Hi Sarah, I have noticed that you have struggled for a long time on getting your diabetes managed. I can't help with splitting your basal or not, I would likely do that if I were MDI. Levemir or Lantus - I don't know why it would matter which one. If you can't get your numbers down, you should try all possible things. I would ask your endo, too but it seems to me that you prefer to get advice from the DOC. So, try splitting your basal and see what happens.
I would not think that it's a good idea to go to the "last option" of pump until you can manage without one. A pump needs to be set with care and knowing your basal and bolus needs are imperative to wear one at all. I will tell you that in my own life with pumping, my basal increases several hours before I wake up to cover DP. I can live on basal alone with no trouble - my bg stays 'flat'. Until you can achieve that, you need to adjust your dose/timing/etc. Life with managed diabetes is possible. Have you read some of the books folks have suggested?
As for liver dumps - T1's don't have liver dumps. In fact it is my opinion that "liver dump" is just a made up word that showed up on the DOC some years ago. Everyone has DP - and a diabetic can manage hers. I actually wonder if your trouble is DP at all. Could also be Somogyi effect. No way to really know without testing and as recommended earlier, recording results. Trial and error is a never ending job with diabetes. Seems you have been trialing for overlong, I wish you success, Sarah.
Here is some info from he National Center for Biotechnology:
Morning hyperglycaemia in diabetic subjects may be caused by the dawn phenomenon, or the Somogyi effect, or poor glycaemic control. The dawn phenomenon occurs when endogenous insulin secretion decreases or when the effect of the exogenous insulin administered to the patient the day before disappears, together with a physiological increase in insulin-antagonistic hormones. The Somogyi effect is present in the case of excessive amounts of exogenous insulin. The dawn phenomenon is more common than the Somogyi effect. To diagnose these phenomena, it is useful to measure plasma glucose levels for several nights between 3 a.m. and 5 a.m. or use a continuous glucose monitoring system. Although their treatment differs, the best way of preventing both the dawn phenomenon and the Somogyi effect is an optimal diabetes control with insulin therapy.
Wow, did I say you shouldn't respond? Am I really the one being hostile? You left pages of responses above to a question that was directed to me by name. I have no problem with that. But I think it should be OK for me to respond to that question too, don't you?
Your reply was that her experience sounded like a "liver dump", and that it was hard if not impossible to adjust long-acting insulin to get good overnight coverage. I disagree with both those conclusions, and was trying to give advice about why this didn't look like a "liver dump" or Dawn Phenomenon to me, and give advice about how I am able to use the Levemir insulin she is using to get a very nice response to my overnight basal requirements as a T1. Overnight used to be the hardest time of day for me, but it isn't any longer, and I think I've learned something in my 39 years as a T1 that might be able to help another T1.
I'm glad you don't think T1 and T2 are the same disease anymore. Maybe we're making progress after all :)
before you decided to side-track my discussion again
If you can't see the obvious hostility in that completely irrelevant comment (in context) we do not have common ground on which to reconcile. Given that, I'll ask again: Please do not address me directly, personally, comment on me, etc. I will show you the same respect. You have trolled me on this forum for many weeks now, because you got your nose bent out of shape over a thread I started comparing the risks that T1s and T2s face, asserting they were the same with some exceptions. Your avatar reminds us all with every post how bent out of shape your were by that exchange, and having some of your uncivil posts removed.
I stand by my statement in that discussion, and to this day continue to provide independent evidence of such, as in this discussion regard DP and "liver dump". Liver dump is not a diabetic phenomena... it's a phenomena of human physiology, experience by all people to one degree or another. Diabetics, obviously, have an issue with it that non-diabetics don't. However, it is not a T1 vs. T2 issue -- not even a diabetic vs. non-diabetic issue. It is simply a part of human physiology, like adrenaline when one gets scared. It's a part of how the body works.
Your individual function in this regard indicates only what your body does, not a general principle of operation of the human BG metabolism.
I'm glad you don't think T1 and T2 are the same disease anymore. Maybe we're making progress after all :)
No, we're not. I have never, ever said, implied, or hinted that T1 and T2 are the same. In fact, we're regressing, as you make one outrageous false claim about what I've said after another.
As for liver dumps - T1's don't have liver dumps. In fact it is my opinion that "liver dump" is just a made up word that showed up on the DOC some years ago.
Hi Karen! According to medical studies and the available literature, T1s do experience "liver dump" -- all people do. I've reference some of the relevant literature above; if you are interested in more articles, I can provide a bibliography.
Also, the term, "liver dump" is used regularly in medical research and clinical treatment... whether its origins are the DOC or the research community, it is an established, well-defined term today.
Dave, life's too short to get so pissed off about nothing. If you want to ignore me, by all means feel free. I think a lot of the things you write on this site make perfect sense and are helpful. But don't expect me to always agree with the things you write - because I won't.
In this case I disagree that the OP is experiencing a case of liver-dump/dawn-phenomenon, and I disagree that long-acting insulin is nearly impossible to use as a reliable basal insulin in a T1. I never said there was no such thing as Dawn Phenomenon (in fact I experience it every day) - I said her reported results were not an example of it. Her blood sugar goes up by way too much and then it comes way back down - neither of which would occur to a T1 experiencing true Dawn Phenomenon.
As to the term "liver dump", I'll respond to that below. Feel free to ignore that too if you choose.
I'll let your accusation that I "make one outrageous false claim after another" about you slide. Really, dude, mellow out.
If you try to find "liver dump" in any of the T1 sources (like JDRF, NDIC, Joslin, the evil ADA, blah blah blah) - you will not find it. And I have never experienced it, I've been doing this a long time. DP - yes, Somogyi - yes, and the most likely culprit here is simply mismanagement.
The term "liver dump" occurs nowhere in the scientific literature as a description of sudden increase in blood sugar. A search of pub med found the only hits on "liver dump" to refer to toxic waste entering the livers of animals in the food chain.
Dawn Phenomenon is of course widely known and experienced, but that is not the same thing as "liver dump" because the latter term is used to imply an unpredictable and excessively large increase in BG at any time of the day.
The term "liver dump" does show up in the DOC, and it is often very loosely used which is what Karen is referring to above. A lot of times someone will get a high BG and rather than trying to figure out what caused it, will throw up their hands and call it a "liver dump".
From what I could find these loose definitions coming from online Diabetes blogs and forums like this one seem to believe that it is a T2 issue but not a T1 issue: "The problem with many people with diabetes is that their liver is waaaay too helpful. It's as though it's over-active and doesn't wait until your blood sugar gets to 50 or below. Research has found that a certain hormone that non-diabetics have that regulates their liver isn't always working with T2." LINK
Since I don't have T2 diabetes I have never researched whether this is a real phenomenon in T2 or not. But I certainly agree with Karen that it is not a phenomenon experienced by T1s.
Just wanted to add Sarah, that I looked at your graph and it seems like somewhere between 12-3 am is when you drop. I have read that that is a natural time for bg to drop due to our insulin needs being lower then. I often, but not always, go lower then- sometimes it's just a drop from a slight after dinner rise to a lower but ok range. I'm nocturnal so my patterns would probably be less similar to yours.
However, I noticed that you're not dropping into hypo territory only into low 100's it seems( I think Holger pointed this out in another graph you posted where you had dropped to 130's from a high a few months ago), at least on this graph, so this would suggest maybe it isn't somogyi. I don't know because I think you mentioned in the past that you do go hypo at that time too which would then suggest your liver maybe be releasing glycogen in a response to this drop anyway. I often feel hungry before I go high and wonder if I'm actually going a bit low before going high and my liver has responded before I got to hypo territory.
This discussion has evoked some thoughtful exchanges and we hope the information exchange has proven beneficial.
Unfortunately, it has also been used as a vehicle to continue an ongoing disagreement between certain members, and some of the rhetoric has gotten inappropriately personal. The discussion is, therefore, being closed to halt the escalation.
