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The Question
03/16/10 08:43 AM

"On Levemir 1 week.. Started at 10 units, but my blood glucose went UP. False hypo and liver dump of glucose?? What to do? Higher or lower dose?"
Asked By: lynnwig  
Category: Insulin

Background Info Hide
Diagnosed Sept. 2009, low carb diet, exercise. Tried Metformin (2000mg/day) for 4 months (no change in BG), then Janumet (no change) Finally started Levemir. Trigycerides, cholesterol, blood pressure, weight all in the normal range. Blood glucose in the 140-200 range and nothing (fasting, oral meds, insulin) brings it down. Question if I'm really type 2; father and grandmother thin type 2(?) diabetics.

Expert Answers (1)

04/14/10 05:30 PM

You need to provide more information about your blood sugar levels for me to answer your question. If you are taking Levemir at night and your morning blood sugars are increasing, then you either need to take more or less. Check your blood sugar around 3AM and again in the AM before breakfast. It the 3AM blood sugar is under 70 and your AM sugar is high, then you may be experiencing a rebound effect. When sugar falls too low during the night, your liver will direct its stores of glucose into your blood stream causing your sugar to go too high in the AM. So, it is true that hypoglycemia during the night may result in hyperglycemia during the morning. If your 3AM sugar is over 70 and even higher in the AM, you may be experiencing the body's natural tendency to increase blood sugar during the mid-night to early morning. This is called "Dawn Phenomenon" and is caused by hormones that are active when sleeping. The treatment for rebound hypoglycemia is less bedtime insulin and the treatment for Dawn Phenomenon is more bedtime insulin.

As for the diagnosis of type 1 verses type 2, you need to speak to your health care provider. The diagnosis is based on risk factors, clinical symptoms and blood work. Tests can be done to see if your pancreas is still producing insulin or if your body is destroying it's own insulin or pancreatic tissue that produces insulin. Self destruction of pancreatic cells that make insulin, and low or non-existent insulin levels are signs of type 1 diabetes. People with type 2 diabetes have elevated insulin levels in the early stages and may have very low insulin levels in the later stages, as diabetes progressses.

I would also encourage you to find a local diabetes education program, support group, diabetes educator and dietitian. All can help you with individual questions. Always check with your doctor about the need to increase or decrease your insulin dose. Good luck.

Answered By: Donna Yuscavage
Accreditations: RN, BSN, CDE
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