you slowly over a period of hours while the Novolog takes effect very quickly and is out of there in 3-4 hours. No conflict.
I inject in stomach. Last night I just dropped it 1 to 4u and I got a perfect number this morning of 89, but I know it's not going to help me probably between meals. But i'm also adjusting my novolog today because after meals have been kinda hig, so I guess I'll jut see how it goes. I'm a little nervous about splitting the dose just yet. It doesn't seem like 2 during the night would be enough if I did 2 at night 3 in morning since 4 gave me a great number? I'm going to see how the next 3 days go and then I'll make another adjustment if needed I guess...and probably try the split dose then if this doesn't help some. Thanks everyone
SO I want to thank everyone for the great advice... So far so good. I decided to split my dose because I was sitting at 160 for like 4 hours so I was just like ok this isn't working obviously my basal isn't helping cover between. So at 6:45 I took my novolog I was a little high on before I ate but not to bad. Then I took 2u on levemir at 7pm and so far so good...I've been keeping track of 1hr and 2hr just to see and then at bedtime and usually I would be kinda high 1 hr and super high 2 hr after dinner and even higher at bedtime...well tonight since changing things up my 1 hr was ok.. and 2 hr I'm actually lower then the 2 hr which is awesome my 2 hr number was 131. :) Taking the levemir at 7pm so that way when I wake up at 7am it will be exactly 12 hours. Does taking it earlier then I usually do put me at risk of going low or high over night now though? thanks everyone
I always gave myself a plus or minus an hour, and it worked ok for me but everyone's a little different.
what do you mean like an hour between each insulin?
No I'm sorry I was talking about when I was on Lantus/Levemir, I'd allow myself a plus or minus an hour...like if I took my pm does at 8 pm, I'd allow myself to take the AM between 7 am and 9 am. That seemed to work ok for me, and allow me a little flexibilty too.
Ok splitting the dose of levermir didn't work. My fasting number is 143 :(. When I was taking 4u at 11pm I was waking up at 89. I was started at 6u. So maybe I should try 4 at night and 2 in the morning tonight? Or how should I do it? I'm going to take the 3 this morning as I planned but this defintely isn't working...now my breakfast is probably going to be super high :(. And if I was taking the 4u before at 11pm maybe the time I was taking it was helping too? Because this time I took the 2 u at 7pm so that way it would be exactly 12 hours apart.What time should I take the doses? Man this sucks I feel like i'm never going to get the hang of it. :-/
Well I've been on it for a wk though the first dose of 6u was causing lows so I went to 5u was still causing lows but not helping in between so I had went to 4u, which was giving me perfect fasting numbers but not helping in between meals. So I tried the 2u at night and just now did the 3u in the morning and so far the 2u at night didnt help at all I woke up high..which im sure will throw the whole day off.
I agree with trying for a couple of days. Any time I make changes, I give it 2 or 3 days w/ the new settings before I make further adjustments.