Question about Background Insulin

Hi,
looking for some help regarding BI, please.
I inject Levermir twice daily, first injection when I wake in the morning at 5am. My question is, if i wake up at 5am, when should I
inject my night BI time dose?

High doses of Levemir last for around 24 hours. Lower doses last up to about 19 hours. This is the reason that it is advisable to dose twice daily just to ensure that there is always some present in your body.

Levemir has a pretty flat profile, so you could probably second-dose at any time between 3 pm and 7 pm that is convenient for you, but probably best to try and inject around the same time each day to avoid hypos (up to a 90-minute variation probably won't matter too much).

Hi Warwixck
Thanks for your reply. As you can see by my diary I am on low dosage of BI and still having low sugars during the night.

You seem to be experiencing two issues here - lows during the day and overnight lows and I think they have different causes.

With regards to the overnight lows, they all seem to be within the 4-hour action period of your QA. You appear to be super-sensitive to insulin (Sat 05.30 = 18.9, Sat 07:45 = 4.4 after only 3 units of QA is quite extraordinary).

For the night time, I think that the amount of QA that you are having for the CPs probably needs reducing. So for example, Friday 23:00 4 CPs with 4 QA, perhaps try 3 QA or even 2 QA for this in future.

Daytime hypos, especially the Friday and Saturday ones around lunchtime aren't within a 4 hour period of QA, so that would seem to indicate that you BI might be too high in the mornings. You could try reducing that from 4 units to 3, and see after a few days whether that is stopping the low BGs around lunchtime.

DAFNE relies on getting BI correct, and then making any necessary changes to QA after that, but to work out whether we are getting the BI right, we really need to have periods of around 8 hours without any eating or QA injections.

Obviously, treat any hypos that occur, but if it is possible to have an 8 hour period of fasting after an evening meal, then you will be able to see if the BI is sufficient or too much.

To summarise:

1) If eating before going to bed, reduce the amount of QA that you have with the CPs. So if having 4 CPs, try 2 or 3 QA rather than 4.
2) Try reducing your morning BI from 4 to 3, and see if that stops the lows around lunchtime.
3) Try and have an 8 hour period without food overnight. Four hours after your last meal, test BGs, and then 4 hours later, test again. If you BI is correct, then the BGs for these two readings should be within about 1.5 mmol/L of each other. You can also run this test during the day if you want to check whether your daytime BI is correct. Have breakfast and dinner, but skip any snacks and lunch.

Hope that is helpful

Hi Warwick,

Thank you again. As you can see my BS is all over the place. If I lower BI in the morning, my sugars are high, have 3cp snack at bedtime with no insuln, I go low.

Looking at this, I'm thinking that Wednesday through Sunday were actually very well-controlled. Apart from the hypo on Saturday morning, you were largely within the range that you want to be in. Well done.

What readings in particular are worrying you? I'd actually be very happy if my control was as good as this.

Hi,
Thanks for your reply.
I am sick of the low sugars at 2am. I don't know how much BI too take. I only am taking 10 total units, 5 in the morning and 5 at night. still go low, and I know 5 in the morning is not enough. Today I had a funeral at 11am, so I took a 2cp snack to ensure I never went low , and at 2:30pm my sugar was at 16.7.
Would I be best taking only one injection in the morning, instead of splitting the dose?
Tonight I will take 3 units of BI and tomorrow inject 10 units in the morning and none at night

I'd suggest still taking a little bit of BI at night. The reason is that while Levemir can last up to 24 hours, it doesn't necessarily do that, and if you are only taking it once per day, then there may be a period where you have no insulin on board at all which can lead to DKA.

Even if it is only 1 unit at night, then at least you will still have some present in your body. You can reduce the amount injected in the morning accordingly, so if you still plan on taking 10 units per day, then try 9 in the morning and 1 at night. If you still get overnight hypos, then try 8 in the morning and 1 at night.

Hope it works out for you