type 1 diabetic here. 21 years old. diagnosed at 15. my night time number seem to rise 30 to 40+ around 10pm to 3 am.... im on a fairly low dose of levemir. me and my doctor are iffy at 10 units at night. and in the morning time 15 to 20 carbs seem to make my blood sugar sky rocket...unless i hit the gym of course... :) any takes /advice on this? i know its a basal insulin thing that im doing wrong but hey im still learning... and my honeymoon phase lasted a long time...
Sounds like your insulin needs are evolving with time. This is not unusual and for a T1 is about the only thing that will be predictable- things will always change.
Do you have a copy of Think like a Pancreas? You can get it for e-reader.
Sounds like you need to do basal testing to get the levemir dose sorted. Then you will need to check your I:C ratio for the time frame/meal you are having your spikes to get your rapid insulin sorted.
Do you prebolus your rapid insulin 15-30 minutes before you eat? It helps prevent/lessen the post meal rise since it allows the insulin to start to work as the carbs start to hit.
It is not unusual for you to need different insulin to carb ratios for each meal/time of day. We tend to be more insulin resistant first thing in the morning. Also you may see that specific types of carbs do not play well with your numbers and need to either reduce the portion size or avoid completely.
The book has detailed information about doing the testing and will work you through it. When you become proficient at doing this you will be able to understand how and what to tweak as your bodies response to insulin varies. There are many thing that effect your response - activity levels, kinds of foods we eat, amount of protein and fat in a meal, type and amount of carbs, hormone cycles, altitude, seasons of the year, out side temperature and phases of the moon. Learning how to adapt is a big part of good management and is a skill worth the effort to acquire.
Have you considered splitting your Levemir into 2 doses, perhaps with a slightly higher dose at night to help you handle the morning? (Ex: 4 units in the morning, 6 units at night)
And yeah - mornings can be rough. My I:C ratio is 1:7 for breakfast and 1:20 for lunch these days. Amazing what a difference a few hours can make.
The book suggestion is a good one. It's really helpful when you need to tweak your situation.
http://tmedweb.tulane.edu/pharmwiki/lib/exe/fetch.php/insulins1.png
If you look at the graph of insulin activity, you see that levemir or insulin determine takes about two hours from dose time to begin to work and then drops of fairly strongly at about 20 hours from dose. For some people that drop of is sooner and faster. Levemir was not designed as a single dose basal. It is intended to be used it two doses that are timed to have the activity of one dose drop off as the activity of the second dose is kicking in. The overlap of the two doses gives a flatter curve that lasts for the full 24 hour period.
Basal testing will let you see when your single dose starts to tail off and will help you figure out when and how much to to split your dose. If you have a bit of dawn phenomena then a bit more at night vs in the morning, or shifting you dose timing might help you achieve a more stable background BG.
Maybe it's time for you to start using some fast acting insulin for meals and corrections.
A 30 point rise or fall in fasting BG numbers is pretty common. Your morning numbers are going to spike when you get out of bead...this is also quite common...again just a little extra bolus insulin may be needed to head off your second phase of DP.
Many pump users need to turn up their basal around 3 am and than also many of us need a little extra bump when we get out of bead...I'm not sure what kind of insulin regiment your on but you may not be able to correct your problem without stepping up to a intensive MDI program and it could be that your Doc is keeping things simple and is not that concerned with your +30-40 point swings...JMHO
I got to thinking that you may not even need to make pm the stronger dose. As hobbit mentioned below, levemir doesn't work a full 24 hours, so your 10pm-3am issues might be the levemir tailing off. Splitting the dose helped me a lot when exiting honeymoon. Worth asking your doctor about.
Here's another possible explanation. An undetected sustained low (say greater than 20-30 minutes) between 3 a.m. and waking could also produce skyrocketing BGs in response to moderate carbs (15-20 grams) at breakfast. Is it possible you may be going low during this time?
no way, after dinner I give myself the right amount of fast acting insulin and no matter what my numbers will still creep up with or without a bed time snack they start slowing trending down around 3 a.m. (i have a cgm so i see my trends :) I give myself the long acting at around 12 am.... Im a college student so of course i stay up late lol
You say you dose for meals after you eat? Are you using a sliding scale or an insulin to carb ratio? If you are dosing for carbs you beat you need to do that 20-30 minutes ahead of your meal if your using novolog, humolog and aphedra. If your using another insulin for rapid the lag time can be much longer.
Also if you have not done basal testing you do not known how long a single dose of levemir will actually work for you. If you are taking it at midnight it takes 2-3 hours for it to have an effect, also it only last for about 20 hours. It means you likly have little to no basal coverage from about 8pm until the next dose kicks in around 3 am.
So the combination of no effective basal and not timing your bolus activity to match your meal time hit is what is going on.
Even if your I:C ratios are good waining basal and late bolus makes for highs that take forever to come down.
Check out Think like a Pancreas, it's available from Amazon for download. It will help a lot! That and the books by John Walsh are my go to reference books.
Having a cgm makes doing the testing so much easier!