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Splitting levemir injections

Padders91

Padders91

Well-Known Member
Messages
48
Location
Manchester
Type of diabetes
Type 1
Treatment type
Insulin
I have recently changed from taking levemir from once a day to twice, the first few days seemed to be alright with sugars between 4 and 7 but now I have finding I am having a lot more hypos, seems to be at the same time as well, I am currently taking 7 units at night and 5 in the morning, I take the night time one between 9-10 and the morning one at 5:30 in the morning getting up for work, and 8:30 during the weekends, my first thought was is it because the injections are two close together, as anyone had teething problems with 2 injections ?
 
In my view your amounts are the wrong way around.

Levemir acts longer and peaks higher the more you take. Given you eat during the day and don't at night, I'd expect you to take 7 in the morning and 5 at night.

Also, given the effective profile, id expect that you would need a separation closer to 12 hours.

Effectively you should look at it as two twelve hour basals and determine what the correct amount is per twelve hour period.

It's worth doing basal testing to confirm what you are doing is working properly.

fWIW, I split levemir on a 12 hour basis with 14u during the day and 8u overnight.
 
I don't entirely agree with Tim. :-)
There's no problem using a split other than 12 hours, if it works for you. And you should not be matching your basal to when you eat. That's what bolus insulin is for.
 
No one can really make a specific suggestion unless we know what time the hypos are happening.

In general I would suspect you previously had a high (blood sugar) period, possibly undetected, possibly at night. That's probably now slightly over corrected so you will need to reduce one or both of your doses slightly. And maybe tweak the timing. But the timing you are using can be useful to counter dawn phenomenon.
 
I'm leaning more towards Tim's observations on this. You take tiny Levemir doses and Levemir doesn't last very long on low doses so I'd expect you to be drifting high mid afternoon into the evening - so I'm surprised you're hypo'ing. I think for this reason Levemir does work better 12 hours apart and I would expect to see the higher dose in the morning. As Tim alluded to, Levemir isn't a flat profile - it has quite a distinctive peak action.

I've swapped off Levemir because I couldn't get it to work effectively for me. It peaked inconsistently and ran out before the end of its 12 hour coverage. I tended to get mid morning hypos and late afternoon highs with it, so don't pay too much attention to my timings and doses, but the most effective I ever made it work was a 12 hour split at 6.30am and pm, with 8 units in the morning and 7at night - although I varied the units a little over time. I would certainly warn against changing the timings of your doses at the weekend - that never worked well for me - so I ended up getting up at 6.30am of a weekend to jab!

Smidge
 
I really don't see how anyone can have much of a reasoned view about the possible causes and possible remedies unless we know what time the hypos are occurring, and what time the previous single injection levemir dose was? Even if we assume that everything else has stayed the same.
 
The reason I changed was because I was going hypo every night, I tried reduced ng the dose with little effect, all That was happening was waking up with dawn phenomenon, the problem is Tim that I am finding I am going hypo between 9 and 11 in the morning, the first thought was is it because I am having novorapid and lev emir at the sine time without their being a 12 hour gap, it is trail and error for me at the mo because I have never done a split dose before, also it seems to be about 4-5 hours after the lev emir injection, I have always been the same in that respect smidge with regards to taking the injections at the same time, don't fancy getting up at 5:30 to jab and eat maybe that isn't helping matters, will have to try and report back, I should mention that I do try and go for a walk everyday. Sorry for long essay
 
@Padders91, there's a new basal insulin that just came on the market last year called Tresiba which is said to reduce the incidences of night-time hypo's and it lasts up to 42 hours after injecting (although you still inject it once a day), Smidge above now uses this insulin and @robert72 has been using Tresiba since late last year, if you struggle to get the split-dose right with levemir it might be worth enquiring about Tresiba.
 
@Padders91 your Hypo timing is consistent with your insulin dose and timing of levemir. Your 9-10 pm 7u will be coming to the end of its action as the 5u is reaching its highest level. Have a look at the graph in the link I posted. Effectively you have elevated basal levels from about 7.30 to around 9-10 am.

I wouldn't be at all surprised if you also suffered higher levels in the evening that are currently being masked by an additional amount of bolus around tea time, again based on the action profile in the link I posted.

I think you need to undertake a proper series of basal tests and get your levemir right because based on what you've told us, it doesn't sound like it is.

Basal testing advice is here although in us units http://integrateddiabetes.com/basal-testing/ and @noblehead can provide ask one.

I strongly recommend you do this. I get the impression with what you have told us that it is currently not quite right and getting your basal right makes every thing else fall in to place.
 
The thing is Tim, I have found with the 7 u of lev emir I am taking at night, is consistent with my morning readings it only goes up by 2mmol either way, so does that mean my night time one doesn't need to change, I don't understand how my levels were alright For a couple of days after the split does, then for it to drastically change, the only explanation is if it is because of the rebound from the hypos mid morning ish, I admit to finding it a little bit confusing and frustrating, as in which one is the culprit, might speak to my DSN, I asked about the tresiba noblehead, but was informed it is to expensive and would only be recommended as a last resort
 
Padders91 said:
I have recently changed from taking levemir from once a day to twice, the first few days seemed to be alright with sugars between 4 and 7 but now I have finding I am having a lot more hypos, seems to be at the same time as well, I am currently taking 7 units at night and 5 in the morning, I take the night time one between 9-10 and the morning one at 5:30 in the morning getting up for work, and 8:30 during the weekends, my first thought was is it because the injections are two close together, as anyone had teething problems with 2 injections ?
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I had horrendous results when I first took Lantus, so was switched to Levemir. And it's been fine. I take my Levemir at 7 am 10 units, and 12 hrs later I take 4 units. But I have discovered if I sleep in on a weekend, it makes little difference if I leave it more than 12 hrs. However, as always, diabetes is such a personal thing. You can't go by other people's experiences. But I would think it better to take more units in the morning than in the evening. My dosage was worked out by my DSN and has totally worked for me. Night time hypos are rare as my body won't let me go to sleep if my blood glucose is below say 6. I lie awake, even though I have tested before bedtime, and am happy with my result, it can drop by a few units within an hour of going to bed. So if I can't sleep (and I can sleep for Britain!) I know to test, and 90 per cent of the time it's dropped to 4, so I take a small real coke, 150 ml which brings it back up to 7. I wish you luck with getting it right, it does sometimes take a time
 
I have split doses of levimir, works much better than one dose. But still not as effective as I would like. I currently take 34 units at 11pm and 13 units at 6:30. Waking up with a BG less than 10 is an achievement. To get it to be in the target range, I have to take two units of novorapid right before I sleep. However don't like doing this as night time hypos scare me! it's just trying to work out what's best for you! :)
 
Padders91 said:
I have recently changed from taking levemir from once a day to twice, the first few days seemed to be alright with sugars between 4 and 7 but now I have finding I am having a lot more hypos, seems to be at the same time as well, I am currently taking 7 units at night and 5 in the morning, I take the night time one between 9-10 and the morning one at 5:30 in the morning getting up for work, and 8:30 during the weekends, my first thought was is it because the injections are two close together, as anyone had teething problems with 2 injections ?
Click to expand...
I'd say a 12hr gap between jabs is more like it. I've noticed a few other people have quoted that too in this thread. I've been using levemir split doses for about 6/7 years and it's helped me a great deal. I was doing 1 lantus beforehand and having loads of hypos, plus I was working nights.
I'm currently having 7 units of a morning 9am and 14 of an evening 9pm alongside carb counting and changing my short acting ratios depending on exercise etc. Its been working for me, my last hba1c was 47mmol and I've had lower results than that. Type 1 of 35 yrs...
 
The Dr at the diabetes centre told me to do this once ....so I did, and I kept having hypos and now I don't anymore...I just keep an eye on what I eat now
 
I use Levemir insulin (basal background insulin) and have tried triple dosing of it .
It has helped to keep me with steadier Blood Sugar levels .

They kept spiking and soaring with many peaks and troughs throughout
the day/evening .
Especially with having infections/illness, also auto immune system conditions .

My DSN suggested I try a triple dose to keep me more consistent with this happening .
It worked :) - so this what I have to do now .
She also mentioned Levemir is more gentle an insulin than some other insulin's .
Lanctus was one she said was a more heavier duty insulin .

I have excellent hypo awareness and know the signs very well .
Know how to treat these accordingly (use jelly babies) - never had one for yonks TBH .
 
tim2000s said:
I'm not sure what a heavy duty insulin is?
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Took it as kicks in with no messing about .

Found porcine and levemir more gentle with their response 'onset time' with me .
Porcine took too long - leaving me with too high BG levels for too long .
Onset time wise - was too long for me .
 
@anna29 that's interesting, I have never heard of anyone on three doses of basal a day but clearly it's working for you. Your DSN sounds very creative - thinking outside the box.
 
Makes sense if you look at the action times of various basals. I had considered it with Levemir but it made life management too hard, and managing with extra bolus seems to work out.
 
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