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Permalink Reply by Zoe on February 7, 2013 at 10:02am

Interesting. Don't you go high at the two hour pp when you've only bolused to cover 1/2 your meal? I'd also be concerned that bolusing 1/2 my meal dose before bed even if I wasn't high would make me go low during the night! But then I do have a pump, so I can reduce my blood glucose at night with a higher basal rate if needed. If this works for you, cool!

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Permalink Reply by Jen on February 7, 2013 at 7:52pm

I'm wondering if this is referring to NPH. When I was on NPH (first 13 years of diabetes) I originally took two shots a day, one R + NPH at breakfast and one R + NPH at dinner. Then about 9 years into diabetes I switched to an adult endocrinologist and he suggested moving my NPH shot to bedtime to avoid overnight peaks and valleys. So then I was on three shots a day: R + NPH at breakfast, R at dinner, and NPH at bedtime. (For a while my endocrinologist tried eliminating R at dinnertime if my BG was normal, but that was quickly dropped!)

Of course, to most people on NPH I would definitely recommend moving to a more updated regimen such as MDI or the pump. But some people are happy only taking two or three shots a day. In some ways, diabetes was much more simple back then; but, of course, decent control depended on a ridiculously strict schedule, and even then was near impossible to achieve.

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Permalink Reply by Brian (bsc) on February 8, 2013 at 4:53am

Bernstein actually recommends the use of Levemir and that you split your injections into two shots. One right before bed and the other no earlier than 9 hours before your nightime injection. I believe this is to try to stack the insulin higher overnight to combat darn phenomenon. If this is about injecting R or a rapid insulin right before sleeping, I really would avoid that. I feel safest if I go to sleep with little rapid insulin on board.

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Permalink Reply by Negg on February 11, 2013 at 6:19am

Brian, i think you got that mixed up. The dose before bed should be no more than 8 1/2 hours BEFORE THE MORNING dose.(page 242).

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Permalink Reply by Brian (bsc) on February 11, 2013 at 6:40am

Yes, you are correct. I am the strange one, since I reverse it in order to try to stack up my insulin overnight.

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Permalink Reply by Leo2 on February 11, 2013 at 8:32am

It's not a way to go. You're still dealing with a high over a long period of time.
Eat 4-5 hours before bedtime. Get the effects of short acting insulin out of the way.
Take a minimal amount of your long acting insulin at bedtime. Enough so it tamps down dawn phenomenon but doesn't send you into a low at 6 hours after taking it.
Don't know when you're taking your major long acting insulin, but if it's in the morning, it has a tendency to run out during the night. So split it.

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Permalink Reply by Holger Schmeken on February 12, 2013 at 6:28am

I think some more information would be helpful. Do you use bolus and basal insulin? And which brands do you use?

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