Changing over to Levemir from Lantus

[Beckie2014]

Hi guys, thanks so much I spoke to her before changing to the levemir but not discussed that, will deffo call back tomorrow. Thanks for your advice x

 

[Type1Bri]

Hi guys, thanks so much I spoke to her before changing to the levemir but not discussed that, will deffo call back tomorrow. Thanks for your advice x

Let us know how you get on

 

[AndyS]

So... you guys seem far more informed than me, so Im hoping for some insight.... I was dx last June. I changed from lantus to levemir for personal reasons and... well I decided to inject at 10pm and 6am. Ive had 2 colds and the dose has increased each time.... Now my 2-3am bgs are consistent and 6am bg is ok but my bgs rise after I actually get out of bed around 7am... so at 9-10am My bgs rise from 5s to 6s-7s (without food)... Any suggestions please. should I consider taking night time insulin later? Im just following intuition

Now this definitely sounds like Dawn Phenomenon.

From what you say it really looks like your basal is about right and you seem to take your levemir at similar times to me but I too see a similar rise.
That said when I check back before lunch I have usually dropped back down so I just treat that slight rise as a normal part of my body getting going for the day and liver dumping sugars to get things going.

I know some people will do a small bolus to cover off DP though if you are only climbing a unit or two by lunch then personally I wouldn't worry about that and just correct down to 5 at lunch.

If that is not for you then you may want to do some basal testing, have carb free day for breakfast and lunch and see if the rise continues through the day, if it does then maybe you need more morning basal otherwise if you are flat then it is just DP.

/A

 

[Cauliflower_rice]

Now this definitely sounds like Dawn Phenomenon.

From what you say it really looks like your basal is about right and you seem to take your levemir at similar times to me but I too see a similar rise.
That said when I check back before lunch I have usually dropped back down so I just treat that slight rise as a normal part of my body getting going for the day and liver dumping sugars to get things going.

I know some people will do a small bolus to cover off DP though if you are only climbing a unit or two by lunch then personally I wouldn't worry about that and just correct down to 5 at lunch.

If that is not for you then you may want to do some basal testing, have carb free day for breakfast and lunch and see if the rise continues through the day, if it does then maybe you need more morning basal otherwise if you are flat then it is just DP.

/A

Thanks Andy, I will do some basal testing as suggested and update you if that's ok. just out of interest, how do you assess your bolus insulin?

 

[Cauliflower_rice]

What doses are you on? what are they as Units/Kg?

It may well simply be you are exiting honeymoon and your requirements are slowly rising.

I am on 5units in morning and 4 at night (well clicks of my insulin pen)... which fits in with the amount bolus I take during the day (50/50). It was after reading a thread on this site that I realised that basal may rise when ill. initially I was only on 4 units per 24hrs and each cold seems to impacted on my honeymoon period. Its funny really cos how will I know I have really left the honeymoon period?

 

[donnellysdogs]

Sounds more like waking phenonemen.
If you lie in does the same happen? Or is it once your feet hit the floor?
DP tends to start when a sleep, WP is when you get out of bed.
For me, my levels stay static if I lie down longer in bed, or even if I wake up but stay in bed having a coffee.
To counteract my rise I have a bolus (without food).
If you are only rising a couple units and your insulin needs are little then you may only need 1/2 unit..
On levemir I had 1-11/2 units each morning. On tresiba I have to give more as it is such a flat running background insulin and given at 6pm each night... Levemir was split to mornings and nights...
I cannot advise you how much you may need but I would certainly talk to your DSN about a small bolus when you get up...

 

[steve_p6]

I am on 5units in morning and 4 at night (well clicks of my insulin pen)... which fits in with the amount bolus I take during the day (50/50). It was after reading a thread on this site that I realised that basal may rise when ill. initially I was only on 4 units per 24hrs and each cold seems to impacted on my honeymoon period. Its funny really cos how will I know I have really left the honeymoon period?

Honeymoon can last a year or more these days if control is good. The rule of thunb for insulin is 1u per 10g carb or 1u to drop the BG 3 mmol. when you reach that point I would say you are probably fully out of honeymoon.

With regards to the comments from @AndyS and @Cauliflower_rice, if what you are seeing is time of day related then it could be the morning stress hormones kicking in, if its a general across the day thing then it could be the exit from honeymoon. Regardless, the truth on T1, even for old hands, is that it keeps shifting and you always have to go back to the checklist - is my basal right, is my bolus calculation right, am I ill/stressed/relaxed, is it something I ate/drank, is it weekday/weekend, have I been more/less active, did it do this last time etc? It's a game of 20 questions!

 

[tim2000s]

Hello, sorry to but in but you've touched on exactly what I'm struggling with, really struggling with highs around 2am. I take levemir in the morning, 29 at the moment as I'm pregnant. I'm rock steady at 5 ish but it rises and rises from 2am so am constantly correcting, your advice would be so welcome as I'm so tired from getting up every hour to check what's going on thanks so much in advance x

Hi Beckie, do you only take Levemir in the morning? Many people find that unless they split dose Levemir it runs out after about 18 hours. Combine that with dawn phenomenon and you'd certainly see the rise you are talking about.

NICE recommends splitting Levemir, as does DAFNE so it would be worth speaking to your DSN about this.

 

[tim2000s]

Thanks Andy, I will do some basal testing as suggested and update you if that's ok. just out of interest, how do you assess your bolus insulin?

Start from the rule of 500.

Divide 500 by your total daily dose. E.g. Your total daily dose across all insulin is 50u then:

500/50 = 10

This is your starter for insulin carb ratio and the amount in grams of carbs that 1u should cover.

Likewise for insulin sensitivity, use the rule of 100.

Divide 100 by your total daily dose (using the previous examples numbers this works out at 2) to determine a value that is roughly how much 1u insulin lowers you blood glucose by.

These are both estimates and following completion you may find that testing reveals these numbers vary somewhat.

 

[Cauliflower_rice]

Start from the rule of 500.

Divide 500 by your total daily dose. E.g. Your total daily dose across all insulin is 50u then:

500/50 = 10

This is your starter for insulin carb ratio and the amount in grams of carbs that 1u should cover.

Likewise for insulin sensitivity, use the rule of 100.

Divide 100 by your total daily dose (using the previous examples numbers this works out at 2) to determine a value that is roughly how much 1u insulin lowers you blood glucose by.

These are both estimates and following completion you may find that testing reveals these numbers vary somewhat.

So.... is this standard for all t1s? are the numbers 500 and 100 based around a person eating around 130g of carbs....? Ive chosen to follow a low carb diet... Im very late onset and I knew the moment I was told (in hospital) ... it was the carbs.

 

[Cauliflower_rice]

Honeymoon can last a year or more these days if control is good. The rule of thunb for insulin is 1u per 10g carb or 1u to drop the BG 3 mmol. when you reach that point I would say you are probably fully out of honeymoon.

With regards to the comments from @AndyS and @Cauliflower_rice, if what you are seeing is time of day related then it could be the morning stress hormones kicking in, if its a general across the day thing then it could be the exit from honeymoon. Regardless, the truth on T1, even for old hands, is that it keeps shifting and you always have to go back to the checklist - is my basal right, is my bolus calculation right, am I ill/stressed/relaxed, is it something I ate/drank, is it weekday/weekend, have I been more/less active, did it do this last time etc? It's a game of 20 questions!

Ok, at least Im in reality mode and need to keep a detailed diary to check exactly what is contributing to changes in bgs... Think Im out of the honeymoon period... thanks for responding and really helping me take a more 'whole' approach.

 

[tim2000s]

So.... is this standard for all t1s? are the numbers 500 and 100 based around a person eating around 130g of carbs....? Ive chosen to follow a low carb diet... Im very late onset and I knew the moment I was told (in hospital) ... it was the carbs.

My average carb intake a day is well below the 130g and the numbers it comes out with are remarkably close to mine so I'd give it a go if I was you. You have to start somewhere and this is as good a place as any!

 

[AndyS]

My average carb intake a day is well below the 130g and the numbers it comes out with are remarkably close to mine so I'd give it a go if I was you. You have to start somewhere and this is as good a place as any!

I used the figures that Tim highlighted as a good starting point a couple years ago and like he said they are pretty close.

The key is to keep detailed records and don't lie to yourself about BG or food intake, you need to be as accurate as you possibly can and anywhere that you guessed you need to exclude that from your analysis. Once you have some results to look at you can then fine tune.

Going back to the OP @Type1Bri how you settling in with the levemir?

/A

 

[Type1Bri]

Been using my libre as well as lots of fasting basal testing. Slowly getting there, afternoon and evening is sorted. Overnight still creeping up and DP causing issues but am getting there. Currently on 12u at 11pm and 8 units at 11am

 

[AndyS]

Been using my libre as well as lots of fasting basal testing. Slowly getting there, afternoon and evening is sorted. Overnight still creeping up and DP causing issues but am getting there. Currently on 12u at 11pm and 8 units at 11am

So better than you were then. Least you can now see changes fairly quickly without the lag you get with lantus.

Hopefully you have it dialled in by the next meetup.

/A

 

[Type1Bri]

Hopefully have it nailed by then Andy

 

[Cauliflower_rice]

I used the figures that Tim highlighted as a good starting point a couple years ago and like he said they are pretty close.

The key is to keep detailed records and don't lie to yourself about BG or food intake, you need to be as accurate as you possibly can and anywhere that you guessed you need to exclude that from your analysis. Once you have some results to look at you can then fine tune.

Going back to the OP @Type1Bri how you settling in with the levemir?

/A

ok, back to weighing rather than visually assessing... I do my BGs regularly, though I haven't weighed protein ... thank you

 

[Type1Bri]

Bit of an update, the change has gone quite well, still getting higher FBS than I want but will tweek until it's where I want it