I am so sick of DP. I am out of ideas

Type 1 and LADA
1

Hi All,

It seems that no matter what I do, I will never wake up at a decent number. During the day, I take 12 units of Levemir and will run fine, but my morning number is always high. I tried:

- taking 12 units at 8 pm, then swithced to 11 to have better coverage trhough the night

- tried, 11, 12, 13 and 14 units
- a snack at bedtime
- waking at 6 am to bolus a unit


Every morning, I go to bed at 100-110 and wake 140-170, usually closer to 170. Last night, I went to bed at 115, woke at 3:30, tested at 113, woke at 8am - 169. Even morning where I wake at 5 - 6am, I'll see a 130, take a unit, and wake 2-3 hours later at 140

I'm not sure what else to try. I keep thinking about continuing to up the Levemir, but its odd because its like the difference between 12 and 14 units has zero effect.

Any thoughts?

Thanks, Jason
2

Split your dosing. Lemevir and Lantus are supposed to have a life of 24 hours, but depending on the person the insulin can act from 18-30 hours. It does last longer than that (half life degradation) and that’s why you don’t want to change your regiment an sooner than ever 3 days. You want your levels to balance out.

I had the same thing when I was on Lantus. My bg at 3 am was 100-110 and by 630 it was 200+. I spoke with my doctor and we split my Lantus in to a morning and night dosage. I was taking 26 units of lantus at night, instead we switched to 13 in the morning with breakfast and 13 before bed. Also since there is some carry over from the prior day it provides a nice steady background of insulin. It worked well for me.

Another thing to try is dietary intervention before you go to bed. This also really helped me. One of the reasons your BG spikes after 3 is that is when your testosterone and growth hormone secretions peak in their diurnal rhythms. When they do that, it is your body’s time to recover and grow. To do this, it needs energy and it will cause your liver to release its glycogen stores if there is no other food present. Before I go to bed I take a casein protein shake, fish oil and CLA. Make sure it’s pure casein protein, not whey. Whey digests in 45 min whereas casein takes 6-8 hours to digest. You can substitute 1/2 cup cottage cheese or two cheese sticks for the casein, but in my experience the shake works much better. The fish oil and CLA are fats and those also take longer to digest (plus they are really good for you). Having slow digesting protein and fats in your system will help to suppress the need for liver glycogen.

Talk to your doc about doing this, obviously. Mine agreed right away when I presented this to them.

SuFu

3

DP hits my son hard too! He is on a pump…we have his basal being uped at 4am to 9am and keep needed to increase that time… haven’t found the magic number yet… to day he woke up 190’s. :frowning:

4

Like SuFu, I recommend to split the dosage. Levemir is not designed to have the same potency for 24 hours. It will last that long but half of its potency is likely gone after 12 hours. The next chart shows the activity of Levemir for two different dosages (the dotted lines) in comparison to the outdated NPH (solid line). Two shots (one every 12 hours) will combine to a very even basal coverage. This will not work from the start and it is possible that you will need more for the night or the day. It is also possible that you end up with less TDD of basal. But this will be fine tuning after your transition to two shots per day. The first day of the transition might be a little bit rough. The shots are meant to combine and overlap. Thus you will likely need some corrections for the first day. So increase your testing frequency and test at night around 4 am to catch raising blood glucose. The outcome is really worth the effords.


5

So if DP hits you hard, why are you swatting it with a feather? I have a wicked case of DP and I try to increase my overnight basal (I use NPH) to be double my daily levels. If you have a wicked case, you may even find that despite splitting doses with Levemir/Lantus you still can’t stack the insulin in your favor. I have heard of some that augment their basal with a nightime dose of NPH, but in the end you may just find that this is a reason to move to a pump.

6

Sorry, I should have been more clear, I am splitting the dosage. I take 12 units at 8 am, and the other half at 11pm before I go to bed. Sorry for the confusion.

7

Thanks for the reply, I like the idea of taking the casien at night. You also just made me think f something. I started hitting the gym hard about 2 months ago. I wonder if that added stress is causing more testosterone to be released then there was before? Up until about 2 months ago, my typical rise was only to about 130ish.

8

…or Metformin to restrict the amount of glucose released by the liver - especially at dawn. It is not common to treat T1 with Metformin but we have some members with this treatment here.

9

I have the same thing with my lantus. I’m thinking of getting a pump to solve this problem.

10

Try taking your levimere arounf 10 rather than 8. I had that same problem and it fixed mine :slight_smile: my problem use to be that I’d go to bed at 120 and wake at 210-270! But my levimere dose was upped a bit and just took it at a later time. Your levimere is probably not lasting thru the long nite… my blood sugar was 115 and woke up this morning with 99. Hopefully this works. It took me a long time to find out a strategy that works for me and I know how frustrating it is when you’re doing everything right! My currrent levimere dosage is 36 in the morning and 36 at night. It seems like a lot, but that’s why it took so long to figure out! Good luck!

11

Maybe add metformin? I take 2 a day to help with liver dumps. It helps a little, but, if I go over my 60g of carbs in one day I am waking up to higher than normal numbers like yours, sometimes a lot worse, so I have to be really careful with the carbs. Also, my doc instructed me to up my lantus dose by 3 if I was high 3 days in a row. So if for one week I was high I would have upped my dose by 6u. BUT, ask your doc before you do anything like that.

12

The only thing I found to beat dawn phenomonon: Wake up early, eat breakfast, take the bolus. If I try anything else, bg’s just go up and up and up.

Your DP sounds relatively minor compared to mine. I can wake up (early! like 6AM) at 80, and if I don’t eat I can be in the 300’s by a few hours later. OTOH if I eat and bolus then I do great.

I tried it and found the snack at bedtime just made things worse for me. I know it’s a common suggestion and it might work for others :slight_smile:

13

Take the nightime dose later, 10-11 pm and why a snack at bed? I found that taking my doses at 10-11 pm and then at 7-8am works great and no snack at bed unless low…first thing in the morning I have to bolus for coffee and 1/2 and 1/2 creamer…hope it gets better for you and good wishes to you!!

14

When I was on the pump, I used to have 4 different basal rates which accommodated my dp nicely. However, the pump was extremely irritating to me and after less than 2 years I had developed scar tissues and had to go back to injections. Now, I take just one injection of lantus in the am, I was taking an evening split dose as well, but had to eliminate it because I kept going low in the mornings. I accommodate my dp now by taking a bolus at 8:30am. I think I must be lucky because my dp starts a little later than most people so I can handle it this way. It’s a great solution though. My sugar usually starts rising at 9am, so I take it at 8:30 to prevent the high, and it’s out of my system by the time my lantus peaks in the afternoon.

15

I’ve been on a pump and a CGM for 6 months. With my Dex I can watch it all night. Some nights I’m steady all night long and others it will steadily drop so it’s way too low by morning, sometimes it gradually creeps up, sometimes will go up and down several times and still others will be good and then it will shoot up right around 5am. Last night it looked like a freakin yo-yo and I woke at 171. Absolutely no reason and so random that I don’t think I can adjust for it even with all the equipment. A 140-170 in the morning is quite normal for me and never really panic. Should I be worried??

16

Well, first of all, I wouldn’t be trusting your CGM… they are not accurate
Have to do it the old fashion way… Manual Testing
Setting the Alarm 4 hrs after bedtime and see what is happening…
Why 4 hrs? Time for REM sleep to complete it’s cycle
Time for any Bolus you may have taken previously to run it’s course

Pick a Wknd , Fri & Sat. to do your testing and experiments… so you can sleep alittle later in the AM if need be…

Do you have a CF/CB ( Correction Factor/Correction Bolus) chart by your Nite stand to glance over in the middle of the nite? So you don’t make mistakes figuring out how much you need to bolus, if necessarily high…

I take Levimire and I gave up and just do the above anytime I get a High AM after 1 nite… It’s become routine now and since those overnites and AM #'s can mean 1/3rd of our 24 hr day, it’s very important to me…

If I go to bed with a 150, take a CB for that extra 50, then the Basal should keep it down, right? No all the time… I can wake up 4 hrs, test and it’s still 150 or 130’s so a 2nd CB is in order…

and starting off the AM with a Higher Than 100 BG for me is not the way I want to start my day and It can take another couple of hours to get it back down to that Magic 100 level …

ave 6% A1c’s using Insulin Pens…for yrs now… LIke to have a Pump, but they won’t give me one…BG’s are too good they tell me…

On the Bright side? If you ave 140’s for overnite x 8 hrs = 1120 and ave 100’s the rest of the day ( 16 hrs) ? = 1600 tot pts, = 2720 tot 24 hr pts by 24 hrs = 113’s…

I would suggest you consult with a Experienced CDE for trying to figure this problem out… They might be able to narrow it down and work with your Endo…

17

Yeah, can drive you nuts doesn’t it? Same here…
I use Pens, NLog and Levimire…
And Similar Problems … goes week to week for me…
1 week everything is great over nite and AM and then the next week? Bam! nothing works…

Do you have the Book By John Walsh> Using Insulin?
is your Basal btwn 40-50% of your TDD?
Could give you an indicator of wether to Increase it or not…
If your 40%, go to that 50% split dosing it, etc…
I found I need More (double) at bedtime vs 12 hrs later… (daytime) …

I used to take a Couple of Units of R- insulin when things keep running too High in AM and that has worked about 70% of the time…

I have little faith in these so call Poor Mans Pump-Long Lasting Insulins…They are not consistant and dependable… except consitantly inconsistant…

But Until something better comes along, not requiring a Pump, like the New Insulin Patch they’re working on, we’re stuck with what we have to work with…

I think a Consistant Dose of The Hard Stuff, NLog is the only way to go…Thus why the pump is the best thing going right now, if you can get one…

I’d like to get a Used one, just to hook up for Overnite…:wink:

I proved that it would work, taking just NLog for me overnite, by taking it at bedtime, then 3 hrs later and getting up 3 hrs after that , etc… But that gets old real quick…

Can try going on a Very Low Carb Meal Plan for Dinners… My BG’s over nite do better when I do that… Not eating more than 20-30 carbs for dinner …and that’s just the Veggies and a Meat dish… Or ?

Eat the Big Stuff for Lunch… so you have the rest of the day to work it off and test more often, etc…

hope some of that helps…
Keep the faith…