Was wondering if anyone had some ideas, suggestions as to how I could change my 1 shot AM basal dose to a 1 shot PM basal dose (levemir).
Also, my pattern is this with or without insulin; from 12am - 3am I have a 30 - 40 point drop, from around 7am - 10am i have a huge rise at least 40 points. I thought it was coffee but I slept in this morning, woke at 9am was 140 and by 9:40am I was 196 with my CGM side arrow going up with nothing to eat and had already given a bolus. So, I'm pretty much lost on how to do this with MDI, I know I'll need a pump. Until, then...any thoughts on how I can get this under control with levemir? My CDE suggested yesterday I try a one shot levemir at around 7pm, start there. I don't know how to move my AM dose to PM?
Levemir doesn't last for 24 hours; it has an action time of closer to 12 hours for most people. Instead of moving your one shot a day to a different time, try splitting the dose and taking it twice a day, half when you get up and the other half approximately 12 hours later. I find I need a bit less than half at night, and I take my evening injection a bit later than 12 hours (my AM dose is usually about 8am, my evening dose about 10pm), but you can tune those yourself when you see what works best for you.
Switching from one shot a day to two shots a day is simple: just take half your normal dosage this morning, then take the other half tonight, and instantly you're on the new schedule.
I did a 24+ hour fast recently and was pleased and a bit surprised at how well this basal coverage worked for a full day of not eating.
If you want to stay with one shot a day, you could consider switching to Lantus, which has a longer action time closer to 24 hours (though I found splitting my Lantus dose and taking it twice a day also worked better for me).
thanks. well, that's what I've been told since honeymoon ended, "levemir doesn't last 24 hours, you need 2 shots." AH, but it does last 24 hours for some, CGM attached, did 8u yesterday morning at 8AM and my CGM from last night - red line, I stayed flat all night long and I ate before bed, that's never happened before. the day before, friday (blue line) 8 units am and 4 units PM and I rebounded high all day long, up and down, and I rose over 40 points upon wake up after rebound high during night. Today,Sunday, through the night with 1 shot (and less) is the best blood sugar reading I have ever had.
I haven't done this however I'd probably figure the planned TDD and take 1/2 in the AM on the launch day. I'd accept some whacky numbers for a test like that and an experiment that I'd hope, after some trial and error, would result in progress. Another alternative is to go for really tight, clean eating. I can't recall your carb philosophy but, while I generally eat 120-140 and have escalated that a bit to 180-200G since New Year's, I still run into days here and there where I am too busy to eat or sort of bored of eating and eat like 30-40G and that's generally a way to mitigate excursions? Good luck!
either what AR recommended, half of your dose in the AM and then the entire dose in the evening. not sure if it will work out. what i think could work as well would just be pushing the shot out by one hour each day, which would make a 12 day procedure out of it and is for sure more time consuming than the first method.
good luck
SC
I've never used Levemir, only Lantus, but I found splitting my Lantus into two shots a day helped smooth out my blood sugars immensely. And it supposedly does last 24 hours for some people. I think the fact that you said you have never remained flat overnight until last night indicates that it may not last, and maybe last night was just some sort of fluke. I would try splitting it and see what happens. When I did it with Lantus and showed my endocrinologist my readings at my next appointment, he said it looked like I'd just handed him someone else's logbook and he couldn't believe how big an improvement it made.
I find that my blood sugar goes up in the morning if I don't eat. But, weirdly, only if I'm awake. If I sleep in, I'm fine. I'm on the pump, so I already have a rise in basal rate to take care of the dawn phenomenon. I told my endocrinologist about this rising after waking if I don't eat, and he had never heard of it before, but thought it could be cortisol (especially since I often don't eat because I'm running late). The only way to mitigate it is to take a bolus of insulin even if I don't eat. I also have my I:C ratio at breakfast a bit lower than the rest of the day. When I was on shots, I also had to get up at 3:00 AM every morning to take a few units of Humalog to take care of the dawn phenomenon.
thanks, everyone. YES Jen, same with me, I'll stay flat or sometimes keep dropping in the AM if I sleep, the minute I wake up, feet hit the floor, my blood sugar rises, which I don't think can be helped with more levemir. My endo told me this is my 'DP', I just keep going up and sometimes can't get the bolus in fast enough to stop the rise..ugh! I did decide to split my levemir (again) yesterday, as I don't think it's going to last in 1 shot. Last night was awful, had to wake up every 2 hours to give a shot as I could hardly keep it under 170. that's the thing, every time I change this levemir dosing it takes days to readjust all over again..ugh! THANKS!
You are aware that Levemir is not designed to last for 24 hours. You still think you can outsmart this and I am fine with that. Trial and error is the best learning experience. With an AM shot you are risking that the time span with the lowest basal coverage will collide with the dawn phenomenon (DP) that will cause the blood glucose to spike in the morning. This unfortunate combination can be prevented with the PM shot. To get there safely you could adjust by one hour every day. After 12 days you are there. This is how I usually prepare for long distance flights.
Prior to going on the punp,I had the same problem when waking going high for no reason. I was on Humalog 3x a day and Lantus at bedtime. Both the endo and nurse/dietician said it was hormones. It was recommended upon waking take l l/2 units of Humalog. An hour os so later when I was ready for breakfast insulin , my reading had improved. This solved my problem and worked extremely well. I have been on the pump for a month and my routine has changed accordingly.
