So, I continually am high at bedtime, 150's 160's. How do I get this number down? I take both am AM & PM doses of Levemir. If I do a correction, at bed for some reason, around 12am the corretion hits as well as my PM levemir dose peaks and I drop then 2 hours later I'm heading up to 200's around 3am. Everynight. Still don't know if it's DP or not enough Levemir. UGH!
Do I:
1) Add another unit to my AM levemir dose 2) Just keep doing corrections at bed
3) Add another unit to my PM levemir dose
Isn't the night time basal just supposed to hold us steady overnight? Last night I just did 5 units at bed and didn't correct, as I wanted to see what happened, I stayed steady at 155 and didn't drop. Woke up at 2am and did 1 unit of novolog and woke up at 98.
Also, I am badly bruising at my injection sites, my tummy - arms, where I give my bolus. Any suggestions, especially with summer time here. What am I doing wrong?
I wouldn't make boluses with basal insulins. You are just making it stack with the next shot and it becomes a mess! When you say 5 units at bed is that a bonus bolus of Levemir?
Still taking Levemir at 9am 9pm as said in the other post?
As regards bruising never had such problems honestly. Are you rotating enough? Is that an immediate reaction or it happens after a few shots made in the same spot?
ha, love you..thanks! i'm now taking 11 units of levemir 9am and 5 units of levemir at 9pm. my objective here is to try and keep my fasting numbers down during the day, of course, and get a good bedtime number, then...find that right amount of levemir to just hold me over night. the overlap of basal and bolus shouldn't matter as basal is long acting, no?
Yes, I rotate, I'm rather petite so I don't have a lot of real estate to work with but I do rotate. I just am bruising now with every injection. Should I pinch up?
You say that your BG at bed is in the 150's. That could be two things: 1) pm basal low
2) dinner bolus low
You can do many things to understand if this is 1 or 2 (eg skip dinner completely and see what happens to BG or check BG after dinner 1h, 2h, 3h, etc. and see how it evolves).
What about BGs during the rest of the day?
If you feel safe try to go to bed with your target BG (correct with Novolog if needed) and see how it turns out. Could be useful to check also once during the night.
Yeah bolus will always work above your basal but that's because you are covering something more than your background BS (eg snacks or meals).
Yeah pinch up. Be sure to inject subcutaneosly (pinching) and not intramuscolar. The reason behind it is that in the former insulin will be released at a normal speed in the latter will be much more rapid. You can use intramuscolar when need to correct a high BG rapidly.
OK, thanks. i would think it would be my AM basal low, as it effects me throughout the day - evening and PM basal dose effects me throughout the night, I'm not sure how they cross over? I have a CGM and have had this same pattern for like a year now. Boluses won't work or hold if basal is not correct, as numbers just go up when bolus burns off.
I see my CDE, pump nurse on Wednesday, gonna print off all my data/stuff and see if she can provide some help, too. I'm going back on pump in a few weeks and have NO idea what my basal needs are, STILL. Half the time I think I'm taking too much, other times not enough. and I can't figure out if I'm having DP or not enough basal at night. IDK, frustrated.
Never used Levemir but sure is weaker than Lantus. Don't know your weight but when you take low doses on long acting insulins they are gonna last (much) less than advertised.
Don't worry about high or low doses. You just need what you need.
You are close to solve it Sarah don't get frustrated! Cmon!!!! Sending you Italian energy right now!
since you're going high at night, I would increasing the evening basal by one unit increments and see what happens. I would also maybe change the time depending on when you go higher.
as for injections.. try your thighs/hips etc. I'm doing that and have very little bruising there...only once every few injections. try applying pressure right after injecting, that's supposed to help.
When do you eat dinner? I eat late and my bedtime numbers are primarily affected by my dinner bolus. I would try to get closer to normal bedtime numbers by bumping up my bolus at dinner.
It sounds like you overnight bump in Levemir worked. I'd try to repeat it.
thanks. i've been trying to eat early, to get a good idea of what my bedtime numbers are without any bolus on board. thus, around 5:30pm...i just keep going up after my bolus wears off, it seems, no matter how much I give. basically managing this on MDI with constant shots of novolog all throughout day/night.IDK, something weird is happening overnight. I'm gonna increase levemir tonight, as Emily suggested and hope it doesn't do a funky drop at 12am then a rebound high again. That's the thing about this stupid MDI - levemir routine, it takes like 3 days for changes to take effect, so I understand, and I'm getting so impatient with ALL of this, I'm just injecting basal at random times and amounts. My body is like, "Wait..what, whatcha gonna do to me today."
thanks. do you bruise? i use thighs for levemir. hips, tummy, arms for my bolus. i'm not brusing too badly on thighs but my stomach, arms, etc... are covered in bruises. it's gross..ha!
This might sound counter intuitive but why not eat dinner a little later so that you can cover some of that basal shortfall with some extra bolus? Even though in theory our basal only covers basal and our bolus only covers food in reality even on a pump some basal covers meals (often protein) and some bolus can cover basal requirements.
If you "just inject basal at random times and amounts", Sarah, you will never figure out a pattern. But then, since you are going on a pump soon I'm not sure why you want to. Basal on MDI is an inexact science at best.
i still have two more weeks of this nonsense...ha! yesterday I woke up at 188 at 6am with a funky low at 12am night before (again), within 10 minutes after wake up was up again at over 200's...corrected, corrected - bolused / ate (a small amount), waited, thought I was OK. Drove to starbucks for just coffee (was by myself) and started rapidly dropping, a 48 in the middle of starbucks drive thru line. I thought I was going to pass out, started seeing black spots and shaking so badly I couldn't keep my foot on my car brake. Seriously...thought I was going down and fast. I downed 4 glucose tabs (which I never take that much) and of course rebounded back up to 200's then low again. Yesterday was an awful day...! Just gotta get through this. having such a dang hard time. ugh!
I've asked you this before, Sarah, but are you confident in your ISF's? And when you say, "corrected/corrected" do you keep careful track of your IOB or just randomly keep bolusing more if you are high? I understand your frustration, but it's important to go about things systematically figuring out your formulas and patterns and not just randomly bolus more, take middle of the night corrections or try and correct with basal, etc. Have you read Using Insulin or Think like a pancreas?
thanks, zoe...i appreciate you taking the time to {continually} try and help me. :) My ISF is 1:60 - 65, but...if basal is not right or I have a rebound high I can inject and correct and it takes a lot more to bring it down, as we all know. When I wake up high like this, I can't seem to bring it down...sometimes if I just give myself another 1 or 2 unit of levemir it will help it come back down. So, either one of these keeps happening, either basal off - not enough or rebound middle of the night highs. I track everything, try to. I keep saying, don't correct when I start to see my BG's rise, until next meal, but then I 'll get to the next meal high and I feel all this. Yes, I have both books and Pumping Insulin too. I know this is my levemir, I know it. I just am trying to figure out or reaching out to see how one determines if it's not ENOUGH basal or rebound highs at night? I'm gonna do as Maurie suggested too, this evening and eat later and have that bolus working later too. One night, I'd like to go to bed at a normal number and wake up to a good number without correcting all through the night and before bed, ya know. On your pump, do you give a lot of corrections. do you find you have to give small corrections after meals everyday? THANKS!
If you correct and it doesn't come down on a regular basis, than you might want to consider changing your ISF. That's a pretty low one. I also generally find I need more in the morning when my body is more insulin resistant. So my ISF is 1:27 during the day but 1:48 at night.
As everyone keeps telling you, basal is not meant to use for corrections. First of all it is not effective because it's long acting. Second, if you are trying to figure out a basal level you won't be able to do so if you just take random amounts.
I'm not sure why you wouldn't correct when you see numbers rise; as long as you keep track of IOB. If you stay high until the next meal you are just going to keep going higher. Then you get frustrated and bolus too much and go low. Better to just go ahead and correct.
To answer your question: There have been a couple times where I had problems recently (realizing I had DP and hadn't been treating it and a sudden onset of metal reactions). When I have a problem, yes, I'm correcting a lot. But in general, no, I don't give small corrections after meals everyday. If I find that I am continually going too high (or low) and needing to correct than that to me is information that my doses need tweaking. And if I regularly correct and don't come down after 3 hours - (unless I'm super high, as in close to 300) than that means my ISF needs tweaking. John Walsh suggests that corrections should only be a very small percent of insulin used. Continually correcting either highs or lows means something is wrong. Now figuring out what, that's the key!
But as I've suggested before I think you are driving yourself nuts unnecessarily about your basal doses. I would just accumulate data for now so when you get on your pump you will have good information as to how to set your time zones. For example, those times you go high or low, and your DP needs.I think you are a good candidate for the pump with your varying basal needs. Some people just can't get it right with long-acting for that very reason.
If you look at the point of the syringe you will see a slope(not a technical term by any means) make sure when you inject the longer part of the slope is on the bottom. That "point" makes insertion of the needle easier and you should not bruise as much. Also reusing a needle (we all do it) can dull that point and cause bruising. I try not to reuse more than 3 or 4 times so that meant a new syringe every day.
I have to ask because I notice that you have been struggling since early March...
high, low, pump, pod, back to MDI, all have given you trouble.
So, have you done any basal testing? Ever?? If I were struggling with control as you seem to be, I would do that.
Are you going back to pumping in two more weeks? How did you determine your basal when you had the pump on?? Did you have better success with your bg's???
I hope you "get through this", seems like you are always having a hard time. And now bruising from injections, too! Do pinch your injection site, and rotate everywhere. I used arms, legs, belly, hips. A bruise would happen rarely. If you are bruising with injection, I worry what will happen when you start wearing an infusion set.
Good luck with this current problem. I hope it gets resolved. I will repeat that basal test is a good place to start!