Erratic BG

Hi all,

I completed the DAFNE course in December, and, after a LONG time of having high BG's, was amazed to finally have BG's in the normal range. There were the few lows which i expected, and indeed which the HCP said would be a normal reaction to the changes in regime.

However, just after finishing the course, i had a severe hypo, which led to my partner administering the glucogon injection, and for the next few weeks, a super tight monitoring regime (usually 10+ tests per day)
Even after decreasing my BI at morning and night, and doing 1:1 for all meals of QA, i found i still dropped in the night-time, but then after treating, would wake up with super highs.
Wanting to sort this, i dropped my evening meal to 1/2:1 which resulted in a higher BG at night, (usually 9 or 10) but still waking on a high (usually 15+) to remedy this, i increased the night-time BI by 1 unit first, then another unit, which seemed to hold it better, but then i had another severe hypo, this time with a seizure, which resulted in hospitalisation.

Needless to say, after this, i was scared to go to bed on anything below 9 or 10, as this is what it crashed from before, but this almost always resulted in the super highs each morning, which wouldn't respond to corrective all day, and then plummeted in the evenings. I saw my HCP who fitted a libre FGM and altered my insulin to the below.

Morning BI (Levemir) 16u
Breakfast QA (Humalog) 1 1/2:1
Lunch QA (Humalog) 1:1
Dinner QA (Humalog) 1:1
Bed BI (Levemir) 9u

I'm now finding that the morning BG is usually high but tends to reach normal levels around lunch time, rises up again by mid afternoon/evening, but then drops low by late evening, which if treated as a hypo, takes a while to raise (even with lucozade it takes 15-20 minutes to raise by 0.2 -0.5)

I'm also on other medication for various things, not too sure if these could affect BG (apart from Metformin obviously)

Metformin 500mg 1x daily
Epilim 500mg 1x daily
Levothyroxine 300mcg

Does anyone have any ideas / tips on what i can try to get these BG's within the target range all the time?

Thank you all,

Hi Steve,
Sorry to hear yluhave had so much trouble. I am very sympathetic to the problems you have experienced. I wonder what time you take your metformin. As you know, one's insulin resistance tends to rise for a while in the early morning, say 3 a.m. and metformin can help to improve one's fasting sugar if taken in the evening. I wonder if you would tolerate 2x 500mg in the evening. The advantages of adjusting this is that it does not tend to cause hypoglycaemia. It reduces the release of glucose from the liver at night. Of course, you would need to check with your medical advisers before making any such changes.
I note you are on a rather high dose of levothyroxine which acn affect one's blood sugar levels. The usual maximal dose is 200mcg daily. I know Epilim induces liver enzymes which may increase the rate of destruction of certain medications but I was not aware that levothyroxine requires a high dose on Epilim.
A few years ago I found it almost impossible to get basal levels right even adjusting by 1/2 unit levemir at night going from one extreme to another, but I've been much better on an insulin pump. Hopefully you will manage to get the adjustments right with patience.
Every good wish,
S.

Sorry to hear you've had problems with hypo's.

I wonder if that morning BI is actually too much, since you say you find your BG dropping low by late evening? As you know Levemir works at it's peak during the first 12 hours, but it's duration is longer, around 18 hours I think (from memory, don't quote me on it).

The only way to really know this is to test the BI, after lunch time looks to be the best time in your case, and means QA insulin won't be causing too much noise to see what the BI is doing. This may of course lead to higher BG initially and the need to change QA ratio as a result, but long term if it's going to be safer for you and make it easier to correct high BGs, I think it's worth digging into.

I think you're doing the right thing to play it safe with the overnight one for now. It can take a while to get it right as changes generally need to be made gradually.

Any questions, fire away.