Three-way split Levemir?

[jaimet]

I think after all this pushback I would be inclined to simply stop telling them I use it 3 times a day. Not the way it should be, and a missed opportunity for them to learn something, but also not worth your energy.

That would a) let them off the hook ("How can we help him if he's lying/not telling us the whole truth?"), and b) put me in the wrong ("He's lying/not telling us the whole truth.")

Instead, I now have a secret weapon: Plank et al, 2005 !! (I'm laughing out loud, but I'm actually being serious.) "Sure, dear Endo, I'm happy to take levemir only twice a day, as you wish. Just let me know what I'm supposed to do for basal coverage for the other 12.8 hours each day."

The most difficult part of this for me is that I have spent years believing that I should be able to make 2 injections last 24 hours (because that's what I've been told / that's what the official documentation says.) I have repeatedly watched my blood glucose creep up to 20 mmol/L, fully aware that I'm now poisoning myself, yet helpless because I've been repeatedly told that my levemir "is working" (cf. Martin Seligman's "Learned Helplessness").

Discovering "Plank et al." feels like a weight off my shoulders.

 

[Antje77]

Instead, I now have a secret weapon: Plank et al, 2005 !! (I'm laughing out loud, but I'm actually being serious.)

Ah, sounds like you're ready to fight!
In that case, go right ahead and tell us how it went!

 

[jaimet]

Ah, sounds like you're ready to fight!
In that case, go right ahead and tell us how it went!

I am, and I will.

 

[EllieM]

Just caught up with your thread (I'm in a different time zone) and am bewildered by the attitude of your endocrinologists. I'm in New Zealand where the only basal supplied is lantus, which I don't much like (would have loved to try levemir) but when I took to splitting it to make it a bit more reliable my endocrinologist didn't blink, though the official line is that it doesn't need to be split. But my appointments tend to consist of me telling them what I am now doing dosing wise, and then they make suggestions.

Have you tried asking for a pump given that their official dosing regime is not working for you? (Am guessing that they won't give you one because your hba1c is too low???)

 

[jaimet]

Have you tried asking for a pump given that their official dosing regime is not working for you? (Am guessing that they won't give you one because your hba1c is too low???)

I was offered a pump years ago (2013-ish?), but I declined the offer as I didn't think I could (psychologically) accept the semi-permanent line / tube. In the last couple of days, however, I have read (online) that the NHS (England) *might* be able to offer me a tubeless pump - this is something that I would definitely consider. I am due to attend a T1D "event" at my hospital next week - a "tubeless pump" is one of the things (!) on my list of questions. (Yes, ironically my low hba1c might be an issue - facepalm!)

 

[EllieM]

I was offered a pump years ago (2013-ish?), but I declined the offer as I didn't think I could (psychologically) accept the semi-permanent line / tube. In the last couple of days, however, I have read (online) that the NHS (England) *might* be able to offer me a tubeless pump - this is something that I would definitely consider. I am due to attend a T1D "event" at my hospital next week - a "tubeless pump" is one of the things (!) on my list of questions. (Yes, ironically my low hba1c might be an issue - facepalm!)

Well, if it's any help (it probably isn't) during my last trip to the endo (after a 2 or 3 gap) and I had my usual whinge about lantus, they offered me a pump on the basis of issues of hypos.... But I stress this is in New Zealand, where they still don't fund cgms for T1s (I self fund a G7) and no tubeless pumps are available.

Good luck with your appointment.

 

[Daibell]

As the original poster perhaps I can add some extra thoughts. Apart from using my Basal to balance my liver's glucose output I also it to smooth my bolus use. My db is poorly controlled if I follow traditional guidelines. Only a small amount of carbs will cause my BS to rise rapidly. To avoid constant correction doses I find using the Basal to smooth things a bit reduces my overall number of injections. My Basal input is roughly 12 units morning and evening with an occasional 3rd injection. My current endo was appalled but just didn't get the point that some of us are very sensitive to carb input and they have no other solution than to re-iterate the usual mantra of doing Basal tests which are a waste on time for myself. I wish more endos would listen and realise that the standard db mantra doesn't always work. BTW I'm slim with effectively no insulin resistance

 

[jrussell88]

An alternative solution would be a pump - is that a possibility? The pump allows fine-tuning of the basal pattern using rapid acting insulin.

I was on twice daily doses of lantus but was still getting intermittent overnight lows and highs. The lows were the critical argument for the PCT to fund the pump. The diabetic team at my hospital were very supportive when I asked about pumps.

Might be worth exploring.

Ps Just read your post on basals.

It's important - for safety - to calibrate your basal to achieve a flat or slightly rising profile overnight. I'm also sensitive to insulin - similar build to yourself - and the switch from Humalog to an ultra-rapid short-acting insulin Fiasp helped deal with post-prandial spikes. There are alternatives.

Secondly, bolusing earlier, before meals. However that can be risky if the meal is delayed, or slowly absorbed.

Thirdly, starting with low-carb buffer foods, and mixing the carbs in after a bit.

I still sometimes get big peaks after a meal though and it's work in progress.

 

[gardener612]

I found Levemir to be fairly useless, a fact that was truly illuminated when I switched to Tresiba. Since then, my numbers have been consistently under 7. If I were you, I'd get a different basal insulin.

 

[jrussell88]

A couple more thoughts, which might be worth discussing with your endocrinologist.

Consider taking your night time basal dose earlier, which reduces the risk of double-dosing overnight when your insulin requirements are probably lower.

Not everybody responds the same to different insulins. A different long-acting insulin may give you better results.

Fwiw, my BG normally tends to rise during the evening when I'm less active (and eating more).

I found that Lantus barely lasted 24 hours for me, although there was a marginal effect over 24 hours, and it was running out of steam after 12.