I'm wondering if any T1's have used Regular for DP? I saw my endo again this morning. It's very clear that adding more levemir (or lantus) at night is making this 12am - 3am DROP (so I cannot correct my highs before bed now either) and huge spike worse for me. On the 'rare' occasion I wake up to a good number, or don't have a significant drop, I'm rising terribly in the morning, pretty standard for T1's. So, by 10AM this morning, I was 259 and climbing with CGM arrows going straight up. I'm still high and, as we all know, these highs can last all day..ugh! He told me I have more then enough levemir on board, it's not a 'levemir' thing, it's my body (and again mentioned this is common with type 1's).
My Endo told me to continue to take small doses of am/pm levemir, wake up at 3AM and take 1 unit of Regular. I'm very nervous about this (will I ever sleep through the night..ugh) so if anyone has experience with this, it would be great to hear.
Actually, Dr. Bernstein recommends the protocol of getting up in the middle of the night and taking R. In my case, the idea of setting the alarm, waking up at 3am, testing and injecting and then trying to fall back asleep is crazy. That is likely to cause more problems than it solves.
The other thing that Dr. B suggests is injecting NPH before bedtime. In fact, my endo last week asked me to try doing that to address my DP "issues." The other thing I do is promptly address DP in the bud. If I wake high, I immediately correct, if I wait around, don't eat, then my blood sugar will just rise.
First you should find out when the DP starts to kick in. I think that 10AM is just too late for the first test of the day. Try to test at 5,7 and 9AM. Perhaps you will find out that you need to have an early breakfast in the morning to prevent the DP. Here the missing carbs are the incentive to trigger the DP.
Second the idea that the DP is just caused by too little insulin on board is too limited. For example if I have 75 mg/dl at 5AM my body will react to that with a huge DP. In contrast with 120 mg/dl at 5 AM this will not happen for sure. So I have to eat something very late that is digested long enough at night so that my blood glucose is higher than 100 mg/dl at 5AM. If I would inject regular at 3AM I would create the low BG that triggers the DP for me.
Third the DP is triggered by your biological rhythm and daylight. So it might make a difference to wear a sleeping mask or sleep in a darker room. There is also the secretion of growth hormons that is triggered by physical activity in your previous day. These growth hormons usually increase the DP. For example I had to reduce my fitness training to get my hormonally induced DP back under control.
thanks, holger. I don't think I want to do this Regular thing. Once again, this made no sense to me. I took 6u levemir the other night, went to bed at 147, by 12am I'm dropping and by 3AM i'm down to 69, that's a drop of 80+ points over night and I did not wake to my CGM alarm or 3AM alarm, I slept right through them. I seem to get a bad rise around 8 - 9am, I was 105 at 8AM this morning (already bolused 2 units for coffee and an egg at 6:30AM this morning so I ate and eat the same thing every morning, I also took .50 unit at 3AM) but by 9AM I'm arrows up going to nearly 300. but the other morning I went low 50's...When I wake up with these highs above 200's, i'm doing crazy correction amounts and they don't come down..then the next night I wake up at 3AM, I'm 143 and only give 1/2 unit correction and it dropped me nearly 50 points. I do not know how much levemir to take and AGAIN what it's supposed to do? What is it supposed to do during the day - where is it supposed to keep you at, the more I add doesn't seem to make a difference. How does one know if they're not taking enough, thus...a high from an extended meal late in the evening or their levemir buring out. Thanks!
As always, YDMV. My DP basically starts when I get out of bed and start moving around. Testing has confirmed this time and again. So, 1u of fast acting on arising flattens it out quite well. Your results may vary.
When are you taking your Levemir? Bernstein argues that overnight Levemir, particularly in small doses, doesn't last 24 hours, it lasts like six hours. This is why he recommends a split dose of Levemir, one first thing in the morning and one at night before bed (but no longer than 9 hours before the morning dose). If your Levemir is wearing off, that may at least partly explain your rise. And despite all this, as Holger recommends, prompt attention to DP by testing and correcting when you first arise can avert later Darn Phenomenon disasters.
Before I went on the pump I could go to bed at 100 and wake up at 250 like clockwork. A lot of testing revealed that I could be 100 at 10:00 PM, 1:00 at 3:00 AM, and 250 at 7:00 AM. I didn't have any lows, just the DP making my blood sugar rise starting at around 3:00 AM. I started getting up at 3:00 AM to take 2-3 units of rapid-acting insulin. It was the only way I could wake up with a blood sugar lower than 180 in the morning. The dawn phenomenon was actually the primary reason I went on the pump.
If you are going low, I think you have to determine whether what you are experiencing is a rebound or really the dawn phenomenon. If it's the dawn phenomenon, you will rise even if you are not going low. If it's a rebound, then as long as you avoid lows (even mild lows) overnight, you won't go high.
Also, even with my pump basal rate adjusted to cover my DP, I still get a rise if I wake up and doing eat almost immediately. Yesterday I woke up at 117 and didn't eat breakfast. Three hours later, no food, I was 265. I believe this is different than the DP, because if I'm sleeping I can sleep in until noon and still wake up with a perfect blood sugar. My endocrinologist speculates that it's cortisol from stress, although I'm not totally convinced of this because I'm not necessarily stressed (from running late) when it happens. Sometimes it's a weekend and I just lounge around before eating, and get the same rise, although not quite as dramatically.
OK, thanks everyone. Maybe it is stress - cortisol related. I think I'll just continue to monitor my blood sugars, I upped my AM levemir dose a bit today and maybe increase 1/5 unit tonight, and will continue to check and give novolog shot at 3am as I've been doing, if high...but I'm not going to do the Regular insulin. Jen, when you go that high, like I did too, do you correct? That's how this was with me too like 150+ point rise within a frickin hour....so this isn't levemir, correct? I mean I gave myself a shot of levemir at 8:30am.
I second the split (as I have in Sarah's other discussions).
The basal coverage at night is a very delicate balacing act. Usually basal insulin will cover the amounts of glucose "constantly" released by the liver. The problem is that the liver dynamically adjusts its release rate over night. Our body needs less energy at night thus the liver will moderate its release down. Usually this happens around 3 AM and later at 5 AM the rate is going up again to prepare us for the day. Unfortunatly the Levemir will have its highest activity around 3 AM as well. The combination of these two effects makes it more likely to go low then.
But here the split has another advantage. Injecting just half of the dosage will cut the peak of Levemir in half as well. So in addition to good coverage this peak reduction (leading to a reduction of lows) is another argument pro splitting: two shots of Levemir per day = more evenly distribution of Levemir activity
Well, label it any way you like -- I'm easy. What I know is that I have a sharp and sudden jump, too high for safety, that happens in a heartbeat and needs to be brought back down again. ;-)
And yes, as you said I know other PWD who experience exactly the same thing.
Are you only taking one shot of Levemir a day? If you are you might want to split it, in case it's wearing off.
When I wake up high I always correct immediately. Even if I'm in range, if I'm not eating right away I take a unit or two. I just have to be careful with this because on the odd occasion I'll go low when doing this.
I hope you get it sorted out. Being high is no fun! I've been dealing with four days of almost non-stop highs and taking more insulin than I've ever taken in my life! I think (I hope!) today I finally have it under control, although still taking an insane amount of insulin to keep things in range.
I think this is highly individual. For some the increasing daylight will trigger the liver response. For others it is to get up and running. Looking more closely it might not even be the activity but being nil by mouth for too long. What I suggest here is that the liver might just help out with the glucose because it is missing the glucose intake from the breakfast.
yes, jen...taking two doses of levemir....doesn't seem to be working. i do take a correction the minute I wake up, usually do 1.5 units and add that to the egg and coffee bolus and yes, sometimes I'll go low too. I can correct and bolus during the day, it's tying the two basal doses together and I've got something screwy happening overnight which I cannot figure out and I NEVER wake up to a good number. IDK, every day is so different and I hardly eat...ugh! I know, i've read your posts....i do so hope you get it sorted out. Is the pump really that beneficial, it seems it's just constant adjusting, too. Typically, on a good day for you, what do you go to bed at and rise at (with or w/out DP), how much drop or rise do you like overnight and where do you stay if you're not eating cause again, I just seem to always be taking shots all day and night long. ugh!
Before I started on the pump I woke up with 95% of my readings above 180 mg/dl unless I woke up in the middle of the night and took insulin. I wasn't willing to do that forever while going to school full-time and then working ... I also started on the pump when I was in a highly variable job (teacher on call) and it helped a LOT for that. I've just got a new job that will also be highly variable (some days at a desk all day, some out in schools, some travelling around the province), so that will be a challenge. And the pump also works well for hormonal adjustments which happen rapidly ... For my first two years of pumping my A1c was in the high 6s compared to high 7s on MDI even with 8-10 shots per day. And for the first time being able to wake up with a blood sugar in range which makes a huge difference to the start of the day.
So for me it was a huge improvement, till the allergy stuff started. But even since I've partially solved that my A1c went down to 7.2 which is lower than it's been in a long time. Lately I've been using the metal sets with no additional tape and as long as I do that and take an antihistamine daily it seems fine, but the problem is the default tape on the infusion set barely sticks so it often falls out easily.
I think this latest thing is my body, as I've taken shots and they don't bring me down, either. I think if it continues into next week I will call my endocrinologist and see if he has any ideas of what to do other than taking tons of insulin, maybe I have an infection or something ... I actually think if I hadn't been on the pump I don't know how I would have dealt with this. My insulin TDD went from 60u to over 100u over three days (today is day five and I'm still taking a ton of insulin but at least my blood sugars have been fine so far). I don't know how I would have adjusted MDI so rapidly. I can easily see how people can go into DKA if that type of thing happens so quickly when they are sick (or whatever) and they aren't able or willing to adjust insulin.
My basal rate is pretty good at keeping me flat overnight, but of course not having a CGM I can't know for sure. I can often go to bed at 110 and wake up at 110 (I don't like going to bed below that), but years ago when my control was better than it is now I went on a CGM for a week and it showed my overnight blood sugars were actually all over the place. It showed that nights I thought I was staying flat because I was going to bed and waking up at the same number, were not flat at all. But there was also NO consistency. Literally no two nights were the same. Some nights I went to bed in range, rose immediately after falling asleep and stayed high all night, and dropped back down into range by morning. Other nights I went to bed high, stayed perfectly flat (but high) all night, and woke up at the same level. Other nights I went to bed in range, dropped low, and rose back up by morning. Other nights I went to bed in range, stayed flat all night, and woke up in range. It was truly mind-boggling and is what convinced me that, for whatever reason, my diabetes is variable and constantly shifting, and I think it would be the same whether I was on the pump or MDI, but harder to control on MDI.
I'm doing two split doses, holger...it's trying to understand what the correct total dose is for me to split. I have a drop starting at 12am; one night 6 units dropped me 80 points, although I went to bed high and dropped to 69, then woke to 78...so, the wake up number is good but the drop is too much, correct....WTH? so, do I split that 6 units at night, that won't be enough. Do I do 6u AM & 5u/4u PM...i have no clue....i just sit there at night and think, "I have no idea how much levemir to take right now." And I know I'm going to wake up high so now I'm doing a shot at 3AM.
thanks, yeah...my endo did say this happens but 150+ points within an hour, isn't it really the same thing though...if it's a cortisol - stress induced release, isn't it still the hormone cortisol (or stressed induced adrenalin, fight or flight) which triggers the liver to do a dump and release glycogen (or whatever it's called), same thing in DP? IDK.
OH Jen, i hope you can figure out your high blood sugars! Have you or can you change insulins...maybe novolog (think you use apidra, no?)or maybe it is you're getting sick..i hope not. :) keep us posted. For me,it seems when these ridiculous highs are a result of a liver dump, DP or incorrect basal, I too need a ton of insulin (and I'm pretty insulin sensitive), like doing 2 units and BG's not even moving or doing anything (hello, am i injecting water here) and these highs feel different to me compared to just an incorrect I:CR which come down nicely.
I do have a Dexcom so yeah, i see what's happening. that's why when people post on here and say they go to bed at 100 and wake up at 100 or whatever, how can that be, especially on MDI? I too am all over the place. I sometimes think it's a con to have a dexcom cause I'm trying to navigate and match levemir through all this nighttime rise and fall nonsense. Endo told me basically levemir is flat so it's not the levemir, it's me (or us as diabetics) and how our patterns are when we sleep. I do want the pump but it just seems like just as much work, certainly more upfront...I'm going to rethink it and maybe retry in March.
My Dp is so variable it is difficult to treat. I'm up most of the night and take my smaller dose of levemir at 3am 2-3 units. Last night 3 units dropped me to 51 at 5 am so I corrected with 8g and ended up at 111 5:54. I was hesitant to take a correction then because I could end up really low again but I decided I didn't want to wake up high again either.I took .5 unit and woke up at 98. I was still tired and meant to sleep for another hour but instead I slept 3 hours and woke up at 160. I really never know what is going to happen. At other times I can take 3 units basal, be fine and wake up at 80-90 or the low 100's. I probably should have taken 2 units but I had eaten a late dinner and thought I would need more as that food could metabolize later. Sometimes it starts when I get up and move, sometimes if I go back to sleep it stays stable and at other times I just wake up high. I think it is also my basal running out since my main dose is at 4-6 pm. Usually if I wake up in the 90's or higher and I want to sleep more I take 1 unit fast acting and that will lower me or keep me stable. Since you have big drops at night I would be really cautious about adding more insulin at night like regular. Have you mapped out what your Dex says is happening to see what is going on? My worst lows are at 5-7 am usually so it is rare for me to correct then, but I can take levemir then and be ok usually. I would also try eating more if I were you because I notice some of the time my bg is much higher when I don't eat and I feel awful, whereas if I eat it seems to stabilize me.
