The One Where Gangrel Does Basal Testing

[Gangrel]

Ok, as some of you know, i finally switched to Levemir a week or so ago, from NPH. Long story short, my nurse has me on a split dose, 7AM and 9PM, and she started me off at 20% less then my NPH dose.

This worked pretty fine for the first few days, actually, but now I seem to be running lower then normal, and having to snack in the afternoons, and some nights before bed. Ideally, i'd like to be able to survive on no snacks, as a plesant side-effect of all the monkeying around i've done since last Nov. is the loss of 10-12 pounds, mostly do to cutting out snacks.

Anyway, I am finding that I can be fine before a meal, in range 4.0-7.0. I then eat and use the same carb ratio I was using on NPH (and it worked) of 1:10. On NPH, I was usually hitting my post meal mark of 10.0, and that's perfect. Now, I can be only 5 or 6 after a meal. So, that means either my carb ratio is wrong and needs to be tweaked, or my basal dose is too high and it's sort of blanketing my sugar and not allowing it to come up.

Being the smart (haha, ya right) guy I am, I wanted to start a basal test, as the basal dose needs to be correct before you can test for carb ratio. I got some nice instructions through a Winnipeg informant, who recieved the info originally from a Southern lad... ;) so thanks guys!!!

ok, the long winded intro is out of the way (long winded and Gangrel go together)

Last night, I took my Levemir at 9:20ish pm, and took 16 units. I last ate at 6pm, and took my Humalog. Following the overnight basal test (mostly) here's what i have:

21:52: 10.3
00:05: 8.4
03:51: 5.5
06:04: 5.8

I slept a tad past my 3am alarm :) but it's close enough.

Assuming the last of my Humalog was still working between 9pm and 10ish, that might account for the drop from 10.3 to 8.4.

But, the 3 point drop between midnight and 3am concerns me, though I don't understand why it then levels out?

So, looking at this I am going to try either 15 or 14 units tonight, a reduction of 1 or 2. Does this make sense to you? Or are you seeing something I'm missing (which is very possible)

If I do an afternoon test, I'll post it in this thread too.

[Stuboy]

what's wrong with 5 or 6 2 hours after a meal?? Those are the number i hit (and 7's sometimes) and after that i level off and remain there...

[Gangrel]

Because right now at least, if i'm 5 or 6 post meal, I will definately go low before my next meal.

Maybe once I get my basal figured out, I can aim for that, but not at the moment........

[Stuboy]

ahh yeh, that's what i was thinking... if you have your basal right then you should be able to remain in the 5's or 6's for a long period of time.

I can skip breakfast and be in the mid-high 4's when lunch is due. or skip lunch and sometimes still be in the 5's when dinner is due.

I think having your basal adjusted right for you gives you great freedom and choice of WHEN you want to eat.

Good luck, keep us updated :)

[belyro]

ahh yeh, that's what i was thinking... if you have your basal right then you should be able to remain in the 5's or 6's for a long period of time.



I've done basal testing that shows my Levemir dose is bang-on, and I still can't be in the 5's or 6's after a meal without going hypo before the next one. I have to be at least in the 8's. I'm looking at options to lower it, but none are working so far.

Gangrel, I feel your pain.

[Gangrel]

I think the reason I (and belyro) have to aim for 8-10 after a meal is the action of the Humalog. For a perfect Humalog curve, I need to be as close to 10 as possible, then after the Hlog runs it's course in 4 hours, i'm (hopefully) back down to 4 or 5 before my next meal.

As it is, this dumba$$ forgot to bring a new bottle of strips to work and just used his last one! Looks like the cat will be getting a surprise mid-day visitor.... i hope he's got his girlfriends outta the condo by then......

[Scratch]

21:52: 10.3
00:05: 8.4
03:51: 5.5
06:04: 5.8

I slept a tad past my 3am alarm :) but it's close enough.

Assuming the last of my Humalog was still working between 9pm and 10ish, that might account for the drop from 10.3 to 8.4.

But, the 3 point drop between midnight and 3am concerns me, though I don't understand why it then levels out?

So, looking at this I am going to try either 15 or 14 units tonight, a reduction of 1 or 2. Does this make sense to you? Or are you seeing something I'm missing (which is very possible)

If I do an afternoon test, I'll post it in this thread too.

For many diabetics, our basal metabolic rate and how much glucose our livers pump out is at its lowest from midnight to 3 AM. That's because we expect to be sleeping at that time, so the liver conserves energy stores until a time we might start needing it, like around 3 AM to begin priming our bodies to wake up. Such metabolic cycling is no problem for non-diabetics since they have beta cells that can respond correctly by releasing more insuling.

But for you, you've got to deal with the flat profile of Levemir. Like I've got to deal with the flat profile of Lantus.

For me the best solution has been getting my dose titrated such that from midnight to 3 AM I'll see a drop of about 40 points, which I think is around 2 in your measurements, and then after 3 AM I'll see my levels begin to rise, usually back to about where I started at bedtime. So my deal is I try to go to sleep at around 140 mg/dl, which gives me some margin against hypos, but also keeps me at a reasonably decent BGL overall. I've also found that margin useful for the times I go to sleep and I'm exhausted. I've observed that my dawn phenomenon will not show up until after I wake up if I'm really tired and my mind and body are demanding rest, and sometimes I've been exhausted enough that even after falling asleep at about 140 mg/dl I'll wake up the next morning on the low side as my liver never kicked in to wake me up.

[Gangrel]

I think I'm going to repeat the overnight test tonight, and try one less unit of Levemir.

I will also still do my afternoon test, my gfriend is dropping me off strips on her way to class. :)

[Injecto]

I've done basal testing that shows my Levemir dose is bang-on, and I still can't be in the 5's or 6's after a meal without going hypo before the next one. I have to be at least in the 8's. I'm looking at options to lower it, but none are working so far.

Gangrel, I feel your pain.


Same here, can't be that low two hours post or I'm hypo for sure. Keep the test up Gangrel, and let us know.

So, looking at this I am going to try either 15 or 14 units tonight, a reduction of 1 or 2. Does this make sense to you? Or are you seeing something I'm missing (which is very possible)

BTW, that makes perfect sense to me as that's what I did.

[Gangrel]

Alright, i'll keep a running tally..... i have my strips now.

21:52: 10.3
00:05: 8.4
03:51: 5.5
06:04: 5.8
Breakfast: 43 gs of carbs, took 4u of Humalog around 6:30.
Took 20u of Levemir at 7am

09:00: 12.5 (higher then it has been post-meal, no idea why
12:10: 6.6

I'll probably check every hour in stead of every 2 like the document says..... now off to Canadian Tire for new wiper blades and washer fluid. ;)

[NoelD]

Aaron, I have always been taught, when you make a dose change, wait and monitor 3 days before making another change.

[Gangrel]

21:52: 10.3
00:05: 8.4
03:51: 5.5
06:04: 5.8
Breakfast: 43 gs of carbs, took 4u of Humalog around 6:30.
Took 20u of Levemir at 7am

09:00: 12.5 (higher then it has been post-meal, no idea why
12:10: 6.6

01:03: 4.9 (mild hallucinations, hearing voices, slight paranoia)



(hey, gotta make it entertaining)

[Gangrel]

Well, to borrow a naval aviation term, *bolter, bolter, bolter*.

I had to abort the test.

21:52: 10.3
00:05: 8.4
03:51: 5.5
06:04: 5.8
Breakfast: 43 gs of carbs, took 4u of Humalog around 6:30.
Took 20u of Levemir at 7am

09:00: 12.5 (higher then it has been post-meal, no idea why
12:10: 6.6

13:03: 4.9
13:35: 4.5
14:20: 3.7

well, it's good to know some info anyway. Obviously 20u of Levemir is too much for me in the morning. I'm at home tomorrow, but still may attempt an afternoon test again. I think I will reduce my Lev. dose in the morning to 18. Thoughts?

[Gangrel]

Ok, update time. I did another basal test this afternoon. I took 18 units of Levemir at 7am., and this is what i ended up with:

12:00:6.7
1300:6.7
1401:5.2
1434:5.4
0259:5.3
1602:4.7
1716:4.0

I am just wondering what may cause the reduction at the end? At that point the Lev would be in my system for 10 hours or so. If there was a peak, i'd think it would occur earlier?

Anyway, based on what i can see, even 18u may be a tad too much. Though it held the 5's pretty good.

Anyone think i should try 17u, or should i stick with 18?

[xMenace]

One day is not a pattern.

From midnight to 4ish most people either stay steady or drop. You may be a dropper. If so, you'll have to go to bed a little high.

[Gangrel]

I know one day is not a pattern. But this was in the afternoon, not the night!

[Gangrel]

To be enviro-friendly I'll just re-use my own thread.

I have a pattern that keeps occuring, and i wanted some opinons on if it's Dawn Phenomenom, or just a hole in my Levemir coverage.

I am currently taking 18u of Levemir at 7am, and 14u at 9pm.

I seem to be doing fine and in range during the day, and into the night. However, I have one niggling problem left, and that's post-breakfast readings that are consistently 3-4 unites too high.

As an example, i'll show you last night/today:

22:47: 6.2
03:18:4.9
07:28:7.7
-Breakfast of 45gs of carbs, on a 1:8 ratio, took 6u of Humalog
09:33: 13.3


This pattern has been occuring since the weekend, or whenever i settled on 14u of Levemir at night I think.


So, my question is, do you think I should add another unit of Levemir at night, to cover the mornign rise? It looks like it may not even be lasting 12 hours at that dose. If I do do that though, I will need to make sure I'm higher when i go to bed so I don't drop low.

Or, do you think I'm being hit with DP and it just so happens to make me conistently run into the 13's after breakfast, and I should just hammer more Humalog into me in the mornings?

[Scratch]

To be enviro-friendly I'll just re-use my own thread.

I have a pattern that keeps occuring, and i wanted some opinons on if it's Dawn Phenomenom, or just a hole in my Levemir coverage.

I am currently taking 18u of Levemir at 7am, and 14u at 9pm.

I seem to be doing fine and in range during the day, and into the night. However, I have one niggling problem left, and that's post-breakfast readings that are consistently 3-4 unites too high.

As an example, i'll show you last night/today:

22:47: 6.2
03:18:4.9
07:28:7.7
-Breakfast of 45gs of carbs, on a 1:8 ratio, took 6u of Humalog
09:33: 13.3


This pattern has been occuring since the weekend, or whenever i settled on 14u of Levemir at night I think.


So, my question is, do you think I should add another unit of Levemir at night, to cover the mornign rise? It looks like it may not even be lasting 12 hours at that dose. If I do do that though, I will need to make sure I'm higher when i go to bed so I don't drop low.

Or, do you think I'm being hit with DP and it just so happens to make me conistently run into the 13's after breakfast, and I should just hammer more Humalog into me in the mornings?
I think if your other numbers are solid, and you've got good numbers for overnight, you may end up needing to use a bit of Humalog to cover your morning.

I usually end up using 1 to 3 units of Novolog every morning even if I don't eat. If I try upping my Lantus shot, it causes me to hypo too much.

[Injecto]

Gangrel, I am by no means an expert, but use this image to help (I based this off of what duck had suggested for me when I did my basal test a few weeks ago).

Based on the Levemir working roughly 20 hours in your body and the times you take the doses you mentioned, you might look like this (see image)

It would appear that your morning rise is due to the fact that the total levemir in your body is decreasing from 3AM to 7AM (before dose). That would explain the morning rise.

About the after breakfast highs, for now I'd say you need more bolus.

You could change the times and units of the basal, but I'll have to look into that a bit later, sorry.

[Gangrel]

Hmmmm, you are probably right Injecto. Is that an excel sheet with formulas? I'll send you my email in a PM if it is, so you could send it to me if you didn't mind.


I think I will give an extra unit or two of Humalog so I can hit my target of 10 then.

Thanks for the advice gang.

[Injecto]

Hmmmm, you are probably right Injecto. Is that an excel sheet with formulas? I'll send you my email in a PM if it is, so you could send it to me if you didn't mind.


You do that, and I'll send if off to ya right away.

[Gangrel]

Colour me confused. Injecto, I just took another look at the chart, and bw 7am until around 11 or so, it would appear I have 1.6 units per hour working. Therefore, at 9am when my spike occurs, I am working on full Levemir (based on it lasting 20 hours in me, which i'm not sure.

A day and a half ago I took 15u at night, and long story short, woke up at 6am yesterday with an 11.0 (too much snacking!). I tested again at 7am, and was 11.3. I tested at 8am, and was 11.1, THEN I tested at 9:30ish, and was up to 13! This was all without breakfast or bolus.

Perfect I think, it all made sense to me, my 'hole' around 9am was causing the spike.

Then, last night, I took 15u of Levemir around 8:30 (I was at the Hip concert so shot up before they hit the stage). When I came home at midnight i was 14, so I took 4u of Humalog, which in theory should be long gone outta me by 4 or 5 am.

I woke up at 7am, at 4.0. I took my Levemir (18) AND ate about 20gs of carbs due to being lowish. I woke up again at 10am, and was only 7.0?!?!?!?

Where did my hole go? I know, I know, one morning a pattern doesn't make.

Do you think because I slept all morning it made some kind of difference, rather then doing the work thing? To me this is a clue for DP, however I wouldn't think DP would consistently put me up to 13 everyday???

Hmmmmm..... thoughts? Comments???

[tanyatype1]

You went to the Hip concert?!

[Gangrel]

You went to the Hip concert?!


Yup. It rawked! My 11th time seeing them I think, in 16 years or so......

You shoulda went when they were in Vancouver!

[xMenace]

Aaron, sounds like a DP from ****. Maybe yours and mine are cousins?

I can wake up anywhere between 6&12 for no apparent reason. If you ever figure out how to reduce these variances, please let me know. I suspect body fat and exercise levels are the cause.

[Scratch]

A couple of possibilities:

My experience is that most times as long as I'm sleeping, full blown dawn phenomenon doesn't get going, unless I'm being really lazy and my body thinks I'm ready to get up. My liver seems to know when I should be sleeping, and when I should be awake. The reverse sometimes happens some: when I'm really really tired, the liver absolutely won't begin pumping out more sugar until after I wake up. Which can be a problem because I tend to rely on it to begin putting out some glucose around 3 AM. I hope that makes sense.

The other chance is that I think sometimes the 24 hour insulins aren't always a consistent time frame. I know I have some times when my Lantus only goes about 22 hours, and I can spot when that happens when my blood sugar is elevated above what I would expect at 9 PM. I just live with it and don't fret over those instances because I will have bolus insulin from dinner available during that time anyhow, so I'm not running without any insulin my system, just not quite as much because the Lantus got used up early.

So it's possible you might have days when one of your Levemir shots goes a full 24.

[Injecto]

Not sure what's going on Gangrel, but I'd say let's try it again, but this time, without too much snacking, and no concert going (or other activity). Just be a sloth for one weekday. Start on after Vanilla day (where nothing out of the ordinary happened, and no hypos), then that night, take your evening shot and have a small snack. Skip breakfast and just go to work. Keep on testing your BGS every hour (well, that's what I did), and check once around 2-3AM. You can have lunch after all that fasting (should be near 15 hours fast).

Let us know.

[Gangrel]

I am going to do more testing soon. I do wonder if sleeping makes the Levemir last longer, though I am becoming more inclined to me having DP hit me then anything.

Diabetes is just as much work as work is!

[Injecto]

Well, take this as advice from a new diabetic with no medical knowledge only speaking from my personal experience (that was the CYA disclaimer :) )

I'd suggest increasing your bedtime injection by 2 units, and take it at 10:00PM. See what that does to your wake up fasting. Keep doing that (upping by 2) until you wake up below 7.0 (that's why my nurse made me do). That may help the DP if that's what it is, and may help your morning post meal tests too.

[Gangrel]

My problem with that is then I need to snack at night. When i started on Levemir, i was on 20 units at night, instead of the 15 i'm down to now. I kept going low around 3am.

If possible, I would like to snack as little as possible, as I kinda like the whole losing weight thing, lol.

It may be something to try moving to 10 tho..... I'm seeing my nurse tomorrow afternoon, so I'm sure this will be the main topic of conversation.

Thanks for the tips tho. CYA? You must work for the government, ;)