Levemir Injection Times

[GrantGam]

Morning all!

I'm currently on a basal/bolus regime with Levemir and Novorapid. I've typically been taking my Levemir as a split dose at 7pm/am. Since using the Freesyle Libre I've had access to graphs and the like and I've noticed a trend.

I can now see that I typically dip lowest during the hours of 2am - 6am then have a peak on waking between 7am - 10am. Note that I'm still getting these AM peaks even when my lowest reading is >4mmol/L, so I don't think it's a rebound high issue. The am peak (sometimes as high as 10mmol/L then comes down to normal range at around 11am; once my morning dose of Levemir kicks in.

I don't normally eat breakfast, but find that I'm needing about 2u Novorapid on waking to try and keep my BGL steady until the Levemir takes over.

I'm wondering if I were to take my pm dose later (at 10pm for example) would this allow a better overlap between am/pm Levemir injections to compensate for my higher readings between 7am-10am? I'm not so concerned about the morning Novorapid correction dose, but if I could get a flatter basal over this morning period without my Novorapid then I'd be pretty happy! The leaflet in the Levemir box says to take one injection or a split dose 12 hours apart. Although this is the recommendation, I doubt very much that the leaflet is diabetic so I'd rather your views instead

Anyone else finding that they need a fast acting correction in the mornings to keep things steady?

Any advice or recommendations would be greatly appreciated!

Many thanks!
Grant

 

[hels]

Hi Grant
I take my levemir at around 7am and 11pm. The times aren't carefully thought out around my levels (more to do with how they fit into my routine) but it seems to work.

 

[hels]

Hi Grant
I take my levemir at around 7am and 11pm. The times aren't carefully thought out around my levels (more to do with how they fit into my routine) but it seems to work.

 

[GrantGam]

Hi Grant
I take my levemir at around 7am and 11pm. The times aren't carefully thought out around my levels (more to do with how they fit into my routine) but it seems to work.

Thanks for your reply @Hels. If you take them 12hrs apart (I'm assuming you have done before) what were you finding? Levemir apparently takes 3-4 hours to work so delaying my evening injection to 10pm/11pm "should" covering my morning time I'm hoping...

Will certainly give it a go and see if it's affecting the mornings after two or 3 days.

Thanks again!

 

[SRO]

Hi @GrantGam1337 - I take Levemir at 8am, and 10pm. I've only just recently (last few days) cut carbs right back to hopefully get a better view of my tolerance etc, and currently it looks like my Levemir runs out at about 10 hours, but also doesn't start working for the first 2.5 hours.
On waking, I seem ok, but then I get a gap between my 8am injection and around 10am (no breakfast).
I like the idea of moving these to 7am an 11pm with my Novorapid covering the break at night. Sounds genius to me...

 

[GrantGam]

So first go with the amended staggered injection timings and seems to be better than the normal split dose 12 hours apart.

10u Levemir at 2200 and 12u Levemir at 0730. Judging by the report, I must have entered my evening Levemir dose twice into the Libre reader...

Bedtime BGL was a bit low at 5.5mmol/L; will try and have this around 6.5mmol/L to keep me above 4mmol/L whilst sleeping. AM peak was 7mmol/L, better than the normal 9-10mmol/L. And... no 2u Novorapid correction dose on waking

Still a work in progress, but will continue to post the 0000-1200 Libre reports for the next few days. If anyone has advice or recommendations to share then please do!

Cheers,
Grant

 

[novorapidboi26]

I also took a morning dose and a pre bed dose as opposed to an even split, and this was to help bring down the early morning peak, this is the only timing tactic you can use trying to tackle that issue really...

 

[GrantGam]

I also took a morning dose and a pre bed dose as opposed to an even split, and this was to help bring down the early morning peak, this is the only timing tactic you can use trying to tackle that issue really...

I wouldn't mind so much if I were a breakfast person, then I could just take a correction dose on top of my breakfast insulin.

I'm confident that I can make this work without AM Novorapid correction doses, a rise in BGL upon waking is something I don't really mind - providing that it is in range. i.e. 4mmol/L - 6mmol/L, for example.

Grant

 

[TorqPenderloin]

I wouldn't necessarily assume that your morning highs/peaks are the result of an improper basal dose.

My Levemir dose is spot on (currently) as my bedtime/waking readings are within 1mmol/l 95% of the time. I can also fast for 5+ hrs with less than a .5mmol/l deviation.

With that said, I have to bolus every single morning otherwise I'll spike to ~10-12mmol/l just as you do even without food.

I've heard some attribute it to dawn phenomenon while others cite my high protein intake. Either way, it happens every single morning and the easiest way to manage it (for me) is to take a small correction dose. Also like you, it would automatically correct itself usually by noon (before I began the correction dose).

Note: all of this is monitored by my Dexcom.


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[GrantGam]

I wouldn't necessarily assume that your morning highs/peaks are the result of an improper basal dose.

My Levemir dose is spot on (currently) as my bedtime/waking readings are within 1mmol/l 95% of the time. I can also fast for 5+ hrs with less than a .5mmol/l deviation.

With that said, I have to bolus every single morning otherwise I'll spike to ~10-12mmol/l just as you do even without food.

I've heard some attribute it to dawn phenomenon while others cite my high protein intake. Either way, it happens every single morning and the easiest way to manage it (for me) is to take a small correction dose. Also like you, it would automatically correct itself usually by noon (before I began the correction dose).

Note: all of this is monitored by my Dexcom.


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Yeah it seems that dawn phenomenon is a factor of course. That's something that I don't think can be overcome?

It just seems a bit of a coincidence that my Levemir takes 3-4 hours to work (as per manufacturer info) and this is the same time frame where my BGL will rise and fall to almost the exact same value.

If I find myself to be going out of range in the mornings after this wee experiment then I'll probably revert to the 12 hour split dose and 2u QA correction.

However, if over the next few days I'm getting a similar result to this morning, then I'll be quite happy to stick to this staggered timing approach.

Cheers for the feedback!

Grant

 

[slip]

An interesting thread, keep us posted.

 

[Cragwood]

Thanks for your reply @Hels. If you take them 12hrs apart (I'm assuming you have done before) what were you finding? Levemir apparently takes 3-4 hours to work so delaying my evening injection to 10pm/11pm "should" covering my morning time I'm hoping...

Will certainly give it a go and see if it's affecting the mornings after two or 3 days.

Thanks again!

I take mine at 10.30 to 11pm every night and it's really had an impact on my morning fasting sugars. Before I did this they would always be the highest reading of the day. Definitely worth a try!

Jo

 

[DR_Hornet]

Morning all!

I'm currently on a basal/bolus regime with Levemir and Novorapid. I've typically been taking my Levemir as a split dose at 7pm/am. Since using the Freesyle Libre I've had access to graphs and the like and I've noticed a trend.

I can now see that I typically dip lowest during the hours of 2am - 6am then have a peak on waking between 7am - 10am. Note that I'm still getting these AM peaks even when my lowest reading is >4mmol/L, so I don't think it's a rebound high issue. The am peak (sometimes as high as 10mmol/L then comes down to normal range at around 11am; once my morning dose of Levemir kicks in.

I don't normally eat breakfast, but find that I'm needing about 2u Novorapid on waking to try and keep my BGL steady until the Levemir takes over.

I'm wondering if I were to take my pm dose later (at 10pm for example) would this allow a better overlap between am/pm Levemir injections to compensate for my higher readings between 7am-10am? I'm not so concerned about the morning Novorapid correction dose, but if I could get a flatter basal over this morning period without my Novorapid then I'd be pretty happy! The leaflet in the Levemir box says to take one injection or a split dose 12 hours apart. Although this is the recommendation, I doubt very much that the leaflet is diabetic so I'd rather your views instead

Anyone else finding that they need a fast acting correction in the mornings to keep things steady?

Any advice or recommendations would be greatly appreciated!

Many thanks!
Grant

I have exactly the same and it is definitely dawn phenomenon. I also inject in the morning and do 2 or 3 units of NR. It won't make a difference when you take the night time Levemir.

The issue is that your liver produced glucose which gives you energy to wake up. I have read a couple of solutions including drinking a glass of wine (not ideal) in the evening and this occupying your liver or eating walnuts at night. I've tried the walnut idea and I can confirm it doesn't work for me but there are other benefits to them, so it will remain part of my daily routine as will the morning NR.



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[GrantGam]

I have exactly the same and it is definitely dawn phenomenon. I also inject in the morning and do 2 or 3 units of NR. It won't make a difference when you take the night time Levemir.

The issue is that your liver produced glucose which gives you energy to wake up. I have read a couple of solutions including drinking a glass of wine (not ideal) in the evening and this occupying your liver or eating walnuts at night. I've tried the walnut idea and I can confirm it doesn't work for me but there are other benefits to them, so it will remain part of my daily routine as will the morning NR.



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Definitely dawn phenomenon? You realise that I now see this as a challenge to prove you wrong? Just messing, I know DP is a factor - but not just that...

I appreciate and understand the effects of apparent DP, however I'm almost sure that the timings of my injections also play an important role in this issue. I accept that a rise in BGL is a natural start to many T1D's mornings, however as you can read on this thread there are other members who also seem able to reduce their AM BGL rise with a delayed evening dose of basal insulin.

Cheers for the reply!
Grant

 

[GrantGam]

Afternoon everyone!

So day two of my wee experiment and results seem promising.

There seems to be an improvement on yesterday's results with my maximum possible BGL rise being just 1.8mmol/L (3.7mmol/L – 5.5mmol/L)

Dipped a little bit low again during the night, but again – this is still an improvement on the previous evening's lower values. Will reduce my evening basal by 10% and see how we go. Glad everything is starting to look a bit more linear now. If it is DP that is causing my raise in BGL in the morning, then this overlap of basal seems to be keeping it at bay.

What do you guys think?

Cheers,
Grant

 

[GrantGam]

Day 3 of the experiment. Not such a great trend however... Pretty messy.

Seem to have dropped quite low during the night (no variables were changed) even though I made a 20% reduction in evening basal from 10u to 8u. My last BGL check before sleeping was 5.5mmol/L. The initial BGL rise before 0700 was from a drink of lucozade. I never had any symptoms of a hypo and I am certainly hypo aware.

I'm wondering if these apparent overnight lows have something to do with me lying on the same side where my sensor is. Is anyone aware if pressure can affect the readout? I did not take a finger prick test before 0700 but as soon as I got up around 0710 I took a finger prick test and it was within 1.5mmol/L.

I'm still well below the previous morning spikes of 10mmol/L or more; but the basal trend certainly needs tidied up. I have reduced my basal dose so substantially that I'm a bit concerned and confused by this. I have been eating less carbohydrates over the past two weeks, no increase in exercise or activity - only some slight weight loss at around 2kg or so. I've dropped from around 36u to (currently) 16u and still running low according to the trends...

Either I was doing things VERY wrong before using the Libre or something else is happening. Is anyone aware of why a reduction is basal insulin requirements would occur even >2 years after diagnosis?

Regards,
Grant

 

[paulorton]

If Levemir takes 2-3 hours to start working and only works for about 10 hours, then wouldn't it be sensible to split it into 3 doses? I take it at 11am and 11pm but get a spike at about 1pm and 7pm. I think I'll try 7am, 3pm and 11pm to see how it goes.

 

[GrantGam]

If Levemir takes 2-3 hours to start working and only works for about 10 hours, then wouldn't it be sensible to split it into 3 doses? I take it at 11am and 11pm but get a spike at about 1pm and 7pm. I think I'll try 7am, 3pm and 11pm to see how it goes.

Yeah I suppose you could split it into as many injections as you like if it's only lasting 10 hours?

My Levemir seems to last the 12 hour period on a split dose. But it takes 3-4 hours to start working (for me) and it's this 3-4 hour period that I'm lacking cover for and then also DP isn't helping either.

This only applies to the morning time, as it would seem that I have enough onboard bolus to carry me over the evening 3-4 hour period where I'm waiting for the Levemir to start working.

Still getting apparent lows at night and I'm on a staggeringly low amount of basal insulin now. Less than half of what I was previously taking... I have gone lowish carb over the past couple of weeks to around <80g per day. I would have thought that if I was lowering my carbs then I would need more basal?

Grant

 

[GrantGam]

So, a poor evening, morning and overall result.

Apparently flat-line hypo last night and then a huge morning spike where I needed a 2u correction dose, which actually ended up taking me a bit too low... Down to 14u of Levemir now and still having hypos, this is all starting to get pretty weird. As mentioned in the above post I've lowered my carb intake but would this have any difference on my fasting BGL or basal dose?

Libre is reading the same as my Dario tester; albeit I've not tried in the middle of the night when the reading appears lowest. Will set an alarm tonight to see...

Grant

 

[JoeT1]

Sorry to bring up an old thread, but didn't want to create loads just for silly old me.

This interests me greatly, as I am seeing rises in the evening, from say 6pm until I take my nighttime Levimir about 10pm. Even if there is a correction dose in there at 6.30pm with my meal, it'll nearly always go up. I seem to be steady enough now overnight with my 10pm dose. So what I am thinking, perhaps it's not the amount of units in my morning time dose, it could be timing. I take 14units at 10pm, and 7units at 7/7.30am, I am thinking of changing the morning dose to perhaps 8.30am, and seeing if my evening readings are in any way better? Make sense?

If not, then I can more so look at fasting from having lunch around 2pm, and not eating again until 10pm, only water. If it rises after about 7pm, by more than 1-1.7mmol, it would be more so the Basal dose in the morning that needs adjusting?