[rea]

So after starting levemir for a basal insulin, I was only injecting my fast acting Humalog an average of 3-5 units per meal. then last week, after finally being over my bad cold, I could not get a decent BS average.

lunchtimes and dinners went all crazy, and I couldn't get enough insulin in, and kept having to correct. (the up and downward spiral). plus, I have by orders of my doctor, only upped my dosage by one unit per every few days. (instructions that sound stupid to me, but since I am a bit of a wimp and not sure how levemir is acting yet, I followed them)

so anyhow, yesterday, I gave up and just gave myself ONE BIG SHOT with my meal of 8 units, and BOOM. 5.0. wahoo! I had the BEST day every, with a daily average of 4.9. which is really good. now, If I can keep it up, for my a1c this april.

but, I was wondering why I started out being okay on such a lower dose, when I even had a bad cold and was sick. normally my bs's skyrocket when I am sick. could I have been on a one month Honeymoon period due to using new insulin???

anyone go through a mini honeymoon with new insulin?

[stella117]

No matter what basal insulin (well I've been on TWO!) or what dosage of basal insulin my carb/insulin bolus ratio has remained the same. I just recently upped my basal dosage from 14 units to 16 units. Post-prandial readings were always good--it was the fasting/pre-meal numbers that were the problem.

Are you sure it's your bolus dosage that's the issue? I find that if my basal dosage is off, I can't really correctly estimate my bolus. If say you are 232 before lunch and then 215 after lunch, then your bolus dose correctly covered your carbs but didn't correct the beginning high BG level. Now the high BG level could be due to incorrectly bolusing for the prior meal or a basal dose that is too low.

There are two ways to check and I suggest trying both:

1. Take your waking reading, two hours after breakfast, right before lunch, after lunch, right before dinner, after dinner, before bed. This way you can get an idea of whether it's your basal or bolus that's off. If your post meal numbers are within 20-40 points (I'm talking US conversion here) of where your pre-meal number was, then you have bolused correctly (unless you're also correcting a high, and then you'd want to be between 120-180). If your pre-meal numbers are high while your post-meal numbers are good, then you need to adjust your basal dose.

2. Take fasting readings by delaying breakfast or lunch--whichever works. For example, take your waking reading. Don't eat breakfast. Test again in two hours. If you significantly rise, your bolus could use adjusting. Test again in two hours. If you are rising instead of falling, your basal is too low. If you are falling more than 20-30 points (again, US conversion) then your basal is too high.

Just some guidelines/suggestions.

Another thing--you may want to consider splitting your Levemir into two injections 12 hours apart. This will give you better coverage and thus control. I find that highs/spikes breed more highs and spikes. So if you're spiking when your basal wears off, it makes it harder to stay stable.

[seacomp]

Originally Posted by stella117

Take fasting readings by delaying breakfast or lunch--whichever works. For example, take your waking reading. Don't eat breakfast. Test again in two hours. If you significantly rise, your bolus could use adjusting. Test again in two hours. If you are rising instead of falling, your basal is too low. If you are falling more than 20-30 points (again, US conversion) then your basal is too high.

I have to disagree here in regards to skipping breakfast. Because of the "Dawn Phenomina", BG will often rise in the morning even if the all the doses are correct. Therefore you don't want to try to adjust your basal rate by skipping breakfast; you might be measuring something else.
The proceedure outlined is fine but should be used at lunch and/or dinner,

[rea]

hey, thanks for the suggestions. I think I definately need to work on just the bolus.

so far, I haven't changed my basal, I have put it at 11 units, and left it there.
My morning premeal BS has been between 4-5. (sorry, I don't know the US conversions yet). I am really happy with my morning bs's.

so I guess I have to work on my boluses. One of my problems I am having about finding a regular 'schedule' is the fact that I SIT all day at my office. my lunch breaks are for and hour which, I alternate walking or running. on days I walk, I am taking 7 units of insulin with lunch. on days I run, I don't inject at all for lunch, but inject a smaller dose with an afternoon snack. it seems to work, as long as I can get the does right on walking days. (the less active ones).

Dinner has been fine for last week, thats the time when the levemir runs out for me. but now I am having a hard time adjusting for dinner meals. yesterday I was 4.4 pre-dinner, had soup and injected 7 units which I thought might be high for soup (normally I take 8 for dinner meals, successfully)- but ended up at 9.0 an hour and a half later. I know exactly what carbs went into that soup, I made it myself. normally I go low.

then, at about 10:00, I had a low, because of the correction bolus from dinner. (even though I had a tiny snack with my correction - which I find usually helps). rollorcoaster is right!

I am going to talk to my doctor about maybe dividing up my levemir dose to get evening coverage.

I desperately want to get this right, and am so glad at least my mornings are normal.

my a1c is in half a month, so I am desperate to get this right, before my doctor tries to change what I am taking again.

[stella117]

Are you not counting carbs to adjust your bolus? You may have very well gone low after taking 8 units and then your liver rebounded to compensate. The other factor is your basal may have bottomed out also allowing your liver to release glucose.

You should be figuring out your bolus based on what you are eating. Since you sound like you're very sensitive to insulin so I'd start with a 1 unit to 30 grams of carbs ratio. I would also suggest doing pre-meal tests for all meals not just breakfast.

I found when I first started on insulin that my morning good numbers were easy to achieve. Much harder was finding what level of insulin I needed when I was working, working out, running around, being stressed, etc. If there isn't a good solid base of insulin running through your system, you will find yourself spiking all over the place. I am still struggling.

[stella117]

Originally Posted by seacomp

I have to disagree here in regards to skipping breakfast. Because of the "Dawn Phenomina", BG will often rise in the morning even if the all the doses are correct. Therefore you don't want to try to adjust your basal rate by skipping breakfast; you might be measuring something else.
The proceedure outlined is fine but should be used at lunch and/or dinner,

True--if you wake up high. But if you wake up in normal range, then the possibility for DP has passed and any rise should be due to insufficient basal insulin.

But I did the after breakfast test for that reason (although I don't get really high morning readings for the most part)--ate around 9 am and not again until 3:30 pm and everything seemed steady.

[rea]

My doctor has me testing prior to everymeal, and 1.5 hours after it

I am testing:
- when I wake up (which I eat breakfast right away)
-before/after breakfast - before and after snacks
-before/after lunch
-before/after dinner
-before bed

also: before any excersize, and afterwards as well

i have also had a few home science projects where I test every 20 minutes after a meal, to see if how long it takes to peak changes at all.

Can you tell I have 100% medical coverage on my test strips??? (thank goodness)

so far I seem to have gotten the right levels for dinner now, AND breakfast.
I know i am fairly insulin sensitive, which is why I have been so slow in raising my bolus dose to higher mid day. I am a bit 'needle shy' after alot of over dosing experiences.

I do count carbs - a bit. but I find it easier to go by serving sizes, and ingredients. ( I am the family cook)

(like for breakfast, I eat only certain cereals/combinations and go by 'serving size'- one and a half servings of cereal. as long as I eat brands I know, (and go by the box carb content per serving, I know how much insulin to use.

or for dinner, I know that 4 baby potatoes is so much insulin, and the same as 1/2 a medium potato, or 1/2 cup of white rice, or 3/4 cup long grain brown wild rice. I know how much extra to compensate for sauces or fruits in the meal used.

but unless I sat down at the internet, I could not tell you how many carbs is in that half potato, but I do know it needs 6 units of insulin if its without any protein.

its the weird restaurant foods that I can't see cooked that mess me up.
Or, like I said, lunchtime on days I am not active.

But I am finding its easier to cut back on lunchtime carbs than to increase insulin, for some reason.and I don't eat alot of lunchtime carbs!

[seacomp]

Originally Posted by rea

I do count carbs - a bit. but I find it easier to go by serving sizes, and ingredients. ( I am the family cook)

(like for breakfast, I eat only certain cereals/combinations and go by 'serving size'- one and a half servings of cereal. as long as I eat brands I know, (and go by the box carb content per serving, I know how much insulin to use.

It appears to me that you are judging the amount and carb content of the foods you eat and adjusting your insulin dose to that. That's the main point, not how you go about figuring the proper dose but that you are figuring the proper dose.
I consider myself a "carb counter", but for dishes that I have often, I know exactly what amount of insulin works as long as I have the same amount prepared the same way. This may, or may not, be the same as the carb count would indicate, but so what?

[stella117]

Originally Posted by rea

My doctor has me testing prior to everymeal, and 1.5 hours after it

I am testing:
- when I wake up (which I eat breakfast right away)
-before/after breakfast - before and after snacks
-before/after lunch
-before/after dinner
-before bed

also: before any excersize, and afterwards as well

i have also had a few home science projects where I test every 20 minutes after a meal, to see if how long it takes to peak changes at all.

Can you tell I have 100% medical coverage on my test strips??? (thank goodness)

so far I seem to have gotten the right levels for dinner now, AND breakfast.
I know i am fairly insulin sensitive, which is why I have been so slow in raising my bolus dose to higher mid day. I am a bit 'needle shy' after alot of over dosing experiences.

I do count carbs - a bit. but I find it easier to go by serving sizes, and ingredients. ( I am the family cook)

(like for breakfast, I eat only certain cereals/combinations and go by 'serving size'- one and a half servings of cereal. as long as I eat brands I know, (and go by the box carb content per serving, I know how much insulin to use.

or for dinner, I know that 4 baby potatoes is so much insulin, and the same as 1/2 a medium potato, or 1/2 cup of white rice, or 3/4 cup long grain brown wild rice. I know how much extra to compensate for sauces or fruits in the meal used.

but unless I sat down at the internet, I could not tell you how many carbs is in that half potato, but I do know it needs 6 units of insulin if its without any protein.

its the weird restaurant foods that I can't see cooked that mess me up.
Or, like I said, lunchtime on days I am not active.

But I am finding its easier to cut back on lunchtime carbs than to increase insulin, for some reason.and I don't eat alot of lunchtime carbs!

**** I want your health insurance! I'd be testing every hour--my poor fingers!

[rea]

ha ha! sometimes i do test every hour, if readings are weird.

I am very fortunate. very., and grateful.

but I tell you, I work for (I won't say who/what) an extended health care provider.

my last employer often didn't pay their healthcare bills, so I never knew when I would go buy insulin and have coverage or not. there was no way I could continue to work there. so right when I was heading back to work after maternity leave, I saw an employment ad for a healthcare company and thought - its fate! thats for me! I was lucky to be hired and get such great coverage.

[rea]

WAHOO!
my average bs this week - 6.5! down from 7.3 last week!

I know when I go get my a1c next week, it won't be so well. I have taken a while adjusting to the right dose of levemir/humalog - have only been on it since (jan-February?).

but, I know if this keeps up, I should get the best a1c in my life next time around.

[stella117]

Sounds great! Keep up the good work!

[DiabetesRockies]

Hello, I am posting concerned about your physician using Levemir. Just to let you know that product is slightly better than NPH insulin which barely any one uses in this modern area. I would be cautious of anything other than Lantus until more data is provided. Levemir is not a true 24hr insulin and will require more insulin and 2 shots a day. In their clinical studies all the patients were treated twice a day versus once a day lantus. The average patients required 30% more insulin than lantus. I would ask your physician if you are on this insulin for for clinical study purposes, it will be expensive too.
My objective is to protect diabetics from dying like several of my family members have. If you don't treat your diabetes it will treat you to an early burial.
If you have any questions feel free to ask me.

[jenet]

Originally Posted by DiabetesRockies

Hello, I am posting concerned about your physician using Levemir. Just to let you know that product is slightly better than NPH insulin which barely any one uses in this modern area. I would be cautious of anything other than Lantus until more data is provided. Levemir is not a true 24hr insulin and will require more insulin and 2 shots a day.

I do agree that Lantus (and presumably Levemir) is better than NPH. (I will never, ever use NPH again if I have any choice in the matter.)

While I have never used Levemir, I can say definitively that Lantus is not always a 24hr insulin - or at least not for all people. I was on this for quite a while, and never had 24 hour coverage. When I took it at 9 PM, it ran out late afternoon the next day (3-4 PM). I switched to taking it in the AM and had even worse highs the following morning. Based on monitoring when my BG started rising on the one shot a day, I figure I got somewhere between 18-19 hours of effective coverage. I only got 24 hour coverage by splitting it and taking 2 shots a day to cover the gaps.

If you look through the Lantus threads here, you'll find quite a few other people split their Lantus dosage AM and PM to get more complete coverage. If one shot of Lantus is working for you, that's great. But we're all different, which is what makes this soooo much fun.

cheers,
j

[stella117]

Originally Posted by DiabetesRockies

Hello, I am posting concerned about your physician using Levemir. Just to let you know that product is slightly better than NPH insulin which barely any one uses in this modern area. I would be cautious of anything other than Lantus until more data is provided. Levemir is not a true 24hr insulin and will require more insulin and 2 shots a day. In their clinical studies all the patients were treated twice a day versus once a day lantus. The average patients required 30% more insulin than lantus. I would ask your physician if you are on this insulin for for clinical study purposes, it will be expensive too.
My objective is to protect diabetics from dying like several of my family members have. If you don't treat your diabetes it will treat you to an early burial.
If you have any questions feel free to ask me.

Levemir does require twice daily dosing for most people. So does Lantus in many cases. Neither lasts for 24 hours. But Levemir is nothing like NPH. It's profile is much flatter and it has less variability than NPH or Lantus.

My last hbA1c was 6.4 after my BG averages have come down even more--around 109. I was not able to achieve consistent control on Lantus--although increasing my dosage and splitting the dose may have helped. I got too tired of the lack of consistency and volatility. Levemir has a shelf life of up to 42 days while in use. Lantus would lose potency for me sometime after 21 days. And Levemir's flexpen delivery system is far superior to the Opti-Click pen.

Please--before you go shooting down a perfectly viable option to Lantus--which has been problematic for many insulin users--get your facts straight. My numbers are much better on Levemir. I doubt I will have to worry about dying earlier than I would when I was on Lantus.