Comment by Trudy on November 29, 2010 at 11:11am

Have you considered switching to Levemir? You do have to take a split dose with Levemir, but the peaks are really minimal. Once you experiment with and get the right timing for the injections, I'll bet the problem would be solved. As for the pump, you could always revert to MDI for the length of time you are actually on the plane, keeping the pump in your carryon. You still need to have some long lasting insulin on hand at home and on trips, while on the pump, to take care of emergencies--and there always are emergencies.

Comment by Riva Greenberg on November 29, 2010 at 11:26am

Thanks Trudy, I haven't tried Levemir. I don't seem to get peaks with Lantus, it just doesn't cover that overdrive in the very early morning.

Comment by Brian (bsc) on November 29, 2010 at 12:28pm

As I understand it, the liver is responsible for most of the insulin clearance overnight. I have had good luck with darn phenomenon drinking a glass or two of good red wine at night, thus keeping my liver busy overnight (bad red wine also works, but is not as enjoyable).

Another thing is that exercise can cause a significant surge in growth hormone, particularly if you do resistance exercise, so it may be good to avoid exercising at night (this is one of my problems).

Comment by Xanthasun on November 29, 2010 at 1:08pm

The only other thing I could think of was to change the location of where you inject (if you don't already) to a different part of the body since they can have different absorption rates.

Comment by Trudy on November 29, 2010 at 1:57pm

I take my largest injection of my split dose of Levemir (and before that Lantus) at about 9:00 pm, which covers my dawn phenomenon of 2-3:00 am. I suppose if I were having your problem, I'd take it at 11:00 pm and hope for the best, but I have no idea if that would work for you. Just incidentally, Levemir works so much better for me than Lantus did.

Comment by SF Pete on November 29, 2010 at 2:46pm

Are you sure you're not dipping around 3? When I was on Lantus, I would find that I dropped significantly around 3 and then the Smogyi effect would take over and I'd wake up with a BG in the 300s. I would take my Lantus at bed time (about 9:30 or 10:00). It does have a slight peak about 6-8 hours after injection. I went to the pump before I started trying to split the dose. I dread the airport security thing but I am much happier with the pump. Consider the pump. Maybe the TSA will come to their senses in the next few months.

Comment by Riva Greenberg on November 29, 2010 at 6:37pm

Agreed on the wine - 2 glasses will have me wake around 60 mg/dl, but then you skirt being too low. And no it's not the Smogyl effect. I wore a CGM for 5 days and saw my bs continually drops til around 5:30 AM when it's around 55 and then begins to slide up, it's just the "up" between 6:30 and 8 AM is fast!

Comment by Brian (bsc) on November 30, 2010 at 5:23am

I know it seems strange, but you actually might consider metformin. One action of metformin is to reduce the production of glucose by the liver and metformin is metabolized by the liver, keeping it busy (just like wine). It is easier to take a metformin when brushing your teeth for bed (as opposed to the 2 glasses of wine). .

Comment by calbeth on November 30, 2010 at 11:13am

I would be interested in hearing how your new experiment is going. I, too, have the same problem, but my doctor has assured me it is nothing to worry about as I don't go that high, but as you know when, someone tells you not to do something, that's all you can think about. I have split my Levemir into two doses, one in the am and one at bedtime. I found I had to increase the dose slightly because of splitting it.

Comment by Riva Greenberg on November 30, 2010 at 12:46pm

I wonder how high is too high. My endo seems happier if my morning blood sugar is under 130 rather than 60, but I'd be happy if it were around 100.

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