Long acting insulin query

[AmyW]

Hello!
My long acting insulin changed from Abagaslar to Levemir in November 2023. Since then my overall control has reduced significantly, I was taking 40 units previously and reduced this to 32 (splitting dose) now I’m taking 60, again splitting and it’s still not enough - I’m cruising around 12/13 every day and I’m waking up really really high. Is this normal? An adjustment period? I’ve convinced myself I’m dying, I don’t have enough prescribed each month to maintain this dose and I get really upset with needing more. I’ve emailed the diabetic service to ask if I can change back to my old one!

 

[EllieM]

Hi @AmyW insulin needs vary from person to person and your GP should give you enough insulin to cover your current needs, whatever they are. Impossible to say what is normal as everyone's needs are so different.

I find that my insulin needs increase when I'm over 10 so it's possible that part of your your problem is that you haven't found the right dose yet?

Are you using a libre or dexcom? What's your fast acting insulin? Has your usage of this also increased and are you using correction doses to get you back to a lower level? (Sorry for the multiple queries)

It seems very unlikely you are dying though running high can make you feel like it.

Your previous posts suggest you were diagnosed in 2022 so it's also possible your insulin needs have gone up due to the ending of a honeymoon. (Other reasons for increased insulin needs include illness, whether, changed weight and/or exercise and multiple other factors.)

Hopefully you can get some clarification from your team soon but please don't despair.
And finally, have you done any basal rate testing to check your needed levemir dose(s).?

 

[CheeseSeaker]

Hi @AmyW,

Couple of things that occur to me might be worth a go - possibly you have developed absorption resistance if you inject in the same site every day - try moving it to somewhere you don't normally inject (stomach, arms etc) and see if that helps - you should know after one injection as things will alter - just watch for lows.

Other thing is the insulin types are different - some of us don't respond well to different types: Abagaslar is a Biosimilar Glargine (Lantus and a few others are the same stuff), but Levemir is a brand name of the Detemir group of insulins - possible your body simply doesn't do well with it.

If the site change doesn't work - I'd ask for a single bottle of your old Abaglaslar from your GP and see if you return-to-normal, if that then returns you to range - go back with your results (BGs before and after, with the quantities used). If you can evidence it, can't see why a GP wouldn't switch you back - even if its to another Glargine type (they usually switch insulins on us based on either cost, or its being discontinued - not sure which is true in your case)

 

[AmyW]

Hi @AmyW insulin needs vary from person to person and your GP should give you enough insulin to cover your current needs, whatever they are. Impossible to say what is normal as everyone's needs are so different.

I find that my insulin needs increase when I'm over 10 so it's possible that part of your your problem is that you haven't found the right dose yet?

Are you using a libre or dexcom? What's your fast acting insulin? Has your usage of this also increased and are you using correction doses to get you back to a lower level? (Sorry for the multiple queries)

It seems very unlikely you are dying though running high can make you feel like it.

Your previous posts suggest you were diagnosed in 2022 so it's also possible your insulin needs have gone up due to the ending of a honeymoon. (Other reasons for increased insulin needs include illness, whether, changed weight and/or exercise and multiple other factors.)

Hopefully you can get some clarification from your team soon but please don't despair.
And finally, have you done any basal rate testing to check your needed levemir dose(s).?

 

[AmyW]

Hi @AmyW insulin needs vary from person to person and your GP should give you enough insulin to cover your current needs, whatever they are. Impossible to say what is normal as everyone's needs are so different.

I find that my insulin needs increase when I'm over 10 so it's possible that part of your your problem is that you haven't found the right dose yet?

Are you using a libre or dexcom? What's your fast acting insulin? Has your usage of this also increased and are you using correction doses to get you back to a lower level? (Sorry for the multiple queries)

It seems very unlikely you are dying though running high can make you feel like it.

Your previous posts suggest you were diagnosed in 2022 so it's also possible your insulin needs have gone up due to the ending of a honeymoon. (Other reasons for increased insulin needs include illness, whether, changed weight and/or exercise and multiple other factors.)

Hopefully you can get some clarification from your team soon but please don't despair.
And finally, have you done any basal rate testing to check your needed levemir dose(s).?

Thank you
I’m using Libre, my hba1c prediction has crept up but it’s never been accurate yet! My GP won’t offer more because it was prescribed by the diabetic team (I’ve just done the DAFNE course so I’ve got a point of contact for 12 months. I’m just always fretting! My basal isn’t enough with the levemir but until I can collect some more insulin I won’t be able to increase any
More! Just a current diabetic frustration

 

[AmyW]

Hi @AmyW,

Couple of things that occur to me might be worth a go - possibly you have developed absorption resistance if you inject in the same site every day - try moving it to somewhere you don't normally inject (stomach, arms etc) and see if that helps - you should know after one injection as things will alter - just watch for lows.

Other thing is the insulin types are different - some of us don't respond well to different types: Abagaslar is a Biosimilar Glargine (Lantus and a few others are the same stuff), but Levemir is a brand name of the Detemir group of insulins - possible your body simply doesn't do well with it.

If the site change doesn't work - I'd ask for a single bottle of your old Abaglaslar from your GP and see if you return-to-normal, if that then returns you to range - go back with your results (BGs before and after, with the quantities used). If you can evidence it, can't see why a GP wouldn't switch you back - even if its to another Glargine type (they usually switch insulins on us based on either cost, or its being discontinued - not sure which is true in your case)

Thank you
I’d changed as I’ve just done the DAFNE course and me and the nurse thought we’d see how I went on with a different basel, so I’ve tried and it’s not for me but at least I know this now! I appreciate your input, I think my rotations are okay but sometimes I think a gentle reminder is helpful for me! X

 

[EllieM]

My basal isn’t enough with the levemir but until I can collect some more insulin I won’t be able to increase any
More! Just a current diabetic frustration

If I'd actually run out I'd be tempted to go to A&E and ask for more. T1s need their insulin. But note that I haven't lived in the UK for nearly 25 years so my opinion is probably not that relevant.

 

[eventhorizon]

When I was using MDI Levemir was my basel insulin. I was taking it twice a day in ever increasing amounts of the years. At the suggestion of my diabetes nurse I switched to once a day Tresiba. I found I was using less basel and getting better control.