Help! Im so sick of waking up every night with 15+ BSL's!

[tattoowrx]

Hey everyone!

My names Jason, im 27 and have been a type 1 diabetic for 10 years now...

Anyway, im up at 2am... again! as for some reason my BSL goes sky high during the night! , for instance tonight at 8.15pm i took 40units of Levemir , my BSL was 4.6 before injecting.. i have now woken up at 1.50am and its 12.7! , usually it wakes me up around 3... last night it was 16.7, I am finding is soooo hard to sleep! I have been on levemir for about 6mths now... before that i was taking HUMALIN NPH at night time, my daily insulin is Humalog

Is it possible that after a period of time an insulin becomes ineffective?? would i be better off going back to a shorter acting bed time insulin? .. i get up every night and have to take around 8-10 units of Humalog just so my BSL will go down so that i can sleep! as i hate the dry mouth, sore eyes ..etc etc i get when really high!

also, ive never ever even spoke to another diabetic, so never been able to find out if some of the stuff i expereince is similar to others... but do alot of you get really bad nightmares when your BSL is high??? i am finding myself lately having the most vivid dreams...

anyway.. going to try and get some sleep again!

[dbaratta]

Hey everyone!




Is it possible that after a period of time an insulin becomes ineffective?? would i be better off going back to a shorter acting bed time insulin? .. i get up every night and have to take around 8-10 units of Humalog just so my BSL will go down so that i can sleep! as i hate the dry mouth, sore eyes ..etc etc i get when really high!


anyway.. going to try and get some sleep again!

I have the nighttime problem. I find that when I eat a good amount of carbs in a given day I dump like mad in the middle of the night. Laying off the carbs for me helps a lot, laying off the artificial sweetener before bed helps me, and staying away from caffeine helps. So, maybe a change in diet to start and if that doesn't help talk to your doc about maybe upping your basil?

[fgummett]

I'm sure you'll get feedback from Type 1's soon but meantime I have a couple of thoughts:

1) you are eating something that spikes your BG much later than expected

or

2) you don't need so much insulin overnight and are actually going hypo first and then waking up after a Liver dump of Glucose.

Can you set your alarm clock for earlier in the night and wake yourself to test?

You have my sympathy as I hold my sleep very precious and am like a bear with a sore head when disturbed :)

[Maddogg]

Maybe you need to adjust your basal rate of levemir or change the time of the injection. Keep in mind, you should be trying to take your injection at the same time everyday. Do you take 1 or 2 injections of levemir per day??

I used to take Levemir way back when, but it didn't well work for me (too inconsistent) so I switched back to Humulin NPH and now that I'm having problems with that one (too many hypos) my endo is making switch to Lantus which I'm looking forward to using.

Have you talked to your doctor/endo about this?

[jenb]

Hi Jason. How frustrating! The only certain thing about using insulin seems to be that your needs will unexpectedly change, and adjusting it will just be an inconvenient part of life.

In my experience the time at which you inject Levemir really does make a difference. After tons of testing I found that the optimal timing for me is 3 doses at 8 hour intervals: Around 10:15 p.m., 6:15 a.m. and 2:15 p.m. (there's about a 30 minute window to play with). Also, if I eat after 9:00 p.m. I almost invariably experience higher-than-desirable BG in the wee hours. Have you done any basal testing? You may find that you need to split your Levemir and increase your overall intake.

Also, are you eating at night? If so, is it high-fat food like pizza? Are you drinking sodas or beer in the evening? These can really come back to bite you several hours after you eat.

Jen

[DanG]

Let's all hope you got some good sleep - good sleep is also good management of diabetes, I think.

As Frank mentions - maybe you should suspect that your high bs is due to liver dump as the levemir is sending you to hypo.

I really have no respect for the medical establishment suggesting that we take a basal insulin at night. You take a levemir at 10pm and go to sleep. You are at resting state and the insulin is there to bring blood sugar down so your system can manage. However, as any insulin, levemir or lantus is going to do something to bs - it lowers bs, if there is no input of glucose producing stuff, i.e. food produces glucose. Hence, your bs drops while you sleep - showing that the levemir is doing its job. Then your body has to do its job and rescue you from this invasion of glucose reducing insulin - so your liver dumps a recovery dose of glucose stores. Sounds like a bad plan to me.

I used to wake up at 3am with the paramedics trying to get me alive, or my wife trying to get me to drink OJ at 3am. Then the brainiac idea of split dose sounded really good - for one week - and the paramedics came that night. I figured after this - stop messing with an insulin at bedtime - so I do my lantus (same as levemir, essentially) at breakfast. I get good sleep and I can go to bed at 120 and wake at 60 due to the tail end of previous morning's lantus.

I did this on my own. Many will recommend that you dialog with a medical professional. I might recommend a visit with the doctor, but doctors have their turf to manage and they are the ones that suggest night time lantus - which for me did not work.

Let us know what you find works for your life with diabetes - we love the dialog.

[bamagigi]

You and your doctor can best work this out. But you should keep a food log (and be honest you and your doctor are the only one who need see it). I have found that a food diary really helps with a lot of issues when you are diabetic, (weight, oral & injected medications). It also may help you to recognize other health issues (such as if you notice headaches after eating certain foods). But always check with your personal doctor before you make any changes to your meds.:)

Hey everyone!

My names Jason, im 27 and have been a type 1 diabetic for 10 years now...

Anyway, im up at 2am... again! as for some reason my BSL goes sky high during the night! , for instance tonight at 8.15pm i took 40units of Levemir , my BSL was 4.6 before injecting.. i have now woken up at 1.50am and its 12.7! , usually it wakes me up around 3... last night it was 16.7, I am finding is soooo hard to sleep! I have been on levemir for about 6mths now... before that i was taking HUMALIN NPH at night time, my daily insulin is Humalog

Is it possible that after a period of time an insulin becomes ineffective?? would i be better off going back to a shorter acting bed time insulin? .. i get up every night and have to take around 8-10 units of Humalog just so my BSL will go down so that i can sleep! as i hate the dry mouth, sore eyes ..etc etc i get when really high!

also, ive never ever even spoke to another diabetic, so never been able to find out if some of the stuff i expereince is similar to others... but do alot of you get really bad nightmares when your BSL is high??? i am finding myself lately having the most vivid dreams...

anyway.. going to try and get some sleep again!

[Grunch]

It's kind of a consensus that levemir sucks, so I would ask the doctor to switch to lantus.

Do you take more levemir throughout the day or just those 40 units? How does your blood sugar behave the rest of the day?

[jenb]

Is there really such a consensus Grunch? Am I the single person for whom NovoNordisk is making Levemir? Quite an honor!

Jen

[Scratch]

I really have no respect for the medical establishment suggesting that we take a basal insulin at night. You take a levemir at 10pm and go to sleep. You are at resting state and the insulin is there to bring blood sugar down so your system can manage. However, as any insulin, levemir or lantus is going to do something to bs - it lowers bs, if there is no input of glucose producing stuff, i.e. food produces glucose. Hence, your bs drops while you sleep - showing that the levemir is doing its job. Then your body has to do its job and rescue you from this invasion of glucose reducing insulin - so your liver dumps a recovery dose of glucose stores. Sounds like a bad plan to me.



This is incorrect. Insulin only lowers blood glucose if the amount of insulin exceeds the supply of glucose derived from both what food is supplied and what the liver provides from the glycogen that is stored away. It is in fact possible to see blood sugars rise overnight when nothing has been eaten if there is too little insulin or no insulin.

I suspect a misconception or misunderstanding. It is in fact true that most people's basal metabolisms slow down the hepatic supply of glucose overnight, which can give an impression that because no food is being eaten, the insulin is lowering blood sugars due to that.

Based upon what information the OP provided us, there are a few possibilities --

1. The dose being taken is insufficient to keep up with his nighttime hepatic glucose output.
2. The dose is excessive, he is going hypo and rebounding from that.
3. He is eating a dinner meal with enough fat that all the carbs in it don't reach his bloodstream until much later on.

Or it could be a combination thereof.

The only real way to answer the question is for basal testing to be done. Until then, we only have speculative hypotheses.

[Grunch]

Is there really such a consensus Grunch? Am I the single person for whom NovoNordisk is making Levemir? Quite an honor!

Jen

I said kind of a consensus. Between levemir and lantus there's a lot more people using lantus but I hear a lot more complaints about levemir not working. So it seems to me that lantus is in fact way more effective. For some people levemir is better but it's a minority of people and usually related to issues other than control, like allergies for example.

[DanG]

This is incorrect. Insulin only lowers blood glucose if the amount of insulin exceeds the supply of glucose derived from both what food is supplied and what the liver provides from the glycogen that is stored away. It is in fact possible to see blood sugars rise overnight when nothing has been eaten if there is too little insulin or no insulin.

I suspect a misconception or misunderstanding. It is in fact true that most people's basal metabolisms slow down the hepatic supply of glucose overnight, which can give an impression that because no food is being eaten, the insulin is lowering blood sugars due to that.

Tell us more about this hepatic supply of glucose, please.

I did a brief google search of "hepatic supply of glucose" and found some interesting article abstracts regarding this issue. If you know stuff about this, please educate us - thank you.

In my case, I would suspect that I have a complete shutdown of hepatic supply of glucose overnight - hence I am successful in sleeping well without a basal insulin overnight, and contrariwise, I go hypo if I have a running basal supply in my system. I theorize that I run without any insulin during the wee hours of the morning - but I don't know. I believe that I could probably run until mid morning without insulin and not have blood sugar rise, nor blood sugar decrease.

Based on your summary statement regarding hepatic supply of glucose - I might begin to wonder what type of hepatic supply of glucose I produce, and why I operate that way. My primary consolation is that others here at DF also do basal insulin in the morning like I do. That operation is very successful in my life, therefore when I see others with "dawn phenomena" symptoms, I make my suggestion that there might be an overnight hypo condition from taking evening basal insulin.

I realize by what little I read in these abstracts online that indeed, the hepatic supply of glucose is a protracted study of interest among researchers - especially at University of Minnesota, it appears.

[sarahspins]

maybe you should suspect that your high bs is due to liver dump as the levemir is sending you to hypo.

I wouldn't be so quick to assume that. I had fasting #'s well over 300 while I was on Levemir.. and no lows at night. My BG would just climb and climb and climb (it would do that during the day too)... I'd wake up feeling absolutely horrid with moderate to large ketones. Levemir was doing seemingly nothing for me, providing almost no basal coverage... I was constantly correcting highs with extra Novolog during the day. When I switched back to Lantus that nonsense stopped... I put up with Levemir for nearly 3 weeks (and my A1C went up nearly 1% in that time).

Now, I wear a CGM and I have a pump, and I am able to keep flat #'s overnight with a very "not flat" basal profile... and I need much more insulin at night (almost 50% more) than during the day... it was always difficult to match my basal needs to the insulin I was taking on MDI.. I'd add in NPH at night to make up the difference in what I needed.

[Tattoo azz]

Hi Jason.
I don't know much about Levemir, but i would suggest first that you maybe increase your dose by an amount you feel comfortable with, say 2-4 units, monitor the effect this has over a period of time maybe a week or two and increase by the same amount if you still aren't satisfied. Another thing to look at would be the time you inject, maybe you aren't giving the insulin enough time to start working, in which case take your injection a couple of hours earlier. It could also be that you just aren't compatible with levemir and by changing to lantus you may find your night time blood levels drop to a better level. In any circumstance i would discuss with your Dr any changes you want to make BEFORE you make them. Good luck and please keep us posted on your progress.

[xMenace]

There are a large number of diabetics whose sugars tend to rise at night (midnight to dawn); though for most it tends to fall, and for some it stays flat. I have an old post on this I'll try to dig up.

First I would confirm it's a basal problem. If I were you, I'd consider a few things:

- skip dinner and test every hour through the evening until very late, say 4am. Do it on a Friday night.

- eat the same dinner every night (and maybe even meals every day) and build an overnight profile. One night test at 2am, the next at 3am, etc. Also test at say 10pm each night so that you have a common time to adjust to. After a week you'll have a complete nighttime profile.

- pull an all-nighter testing hourly.

Once you have a profile you trust, then you can better attack your problem. I'd probably consider a hot of NPH at night plus maybe your Lev in the morning, but I'd definately test first.

[tattoowrx]

Thankyou everyone for you input,

To be honest, i have no idea what "basal" means or "basal testing" ive never ever heard that word mentioned to me, I am abit slack when it comes to Dr's... i dont see an Endo, i just go to my GP and he put me on the levemir... but i ONLY take levemir before bed, Before Breakfast, Lunch and Dinner i take HUMALOG. i take 20units of humalog during the day and then 40units of the levemir at bed time.

Its just really started to get to me alot now, as anything over 11 and i just wake up feeling like total ****..and i sit on the computer for a good hour waiting for it to come down after i have taken some extra HUMALOG as that acts fast...

all i ate for dinner last night, was Salad and some roasted chicken... that was at about 7pm, i then took my levemir about 9pm and crashed...

ive been diabetic for around 10 years and ive always really just gone about my ways and managed with it, ive been hospitalised about 4-5 times with a Ketoacidosis ..i think thats how you spell it!

and ive never heard of Lantus...

[DeusXM]

Ok, some of this has been said before, but let's go over a few things again.

1. Levemir doesn't work for everyone. I'm one of those people. I use Lantus, which for me seems to last longer and give more even coverage. I could take an entire cartridge of Levemir and still be running high throughout the whole day. I would suggest you try Lantus.

2. The fact that you were on NPH originally, tells me that, contrary to what has been suggested here, you do have a steady flow of glucose coming from your liver over night. In fact I'm amazed none of the pumpers has taken this notion to task - after all, the entire principle behind an insulin pump is that it releases a steady, small stream of insulin to deal with the small, steady stream of glucose coming out from your liver, and then you have the option of larger doses when you eat.

If a pumper disconnects their pump and doesn't eat, their BG will go through the roof and they will be in DKA very bloody quickly - because of the steady stream of glucose coming from the liver. I have to be honest, I'm amazed this notion is even being questioned.

3. The other, final thing is you MAY be having hypos in your sleep. I think this is unlikely because you say you're testing at 2am (prime hypo time) and you're already running high then. Maybe test at 11pm/12am and see where you're at. The fact that you are describing vivid dreams could indicate either sleep hypos or high blood sugar.

[fgummett]

...i have no idea what "basal" means or "basal testing" ive never ever heard that word mentioned to me...The books "Using Insulin" and "Think Like a Pancreas" come up often, as recommendations, here on DF.

In brief and general terms: the body needs a relatively slow trickle of insulin throughout the day to manage our background needs... in Type 1 D this is often replaced (or supplemented in Type 2) with a slow acting or basal insulin, such as Lantus or Levemir... commonly given as a once or twice daily injection. An insulin pump simulates this same action by providing a slow trickle of fast acting insulin through the day

When we eat foods that raise the BG -- carbohydrates and to a lesser extent protein -- the need for insulin rises in line with the BG rise (more BG = more insulin)... in D this need is covered with a fast acting or bolus insulin, such as Humalog

But BG does not just rise as a result of what we eat... there is a ready supply of Glucose (stored as Glycogen) in the Liver and muscles... if the BG is tending to fall below the normal range, or often around waking time, or when stressed, or sick (or sometime just due to space-aliens!) the Liver may dump out Glucose and raise the BG.