[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]

Originally Posted by 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'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]

Originally Posted by Gangrel

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]

Originally Posted by belyro

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.

Originally Posted by Gangrel

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.