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Levemir users - suggestions please

D

DunePlodder

Well-Known Member
Messages
861
Location
N Somerset
Type of diabetes
Type 1
Treatment type
Insulin
After 10 years or more on Lantus I was finding it's effects more & more erratic. My GP agreed I should try Levemir.
I changed about 10 days ago & initially I was quite pleased. Importantly it seemed to have stopped the abrupt dips towards hypos which I've been struggling with - my Dexcom means I avoid an actual hypo, but it's frustrating.

I think I'm close to the right dosage of Levemir in the day time, though I've had to increase my meal time boluses. It's a different story at night. With Lantus I've always tended to creep up at around 04:00 (DP?) which has been difficult to cope with as there was also a tendency to dip around 02:00 .. I've tried different dosages & timings but never completely solved it.

With Levemir the dip early in the night seems to have disappeared, so I've been increasing my evening dosage to cope with the 04:00 high. However it doesn't seem to be having much effect - in fact increasing the dosage last night seemed to increase my bgs! Initially I was dosing at 08:00 & 20:00, & now I'm trying a move to 22:00 for the second one

I'm trying to be logical about this but a lot of broken sleep isn't helping at all. I know I need to wait & repeat the dosage for a couple more nights. It's been less than 2 weeks. It could be a bad injection site, it was the last dose in the pen, perhaps the warm nights aren't helping...

Any experienced Levemir users have any thoughts?
 
Hang in there - I know it's frustrating but you're right, make a small change and wait for the pattern to emerge. There are so many reasons why you could've had the rise today, try not to overthink it (says the world's worst overthinker!)

And remember that your 22:00 dose will still be affecting levels the following day so if you need to keep increasing it you may have to tweak the 08:00 dose again too. But you're more than capable of doing it I'm sure.
 
BeccyB said:
Hang in there - I know it's frustrating but you're right, make a small change and wait for the pattern to emerge. There are so many reasons why you could've had the rise today, try not to overthink it (says the world's worst overthinker!)

And remember that your 22:00 dose will still be affecting levels the following day so if you need to keep increasing it you may have to tweak the 08:00 dose again too. But you're more than capable of doing it I'm sure.
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Thank you BeccyB, you are right of course. Patience, patience..
 
Although I agree with the need for patience, it is not as important as compared with Lantus. Levemir responds much more quickly to a dose adjustment because it doesn't stay in the body as long.

Whenever I change insulins it takes a while for my body to adjust to the insulin (I think it is an immune-response thing). This could be why you went high the same night you increased your dosage - or any other number of one-off factors.

Personally I had a dip at around 2am on Levemir that I couldn't fix, followed by a rise, but if you're not getting it, great!
 
Does your CGM show that you are fairly level for most of the night up until 4am?

I have had some instances where reducing evening levemir actually got rid of higher morning since I was dropping a little and my liver was doing a dump so never actually went hypo while sleeping, though hard to tell since wasn't on CGM.

Another thing you may want to consider is the injection site for the levemir in the evening.
I have found that if I inject in belly or legs then it doesn't seem to give as flat a profile, injecting in my buttocks seems to give me about the best profile overnight.
I do my shots at 6am and around 9-10pm.

/A
 
No AndyS it seems to climb fairly steadily from around 01:00 which is why I'm increasing the evening Levemir. On several nights I've woken around 04:00 at between 12 & 14 mmol/L. On these occasions a bolus correction sorts it out by breakfast time.

Interesting you should mention reducing the evening dose though, my best night so far was on a lower dosage, but only once. Don't understand it. Definitely no hypos.
I've been injecting it in my buttocks as I hadn't injected in that area for some time.
 
I was on Levimer for a number of years and found it was quite good though my doseage would go out occasonally. I was takeing the 2 doses at 6am and at 6pm and it seemed not too bad. It could be that taking your evening dose later at 22.hrs micht make it worse. Insulin needs a while to kick in. I can't remember when it is at it's strongest though but 6pm worked quite well for me. I was on 16units and 6units
 
DunePlodder said:
Interesting you should mention reducing the evening dose though, my best night so far was on a lower dosage, but only once. Don't understand it. Definitely no hypos.
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Read about the Somogyi effect.

Also, remember that "more insulin -> lower sugar" is only a rule of thumb. Insulin is a hormone, and like all hormones it affects a lot of things in the body. Sometimes a bit more insulin can stir something up that increases sugar. Usually increasing insulin even further will drown this out and force sugar to be reduced.
 
Hi Mentat. My Dexcom means I haven't had a proper hypo for quite a long time so I don't think the Somogyi effect is relevant (if I understand correctly).

So last night was an improvement. Same evening Levemir dose and though I had my usual 04:00am peak it was 11, not great, but better than 14. Most of the night was in single figures & I woke with a 6.1 The downside is it was still dropping but easy enough to deal with when I'm awake.

Oh, and no 2 am dip again!
 
DunePlodder said:
Hi Mentat. My Dexcom means I haven't had a proper hypo for quite a long time so I don't think the Somogyi effect is relevant (if I understand correctly).
Click to expand...

Probably not the Somogyi effect then - but I think it's possible to have the effect even without a full-blown hypo.

DunePlodder said:
So last night was an improvement. Same evening Levemir dose and though I had my usual 04:00am peak it was 11, not great, but better than 14. Most of the night was in single figures & I woke with a 6.1 The downside is it was still dropping but easy enough to deal with when I'm awake.
Click to expand...

That's not bad! If you can't get rid of the peak, consider adding a short or medium-acting insulin at bedtime, something that won't peak until about 4am and will then drop off again. See
http://www.diabetes.co.uk/insulin-in-the-uk.html and http://www.diabetes.co.uk/insulin/insulin-actions-and-durations.html
 
Having been on lantus and now levemir, I found the easiest way to make sure my blood sugar stays level overnight is making sure it is level for around 2 hours before I go to sleep. I give my levemir at 10pm and 10am and by the time I go to bed (around 11pm) I haven't eaten anything for two hours and try and make sure my bg is roughly the same as it was at 9pm. This made it a lot easier to adjust to early morning highs as for me all it needed was 2 units more of levemir and eating breakfast at 7am rather than 8am.
 
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