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.
Do you not have any fast acting insulin? I'm thinking that a big part of the unpredictability of your BGs is directly related to using long-acting insulin for 'corrections'.
When it comes to dosing, I think you've been getting good advice. I'd add two thoughts.
1) Focus on one variable at a time. For me, the bolus was easiest because I can eat literally the exact same meal 6 times in a row and be OK with that. For instance, 3 eggs, an ounce of cheese and a green salad with oil and vinegar for breakfast, lunch and dinner two or three days running. The exact same meal makes it easy to adjust the meal bolus. Not everyone can... tolerate that sort of thing, but by eliminating all the variables except time of day, I dialed in my meal bolus very quickly. Once my boluses were good, I could start skipping meals to see how my basal was holding up. I don't think everyone (anyone?!) should do what I did - I just wanted to illustrate that eliminating variables makes insulin dosing much easier to work out.
2) Little good happens quickly with diabetes. Take your time and collect good data. Don't be pressured into correcting every high - especially not with Levemir. You need to know your particular action curve for the meal you ate, and that means how fast you went up and how long you stay there. Of course if you go really high - over 200? - you need to correct that, but resist the urge to fiddle because that tinkering is very hard to account for when trying to work out your dosing needs.
There is something missed here. On my body I have two peaks from the digestion process; one at 2 to 2.5 hours and one at 5 to 6 hours when the harder to digest and crack proteins etc which means when I eat at 5pm ; I will see first peak at 2-2.5 hours and another peak at about 11:00pm. I end up running anothert shot of fast acting insulin late at night. I take one at 7:30 pm that last 4 hours and second at midnight. I usually see my late night glucose readings at 140 to 155 due to the late night glucose release by my gut.
yes, i use novolog. and yes, i eat the same thing everyday, very little carbs too. my I:CR and ISF are fine, they work but what isn't working is my basal. I can do corrections but it burns off and BG's go right back up because my basal is wrong and I've tried so many different combinations. I think maybe levemir worked while I was honeymooning and it's just not strong enough anymore. IDK! i do basal testing, yes...every night and usually go 5 hours fasting between meals (but I start to rise) so I know at 3, 4, 5 hours my basal is off after meals. UGH! Either levemir isn't lasting long enough for me, seems to burn out at 8 hours or it's not enough or I have DP or rebound highs.
And, yes..Karen, when I pod I had to cut my basal back to .30 but I wasn't ready to go on pump so I thought I'd just go back to shots (IDK why?). When I did, I've needed to add more and more and more levemir, which doesn't seem to hold or work. CORRECTIONS won't work if basal isn't correct because my blood sugars keep wanting to push back up. I add more, especially at night, then I drop and wake up even higher. So, I'll just keep trying until I can get back on pump. Thanks for the suggestions.
Hence, this is my CGM from the 6th - overnight. I do corrections before bed, it will come down a bit, then go back up to around 150 - 160 although I keep adding more levemir, then levemir kicks in or the correction or something and drops me (although not even low) and then I shot right back up again and wake up high. So, again I cannot tell if it's DP or not enough levemir. Hopefully my CDE can help?
I do bruise but not all the time. at first I was injecting tummy, then arms and now mostly thighs, tush, hips etc. I seem to bruise less there although I do still sometimes bruise. my inr nurse said to put pressure on the site directly after and this should help stop bruising. I think the tummy and arms are my worse areas for bruising.
I agree with everyone to not correct with your basal. Just first try increasing the night time levemir and see what happens and try doing it earlier. I found 6pm and 4am are good times for my basal, I'm on levemir too. I would still do only 1 unit corrections for going high until you figure out if increasing basal will help, as well as drink water and do some exercise. It could be you're spiking from glucose released later but it could also be that your basal at night isn't enough. If you're out of the honeymoon, it could be that the overall basal just needs to be higher. I think you need to do more to increase insulin sensitivity when you're high, not just bolus, add water and exercise and see if this helps. Be careful not to stack insulin bolus for your corrections, with no food this can drop you low all of a sudden when you do come down.
So confusing! I thought your trouble was high at bedtime, and now it seems you are high at waking as well. Your basal needs to be adjusted for sure.
When I do a basal test, it is for 12 hours, not between meals. I don't know what it means where you say your basal is off after meals. Your basal should keep you steady ALL the time, if it is not then that is your first trouble and it is certainly something that can be tested and resolved fairly easily. It's no fun, but it's doable.
After that is determined, the ratios can be corrected. And I am going to jump out on a limb and suggest that your ratios are all not set properly. Stacking insulin is dangerous and as meee and others have said should not be done with basal insulin. One thing I don't do is eat if I am correcting for a high. I wait until the high is actually corrected, then bolus for my meal and carry on.
I am glad to learn that there is a CGMS involved, does your CDE review the data from it?
i'll have her review everything. basal off after meals means, i'm fine at 3 hours after meals but then it starts to trend back up. that's the thing, I keep adding more levemir but it doesn't seem to do much. i'm not 'correcting' with basal, what I'm saying is it's not lasting past 8 hours (it seems). thus, i'm adding an additional small third dose which my CDE suggested i do. However, i think this screws up everything too because they're peaking a different times. UGH! I'm gonna add one more unit tonight with my PM dose..and see. mayve add another dose with AM. YES,probably everything is off. I may try the 12 hour thing, overnight too. but I am going on pump in two weeks and will have to redo basal testing all over again. It's probably not going to be a smooth transition. Thanks, Karen for your suggestions. It amazes me when people just take their MDI basal and wake up with a good number...I'm like..."how does that happen?" HA!
I would focus on adjusting both the dose and the timing of the pm levemir. Timing is just as important as dose and there’s no rule that says you have to wait until bedtime
I find that sometimes if I treat a high, not super high, with insulin, exercise and water and then bolus to eat after I get back to normal I get the stacking effect, sometimes it's better for me to just take a larger bolus with the correction and eat. I usually end up back at normal, or at worst I stay the same. I wait 15-20 minutes to eat. And then the protein seems to keep me stable after too. We have to remember that all that insulin is in there getting ready to work, even if it seems like it isn't doing anything right away, it can sneak up on us and cause a dangerous low.
