Levemir not reducing BMs enough: would it help to change HOUR I take it to morning (from evening)?

[NoSugarBabe]

I have diabetes 2. I have just seen the diab specialist again. At my previous specialist appointment the dr had started me on insulin (Levemir), as the Metformin, Victoza, & Glimepiride that I had been taking till then weren't reducing my BMs sufficiently.

So I currently take: Levemir [1 injection p/d: 30 units] + Victoza [1 injection p/d: 1.2 units] + Metformin [3 tablets p/d: 800mg each tablet] + Glimepiride [1 tablet p/d: 3mg]. (Plus 1 x 80mg Simvastatin p/d, for high cholesterol.)

I have just seen the diab specialist again, who said this even this new mixture of insulin + meds weren't doing the job of reducing my BMs enough. The specialist said my pre-brek reading wasn't too good, but that my post-lunch & post-supper BMs were way too high i.e. spiking . My own diary (BM data record!) agree with this point of view.

The specialist therefore said he wants to change the type of insulin I am on (Levemir) to another type of insulin (a non-basal type called Humulin M3). Which is where the problem comes in . . .

I have been taking Levemir in the evening (bedtime), as I find that time (i) easier to fit in with my lifestyle/work routine i.e. less invasive to my schedule & (ii) easier to remember to take the injection! (I take the Victoza at the same time for the same reasons.)

The specialist has therefore suggested my starting on a different insulin; this would have to be taken twice per day. This means I would have had to increase from taking just one insulin injection p/d to two. However, that I could have handled. But unfortunately it will also have to be taken at mealtimes, which restricts my diary somewhat. Not only that, but it has to be taken not just with a meal but I would have to remember to take it just before (30 mins before) a meal. That would really mess up my diary & routine. I do NOT want this diabetes running my life any more than it does already! so I'd prefer to stick with the Levemir if at all possible rather than have to mess around with injections both pre-brek & pre-supper.

I then remembered - when I had already left the specialist appointment (isn't that ALWAYS the way! LOL! ) so I couldn't ask the specialist re this - that someone had said that Levemir works more effectively for the first 12-18 hours (of a 24-hour dosage), then wears off. (This is due to Levemir being a background/basal insulin.) Surely, then, taking Levemir at 10pm defeats the purpose of this insulin, as I eat during the day, i.e. I eat from 10 hours away from the 10pm injection time, not during the night just after the injection time!

BTW, I can't remember if the specialist is aware - i.e. if he had fully absorbed my medical record/notes - that I currently take Levemir in the evening rather than in the morning.

Is this true re Levemir working more effectively for the first 12-18 hours?? If so, then I might try changing to taking Levemir first thing in the morning. And see how that works on my day's BM readings.

Anything to avoid - without taking foolish risks of course! - having to start taking umpteen injections & at specific mealtimes every day for the next gazillion years!

Has anyone had any experience in this matter i.e. if changing the time of taking Levemir changes the level of long-term blood sugars or a specific BM reading?

 

[Daibell]

HI. The fact that you are on Victoza and high insulin shots indicates you are overweight and have the wrong diet? Have I guessed right? You probably need to seriously reduce the carbs in your diet to around 150gm/day to start with. The aim must be to get to the point where you can reduce the meds but with sensible blood sugar. You are right that Levemir only works for 12-24 hours. Many users split it into morning and evening injections to make it last 24 hours. I take mine in the evening but take rapid insulin during the day at meals which covers the decline during the day. Moving over to a mixed insulin (Humalin) enables you to keep the injections down and in some ways could be better than just the Levemir. Those with T1 would normally have something like 4 injections a day using both a 24 hour such as Levemir and a rapid insulin for meals. Your highest priority is to reduce the carbs in your diet and hopefully it will become clearer what meds you need to remain on

 

[ConradJ]

I agree with Daibell - although, perhaps not to the full extent of the carb-reduction... it certainly sounds like you need to reduce your carbs, but you should start off slowly because going 'cold-turkey' with carbs can be as unproductive as going cold-turkey on cigarettes, alcohol, or hard drugs.

You could also look to 'split-dose' your Levemir, taking one shot at say 6pm and the other at 6am - BUT you MUST talk to the specialist before trying this out!!!

The thing is this: if you don't start making the changes now, you will find your diabetes running and then ruining your life! When you get the condition, you need to make changes to your diary and routine in order that you can get to the bottom of the issues for your poor BM results... and the reason for your original diagnosis as well.

Once you've established the parameters, you can then reintroduce things on a piece-by-piece basis to establish what was the primary issue.

It's not easy - I know from my own experience, but the facts eventually stare you in the face (until the retinal bleeding completely obsures your vision).

 

[Jung the foreman]

After steadily increasing my Levemir to 2x100 units per day after a 3 years or so I was taken off it and now inject 36 units per day of Lantus along with other stuff. So Levemir was not for me .Lantus I feel has helped, but basically my control is still poor and after 8 years my DB care team are still scratching their heads.

 

[NoSugarBabe]

Thanks all for the advice & info.

BTW, what should my post-meal BM reading IDEALLY be, as all the diab specialist was that "it is too high", without telling me by how much! LOL!

i.e. what mmol reading should I be aiming to see in the BM unit (I use an AccuChek unit) after a brek, a lunch, or an evening meal?

I am not due to see the diab specialist again for at least 2months. I could phone the number for the local clinic's diab helpline, which is answered by nurses, but they are NOT doctors. So I can't ask the dr what my target mmol post-meals should be.

 

[NoSugarBabe]

Hi all

Well, after trying a split dosage of Levemir for a few weeks, I saw no change to my BMs at all; so I have had :-( :-( :-( to change to the Humulin M3 that the specialist suggested (see footnote to my signature, below, detailing my "meds"). I am very sad to do so but needs must, & yes - ConradJ - I don't fancy any retinal bleeding!! ,-)

However, as I thought it would be, this new type of non-basal-only insulin is a real pain as I have to take it "30 mins before a meal", which I am finding very difficult to fit into my daily routine.

So I was wondering: re that "30 mins", what is the margin for error? I ask as sometimes I take the Humulin M3 & then forget to eat (the meal it is supposed to 'cover') for a few hours; I find remembering this deadline is particularly difficult if out for a meal e.g. the other day, when we were out on a picnic & looking for a site at which to eat! Also, occasionally I have started eating & only then remember to take the insulin. Obviously, over time I hope taking the insulin will become more routine & I'll remember to take it on time, but while I am on that learning curve what is the room for error/manoeuvre with this Humulin M3? I find it unlikely that people will start to eat 'exactly' half an hour after an injection, so surely there must be a bit more time the injection covers??

 

[lianne852]

Hi I am only on humalog mix 50 a and I can take that 15 mins before or afterwards