[Eddy]

Whatever the cause, my basal needs have been higher lately. I've been fiddling with both dose and timing.

To tide me over in the evenings until my 2200 Levemir, I've been doing 2U-3U of NPH around 1800.

A couple evenings ago, after an unusually "normal" (in both timing and quantity) day of eating, I decided to skip the evening NPH. I'd recently had a few late-evening hypos, and I wanted to see how the Levemir would do on its own.

I:BG = 1U:35mg/dL
aspart = 1hr 15min duration
human = 2hr 0min duration
NPH = 5hr 30min duration

BG @ 2013 : 67 (corrected towards 90-ish)

So far... so good... (At this point, Megadeth fans probably would say "So what!" )

A bit more than an hour later, I felt like my insulin levels had dropped below basal requirements; it's hard to describe, but I feel a certain lethargic and "bleah" way. I tested and corrected thusly:

BG @ 2126 : 124 (did 1U aspart + 1U human)

I thought the 1U aspart would correct nicely, and the 1U human would hold me until Levemir ramped up. Was I ever wrong! A bit later, I felt rather rotten, and decided to check.

BG @ 2302 : 196 (time for 3U of aspart!)

Ughh.

BG @ 0106 : 67 (corrected towards 90-ish and went to sleep)
BG @ 0756 : 78

Although this is but one [statistically-invalid] experience, my take-home conclusion was this: A latent dose of faster-acting 2U does not make up for an earlier 2U of missed intermediate. Once I drop below basal requirements for "too long", I really start cranking out the glucose.

[morrisma]

Interesting results. BG must have been rising fairly sharply at 2126 for the 2302 reading to be that high in spite of corrections.

[Subby]

Originally Posted by Eddy

BG @ 2013 : 67 (corrected towards 90-ish)

So far... so good... (At this point, Megadeth fans probably would say "So what!" )

A bit more than an hour later, I felt like my insulin levels had dropped below basal requirements; it's hard to describe, but I feel a certain lethargic and "bleah" way. I tested and corrected thusly:

BG @ 2126 : 124 (did 1U aspart + 1U human)

I thought the 1U aspart would correct nicely, and the 1U human would hold me until Levemir ramped up. Was I ever wrong! A bit later, I felt rather rotten, and decided to check.

BG @ 2302 : 196 (time for 3U of aspart!)

Ughh.

BG @ 0106 : 67 (corrected towards 90-ish and went to sleep)
BG @ 0756 : 78

Although this is but one [statistically-invalid] experience, my take-home conclusion was this: A latent dose of faster-acting 2U does not make up for an earlier 2U of missed intermediate. Once I drop below basal requirements for "too long", I really start cranking out the glucose.

You start with a BG of 67... low enough to trigger a liver release, which would certainly account for the increased, atypical needs in the next few hours. Even if you are commonly around those numbers it is very possible your BG meter was a little off and you were lower.

Lethargic and bleah are perfect words to describe what a liver release feels like for me. With your return towards normality a few hours later, It all sounds like you got off pretty unscathed.

I would say when you get the hypos/dips under control, you'll see a likewise decrease in these glucose hikes as well. What I'm saying is all pretty much obvious, more an observation that it can be like a train out of kilter: get the first carriage moving straight and the next will tend to follow suit.

[Eddy]

Originally Posted by Subby

You start with a BG of 67... low enough to trigger a liver release

Doubtful. I've hit the 40s many a time with nary a liver dump.

[Eddy]

Ack. I missed the "edit" window.

I'm not prone to low-BG liver dumps. My intended point was that the spike seems to have been caused by insufficient basal insulin, and that the observed response seemed even greater than I'd have expected; the greater-than-expected part would seem to signify a liver dump -- but I believe it was caused by excess glucagon and/or friends, which in turn was due to a sagging basal.

Oh, well. I've resumed the evening interim NPH. Last night: 83 shortly before bed, 5 g CHO (about 12 mg/dL) "to be safe", 88 upon awakening, 101 @ 2 hr PP, and 98 before a snack 1.5 hr ago. It's good to be back.

132 now, though. Must fix that.