Insulin Adjustments Needed?

[centuryhouse]

Hey Everyone:

You may or may not be aware that I started on insulin a week ago. Everything is going pretty well but I have a few questions. My morning numbers are still a little high, around 8.3 or so. During the rest of the day my numbers are coming within target range or very close. I've finally stopped feeling dizzy and weak when my numbers started to come down into the single digits!

If I want to bring down my morning numbers, how do I do this? My numbers through the night are not dropping much and are staying consistent. It just seems to be that my bg starts to rise in the mornings. I have been having a snack before bed, should I not do this? More basal at night? Would splitting my basal, say 12 hours apart help?

If I'm testing 2 hours after a meal and my reading is above my target range, do I correct this by injecting more bolus? Or do I just adjust my bolus at the next meal? I'm finding that I'm really carb sensitive and it doesn't take much to throw things out.

Please forgive my ignorance. I'm still trying to get a handle on how the different types of insulin work. I don't have an appointment with my doctor for another week.

I apologize if this has been discussed previously but my searching technique is still rusty. Honestly, I don't know what I would do without this forum. I have learned more on here than I would have ever found out from all my other resources combined. You guys are great! I appreciate all of your help.

[BlueSky]

... My morning numbers are still a little high, around 8.3 or so. During the rest of the day my numbers are coming within target range or very close. ... If I want to bring down my morning numbers, how do I do this? My numbers through the night are not dropping much and are staying consistent. It just seems to be that my bg starts to rise in the mornings. I have been having a snack before bed, should I not do this? More basal at night? Would splitting my basal, say 12 hours apart help? ....

The first thing I would try is to stop the evening snack. If that doesn't bring the morning readings down you can try increasing the Levimer in the evening. But be aware that Levimer has a long flat-action. So increasing it could also cause your numbers to drop later in the day. You could also find that you put on weight because you are subconciously "feeding the insulin". Anyway, you just have to experiment and see what happens. I don't think splitting the Levimer dose would help. If increasing the Levimer doesn't do the trick, you could switch your basal to NPH. Because it peaks at 6-10 hours, NPH deals very effectively with the morning blood sugar surge (the Dawn Phenomenon).

[pdxdennisj]

Many docs (including mine) have people on an evening dose of Metformin to help with the overnight numbers.

[DonnyC]

I use the Novolin NPH insulin. It has a peak time of
6-8 hrs. My Am numbers are great. Normally in around
the 4.0 – 5.0 (72-90) area. I inject 8u at 7 am, 14u at 1pm,
and 10u at 10pm. My doc told me to adjust my insulin intake
a I needed. He started me off at a low dose 2x per day.
I found that injecting 3x per worked better for control.
With the 6-8 hr peak time I time it so that the peak times
are normally after the time I would have a meal.
I am rarely over 8.0 (144) after meals. If I do go higher,
Its normally a short time before my number drop below 8.0 (144)
Where before I started using insulin and on meds alone my levels
would be in around the 12 – 13 range (216 – 234).
I definitely don’t feel the lows like used to. My body has adjusted
to the lower ranges. Before insulin I was constantly struggling with high numbers.
Not only did I feel crappy, but I was depressed every time I tested my self.
I was offered the quick acting insulin to take before meals, but
I really don’t need it with the schedule I am on,
and it seems to be working.

[centuryhouse]

Thanks for the help. I guess I'm impatient to see my bg come down and feeling a little frustrated. The instruction that you are given when you are prescribed your insulin is so vague. I'm not sure what to do or how to adjust it or even if I should. How much is too much? I certainly haven't had any low blood sugars but I'm still not on target and I'm sure how to get there. I have been limiting the amount of carbs that I eat as that seems to spike my bg more than anything.

I do have a doctor's appointment this week so I'll have to write down my questions so I don't forget when I get there. I guess I just have more questions than answers right now. I can see the learning curve is huge...mountainous. I'm feeling very unsure of myself and not sure how to correct things. I'm sure once I'm not so ignorant and understand how things work that things will come into focus.

Thanks for listening (reading )!