Need to lower BI in the morning, is it a problem?

Hi all,

I'm new to DAFNE and results are very much a work in progress as you will see!

Main thing I want to concentrate on is eliminating the lunch time hypos, which have happened 4/5 days as you'll see, so there is a clear pattern.

My approach so far has generally been to reduce morning BI (Levemir) to try to avoid the hypos and get to a position where I can try a carb free meal at lunch time - that would let me test whether the morning BI is correct or not. Hypos have meant that carb free lunch has not yet been possible as I'll probably go hypo (or have already been hypo) and have to eat, which would confound the results unfortunately. I am now trying a 0.5:1 ratio at lunch time while reducing the BI until I can avoid the hypos.

However, while I am making the changes, I am a little concerned to see how much the morning BI is reduced to now. I foresee that I may get to a point where I am taking hardly any morning BI at all! Is it generally accepted that morning and evening BI doses can be quite different on a Levemir split, or does this go against how the BI is supposed to work?

Think of your ratios in another way. A dose of QA, produces an outcome - 4 or 5 hours later. It's the ratio before your high BGs start that needs sorting.
Try and look at your breakfast QA ratio and change for 1.5:1 to 1:1 and spot the pattern over a few days.
Your individual BI dose changes will take 3 days to show an understandable result as normally we respond very slowly to changed BI doses.
You may well be right in that, on a morning your QA+BI acting together very rapidly change your BG, but fixing that is best done by QA alterations which you can see the result of straight away.
May I suggest that you leave your BI alone for now at your original 10 + 11 and focus on QA ratios at meal times to try and get those right.
Shame that on Saturday 15th 22:15 you had CHO and that affected the following mornings BG...or you would have had a good indication as to whether your daily BI dose was roughly right. Ideally most of us look to go to bed and get up on a result which is within 1 or 2 mmol/L of the previous night result.
Stick with it dunkers7...and please take your time making changes. Too rapid...and if you are anything like me, I'll get confused. Doesn't take much to do that to me however
Regards
Garry

Thanks Garry,

That's helpful, I had thought that QA generally wears off after about 3 hours, and after that the problem was more likely to be BI - suppose I may need to be a bit more open minded about this and consider the outcome as you say.

I can also see that, when I'm having hypos well after lunch on a 0.5:1 ratio and my lunch time BG is in target, reducing the morning BI is perhaps the only option for reasonable control, as today and yesterdays results highlight.

Anyway, it's all good stuff! Like I say it's very much a work in progress and there is more than one problem to fix.

Thanks for your help.

Hi Dunkers7,

One thing to be careful of is that if you reduce your morning BI, you may eliminate your lunchtime hypos, but your afternoon reading may start to spike instead, so do be careful there.

Another option may be to keep the BI the same, but perhaps have lunch half an hour earlier, or at least do a test half an hour to an hour earlier than lunch and take carbs if it is indicated.

Thanks Warwick,

Yes good point about lunch and makes sense on the BI.

The plan was always to do some BI testing at lunch time to establish whether reducing BI is the right thing to do. Today, I didn't hypo so some BI testing actually happened. Looks like that morning BI is just about holding now.

Bigger picture is, that's an overall drop of 11 on my morning BI dose since starting the DAFNE course last month, so that really has been a big change. Getting there!

Thought it was worth an update to say I tried moving my morning QA site to Stomach, where the QA works faster. After that, the pattern changed and I initially started having a few hypos in the morning between 11 and 12am.

It seems part of the problem with the afternoon hypos was the morning QA taking longer to work than anticipated, which made it difficult to see the wood from the trees.

Glad to say today's BGs have been much better so far. A second pair of eyes definitely helped!

I think that in the 4+ years since DAFNE I have had 3 green days. Good progress
Like to know what your bedtime BG was and look forward to congratulating you if it was another green.
Regards
Garry

Nah, it was 9.0!

Relatively BGs are a lot better though, and BI held with a fasting BG of 7.8 this morning. so I'm happy with those results.

Have to say the green BGs through the day struck me as too good to be true, suppose the 9.0 added a realistic edge.

Don't think that, not too good to be true - 9.0 is good. Progress toward sound HbA1c results evident.
Strive on!
Been doing this for 34+ years now...albeit only the last 4 under DAFNE guide lines!
Here are April results so far........
Not too impressive Huh.
Thanks for your reply.
Regards
Garry