Question on Levemir's longevity

[Bluemarine Josephine]

Good morning everyone! I hope that you are all very well today and that you levels are on point!!

During DAFNE course, we were told that Levemir lasts for 16-18 hours average.
I am wondering, however, is there a possibility (depending on the dosage) that it can finish earlier than 16 hours?

The reason that I am asking you is because I am splitting my Levemir dosage, 7 units at 07:00 am and 7 units at 22:00 am.
My last Novorapid is at 19:00 pm on a 1:1 ratio.
Somewhere in between 21:00 – 22:00, my levels stay weirdly stable.
In between 23:00 – 24:00 they elevate by almost 1.5 mmols
When I give a Novorapid correction of 1 unit at 24:00, I wake up in the morning with a fasting level by 3 mmols lower (and slightly lower) so, this indicates to me that my evening Levemir on 7 units which I inject at 22:00 is not insufficient (I suppose...)

Unless my evening Novorapid ratio has changed, is there a possibility that my morning Levemir abandons me before my evening Levemir begins?

I asked my nutritionist (who was also my DAFNE educator) who replied “No no, that is impossible, Levemir lasts for, at least 16 hours so you are well covered.”

I would love to hear your thoughts and, as always, thank you so very much for your helpful suggestions.
(I have found more help in this forum than from my diabetes nurses and DAFNE educators.)

Thank you
Have a great day ahead
Josephine

P.S. Rant/gossip of the day: I asked through text message the opinion of a diabetic friend whom I met during the Dafne course about this concern of mine. Here is what she replied:
Quote:
"Wow! Joss stop over-thinking it all and it shouldn't matter on diet etc just give it a solid month of one routine and then re think, I think maybe you are trying to change it too much let the insulin have time to adjust before making adjustments"
Un-quote.-
So, now I feel like this crazy OCD overthinker as well...

 

[tim2000s]

Hi @Bluemarine Josephine Josephine I know this is a touchy question, but what is your weight? Assuming you are around 60kg, your u/kg would be 0.12 u/kg and at this amount, Levemir has been shown not to last for 16-18 hours. Typically it lasts for a total of 16 hours at 0.2u/kg and the last four have minimal impact, so we estimate it loses effect earlier than that at lower doses:

If you look at the graph you see that at 0.2u/kg, the amount being absorbed after about 10 hours is minimal so is having next to no effect. At 0.12 u/kg it will be lasting even less long and having less effect after 10 hours. Based on this graph, an injection at 7am will be having minimal effect by 7pm at 0.2 u/kg and will definitely have run out by 10pm.

Your observations are in line with those of many users of Levemir and the experimental evidence provided. I used to take 8u overnight and 14u in the morning. My 8u taken at 9.30pm would stop having an effect by 8.30am the following morning and I used to take my 14u at 7.30 to try and get some overlap. The 14u used to start expiring by about 8-8.30pm and I'd need rapid acting both am and pm to manage the effects of the insulin run off period.

While the lifetime in the body is stated, the period where it is effective seems to be some four hours shorter than the duration of its action.

 

[Bluemarine Josephine]

Hi @Bluemarine Josephine Josephine I know this is a touchy question, but what is your weight? Assuming you are around 60kg, your u/kg would be 0.12 u/kg and at this amount, Levemir has been shown not to last for 16-18 hours. Typically it lasts for a total of 16 hours at 0.2u/kg and the last four have minimal impact, so we estimate it loses effect earlier than that at lower doses:

If you look at the graph you see that at 0.2u/kg, the amount being absorbed after about 10 hours is minimal so is having next to no effect. At 0.12 u/kg it will be lasting even less long and having less effect after 10 hours. Based on this graph, an injection at 7am will be having minimal effect by 7pm at 0.2 u/kg and will definitely have run out by 10pm.

Your observations are in line with those of many users of Levemir and the experimental evidence provided. I used to take 8u overnight and 14u in the morning. My 8u taken at 9.30pm would stop having an effect by 8.30am the following morning and I used to take my 14u at 7.30 to try and get some overlap. The 14u used to start expiring by about 8-8.30pm and I'd need rapid acting both am and pm to manage the effects of the insulin run off period.

While the lifetime in the body is stated, the period where it is effective seems to be some four hours shorter than the duration of its action.

Good morning Tim2000s! Thank you so much for your reply!
My height is 1.78 / 5.10 and my weight this morning was 64.5/10.2.
I will need your further advise regarding this matter please.
Thank you so much!

 

[tim2000s]

@Bluemarine Josephine You are in the small amounts of Levemir camp there then, in terms of u/kg - 7/64.5 is 0.1u/kg. That would put you squarely in the realm of the insulin definitely not lasting 16 hours, and more than likely only lasting 12-14 hours. Even with a duration in your body of 12-14 hours, you will be seeing its effects diminish after about 10-12 hours.

I'd say your hypothesis is correct. Your morning insulin does not last until you take your evening shot. In this scenario, most people compensate by taking more rapid acting insulin in the evening.

 

[Bluemarine Josephine]

@Bluemarine Josephine You are in the small amounts of Levemir camp there then, in terms of u/kg - 7/64.5 is 0.1u/kg. That would put you squarely in the realm of the insulin definitely not lasting 16 hours, and more than likely only lasting 12-14 hours. Even with a duration in your body of 12-14 hours, you will be seeing its effects diminish after about 10-12 hours.

I'd say your hypothesis is correct. Your morning insulin does not last until you take your evening shot. In this scenario, most people compensate by taking more rapid acting insulin in the evening.

Thank you so very much Tim2000s!!!
So, the solution is to keep my Levemir at the same dosage (7&7 units) and alter my morning and evening Novorapid ratios in order to cover for the gap. Is my understanding correct please?

 

[tim2000s]

Given your timings, I think your morning is likely to be okay. What you'll need to do is work out how much additional to add in the evening and whether to do it with your evening meal or slightly later as a correction.

 

[Bluemarine Josephine]

Given your timings, I think your morning is likely to be okay. What you'll need to do is work out how much additional to add in the evening and whether to do it with your evening meal or slightly later as a correction.

Your diabetes understanding and management is literally goals, Tim2000s!!

 

[tim2000s]

Your diabetes understanding and management is literally goals, Tim2000s!!

I wouldn't say my management was, I just understand how insulin is supposed to work

 

[AndyS]

I wouldn't say my management was, I just understand how insulin is supposed to work

Supposed to work I think is operative there.

Now, if only we could get most HCP's up to your level of understanding Tim. Or at least get them to understand stats well enough at any rate.

/A

 

[tim2000s]

Now, if only we could get most HCP's up to your level of understanding Tim. Or at least get them to understand stats well enough at any rate.

As Partha Kar said, those with the condition are experts. Those who are Consultants in the condition are simply specialists...

 

[cz_dave]

Hi @Bluemarine Josephine Josephine I know this is a touchy question, but what is your weight? Assuming you are around 60kg, your u/kg would be 0.12 u/kg and at this amount, Levemir has been shown not to last for 16-18 hours. Typically it lasts for a total of 16 hours at 0.2u/kg and the last four have minimal impact, so we estimate it loses effect earlier than that at lower doses:

If you look at the graph you see that at 0.2u/kg, the amount being absorbed after about 10 hours is minimal so is having next to no effect. At 0.12 u/kg it will be lasting even less long and having less effect after 10 hours. Based on this graph, an injection at 7am will be having minimal effect by 7pm at 0.2 u/kg and will definitely have run out by 10pm.

Your observations are in line with those of many users of Levemir and the experimental evidence provided. I used to take 8u overnight and 14u in the morning. My 8u taken at 9.30pm would stop having an effect by 8.30am the following morning and I used to take my 14u at 7.30 to try and get some overlap. The 14u used to start expiring by about 8-8.30pm and I'd need rapid acting both am and pm to manage the effects of the insulin run off period.

While the lifetime in the body is stated, the period where it is effective seems to be some four hours shorter than the duration of its action.

Although my Levemir doses are still small, they have recently been increasing. I have also started noticing the effect of Levemir running out more than in the past. I currently inject only 0.07 units/kg of Levemir twice a day and I can confirm (as suggested by the above graph), the effect does not last even 8 hours. I have noticed somebody on this forum mentioned injecting Levemir three times a day, I suppose that would be the solution but seems like a real pain. I was thinking I will just wait until my Levemir needs increase even more so that I am able to cover the 12 hour period but it seems that I am still quite far from it. I guess these are my options:
- Stick to Levemir twice per day (and possibly compensate with NovoRapid when it starts running out)
- Inject Levemir three times per day
- Switch to Toujeou (Tresiba is not approved yet where I live).

I like Levemir but hate the fact it does not last even 12 hours when taking small doses. Not sure which option I will choose but I may give Toujeou a try.

 

[misswhiplash]

When I was on MDI, my levemir doses were a bit more than yours and they still didn't last anywhere near 16-18 hours - I'd say barely 12-14. Pretty common with levemir, I think.
Personally, I found Lantus a lot better (longer lasting and flatter action), but I know that not everyone loves it.

 

[cz_dave]

Thanks for the comment @misswhiplash. One more reason why to give Toujeou (a Lantus clone) a try.

 

[Bluemarine Josephine]

Thanks for the comment @misswhiplash. One more reason why to give Toujeou (a Lantus clone) a try.

Hello!
Please let me know how you find Toujeo? I heard it is Sanofi's equivallent to Novo Nordisk's Tresiba.
They are different insulins (Toujeo being a glargine while Tresiba is a degludec) but, the philosophy is the same as they are both considered very flat (without any peaks whatsoever) and very longlasting.

I have tried Tresiba and I really, really liked it!
Regards
Josephine

 

[cz_dave]

I will certainly report on my findings as soon as I give it a try. I have some extensive travel in front of me, so will want to postpone any experiments once things calm down.

What is your basal currently?

 

[isjoberg]

Thank you so very much Tim2000s!!!
So, the solution is to keep my Levemir at the same dosage (7&7 units) and alter my morning and evening Novorapid ratios in order to cover for the gap. Is my understanding correct please?

I know you already got a brilliant answer, but I would like to add something - I try and keep my blood sugar stable for 2 hrs before bed and 9/10 times this keeps it stable overnight with my levemir.