How much Levemir are you taking?

[sololite]

Hi everyone, I am back with more questions, thanks for your support.

I am LADA 1.5 and been taking Levemir once a day at 10.30PM

I started on it 6 months ago when my diagnosis was switched from T2 to T1.5

I started on 2 units, then went to 4 and now on 6 but close monitoring of my BS over last 3 weeks is showing that my control is poor even though I am eating properly and exercising. I usually wake up with an 8, sometimes will spike at 10 2hrs after eating but then at other times will see 5's, 6,'s 7's - there is no pattern I can determine by analysing my diet/BS scores

I have 2 questions: 1, the markers on my pens go all the way up to 60 and my diabetic nurse is always asking me to try 1-2 more units until I get things under control. Is this what others were advised? 2, at what point have people been told to switch to meal time insulin and what are the deciding factors?

I can see that for last couple of months that I have been kidding myself that the great BS scores I get when I do loads of exercise are reflective of good control when in fact this may not be the case.

thanks for listening

 

[Juicyj]

Hi @sololite - As a type 1, dependent on insulin, the advice given by your DSN sounds like standard advice in terms of increments required to bring BG levels down to get back into range.

The point at which you should start to think about taking quick acting insulin to cover your meals is when your BG levels start to rise to uncontrollable levels after eating, at the moment it sounds like you still have some pancreas function as your BG levels still sounds pretty good. How high you spike depends on carbs eaten and fat content of food, fat can delay spikes, whereas eating say crisps will spike my BG levels quite quickly, there are no set patterns to this hence why it's difficult to see a pattern, unless you eat the same thing/do the same exercise etc all the time there will be no set pattern.

In regards to Levemir this can run out after around 20 hours, some opt to split their dose so that it overlaps, something you should be mindful of, however with any changes you should run these past your DSN first.

Exercise helps my BG levels greatly, I can counter any post meal spikes quite easily if I do some gardening or a bike ride, so it's not reflective of your insulin production/control, but it is definately something you should continue to do

 

[sololite]

Thank you Juicyj. Your reply has given me the lift I needed. It's been so tempting to get a good score after exercise and think thats it - I've cracked it. I didn't know about the potential for the Levemir to not go the full 24 hrs. I experimented with eating earlier last night and getting my carbs in earlier in the day, I will try this for a while and see what happens. Today I am having a good day and I hope you are too.
regards,
Chris

 

[thequo]

Hi everyone, I am back with more questions, thanks for your support.

I am LADA 1.5 and been taking Levemir once a day at 10.30PM

I started on it 6 months ago when my diagnosis was switched from T2 to T1.5

I started on 2 units, then went to 4 and now on 6 but close monitoring of my BS over last 3 weeks is showing that my control is poor even though I am eating properly and exercising. I usually wake up with an 8, sometimes will spike at 10 2hrs after eating but then at other times will see 5's, 6,'s 7's - there is no pattern I can determine by analysing my diet/BS scores

I have 2 questions: 1, the markers on my pens go all the way up to 60 and my diabetic nurse is always asking me to try 1-2 more units until I get things under control. Is this what others were advised? 2, at what point have people been told to switch to meal time insulin and what are the deciding factors?

I can see that for last couple of months that I have been kidding myself that the great BS scores I get when I do loads of exercise are reflective of good control when in fact this may not be the case.

thanks for listening

How is one diagnosed as Type 1.5 and what are the differences from Type 2?

 

[librarising]

How is one diagnosed as Type 1.5 and what are the differences from Type 2?

http://www.diabetes.co.uk/forum/thr...ver-genetic-features-of-lada-diabetes.120410/

 

[CHIET1]

Hi Sololite,

I see myself as a T1, but I still have create some of my own insulin which was confirmed by a C-peptide test. That was three years ago now though. Anyway, some might consider me a 1.5 or LADA as I still create some insulin, but not enough to maintain what is considered normal blood sugar levels.

Anyway to your questions, I take 4 units of Levimir in total and I split this into two injections of 2 units. One before bed, normally around 11pm and one injection upon rising normally around 7am. This seems to work well for me, but of course our individual insulin needs are very different. The key thing I believe with the basal insulin dosage is whether or not the dosage you take keeps your BS levels stable through the night. With my current dosage, my variance between my last reading at night (before bed) and upon rising is usually within 0-0.5 mmol/l , I am happy with that.

Of course if I eat late or do exercise late in the evening, this is also going to affect by blood sugar levels overnight.

 

[Jordi77]

I'm taking 44 units at 2030 each night and I am also taking novorapid before each meal and I wait for 30 minutes after I take it to have something to eat and when I place it in my thigh I get a slight lump for a hour or so which is the insulin and when I check the lump it has gone and it is not a insulin on insulin lump it's the injected insulin and I have had the lumps of over use of the same place before and I will try not to use the same spot for a few days so that it can heal and I will use it again after that and I am always trying to sort out the best places to inject each night as I don't have much fat to inject in to as I lost all my weight over a few years and I am slim and only have the option of my stomach and leg's

 

[sololite]

Hi Sololite,

I see myself as a T1, but I still have create some of my own insulin which was confirmed by a C-peptide test. That was three years ago now though. Anyway, some might consider me a 1.5 or LADA as I still create some insulin, but not enough to maintain what is considered normal blood sugar levels.

Anyway to your questions, I take 4 units of Levimir in total and I split this into two injections of 2 units. One before bed, normally around 11pm and one injection upon rising normally around 7am. This seems to work well for me, but of course our individual insulin needs are very different. The key thing I believe with the basal insulin dosage is whether or not the dosage you take keeps your BS levels stable through the night. With my current dosage, my variance between my last reading at night (before bed) and upon rising is usually within 0-0.5 mmol/l , I am happy with that.

Of course if I eat late or do exercise late in the evening, this is also going to affect by blood sugar levels overnight.

Thanks for sharing this. Sounds like your control is super tight - congratulations

 

[sololite]

I'm taking 44 units at 2030 each night and I am also taking novorapid before each meal and I wait for 30 minutes after I take it to have something to eat and when I place it in my thigh I get a slight lump for a hour or so which is the insulin and when I check the lump it has gone and it is not a insulin on insulin lump it's the injected insulin and I have had the lumps of over use of the same place before and I will try not to use the same spot for a few days so that it can heal and I will use it again after that and I am always trying to sort out the best places to inject each night as I don't have much fat to inject in to as I lost all my weight over a few years and I am slim and only have the option of my stomach and leg's

Thanks for sharing this. There is certainly huge variation in what we are all taking isn't there. I switched from top of leg to my stomach as I didn't seem to have enough flesh there. I too have the slim thing. I don't get lumps just an occasional bruise and once scarily a bit of blood but maybe I just hit something like a small vessel.

 

[Star_Anise]

Hi there

I was LADA / 1.5 for a few years
I was mis-diagnosed 2010 as T2 then T1 (or slow onset T1 or LADA/1.5 etc) in 2011.
I was in honeymoon quite a while really until this year but pretty much since 2014 I am producing less of my own insulin overall as you'll see below from my basal changes over time.

I used to inject tiny amounts of insulin an was on 6u of Lantus however it gave me hypos every 3/4hrs (not commonly reported but for some diabetics this does happen).

I remember eventually moving to a 10u of Levemir daily for just less than a year. I was also taking bolus insulin with meals pretty much from the start too.

Eventually my morning readings showed higher than bedtime so my Levi was split equally into AM and PM doses advised by DSN. Taken at 7am and 7pm.

I hated having this regime to be honest (reminder alarm...going off at the cinema and on nights out....) but eventually got used to it. It gave me flexibility to reduce either dose following exercise. It was liberating and I felt better overall.
This worked for a while but my morning readings started becoming a problem again.

The Endo then advised notching the PM dose up by 1-2units and leave AM as it was.
So I was on 10u PM and 8u AM. I had to do a 2am nightime basal test a couple of times to ensure my background was holding stable until I woke up.

This worked ok but I was then beginning to have challenges with my menstrual cycle. I had come off the pill in 2015 so my diabetes has become quite affected by the hormones changes really since 2016 and more so this year.

I also did a DAFNE course 2015 which was fantastic and helps diabetics learn a different but methodical approach. I can't recommend this enough so get yourself on the waiting list when you move to a basal and bolus regime.

The DSN suggested the "rise and rest approach" after some latest medical research. I don't know how it works but it does.
I take my PM dose just before bedtime and AM when I wake up (always ensure minimum gap of 12hr between the two). I found this worrying to start about forgetting bed dose...but always have my diabetes kit out near me. ( also I use a Timesulin cap on my pen so I can see when I last dose. A lifesaver!)
If I have a late night social event I just take it 10pm/11pm (and carry on with socialising) and take AM dose when I wake up (as long as 12hrs have passed).

I now find the "rest rise" approach more freeing, no set alarms.

Your basal needs (and bolus eventually) WILL change during your LADA journey.

The past several months I am typically 8u AM and 8u PM (what? No morning blood sugar rise? I know...mystery)
but due to my hormone cycle my basal increases so I am then 20u AM and 10/12u PM! So double then I have reduce it all back down with 3 days (oh the hypos!).

So my diabetes has become very challenging lately and my Endo recognises this. I am struggling despite being very fit and monitoring and managing my diabetes around exercise as well as hormones.
I will be getting a pump in Feb 2018 (after I return from my travels). I was put off getting a pump in the past as it was too much psychologically but it is something I evidently need now to help automate my fluctuating basals.

Hope my story gives you some insight on how LADA can progress to full on T1 and your body's insulin needs will change over time.

 

[CHIET1]

Thanks for sharing this. Sounds like your control is super tight - congratulations

No problem!

I have been maintaining blood sugar between 4 - 7 mmol/L for a while. I rarely get a number >7 now as I eat very low carb. Mostly the numbers are in the 5's and 6's. Its not easy, but it works for me generally quite well. I felt awful eating higher carb and trying to cover with higher insulin amounts. Still suffer from insulin resistance as well and my cholesterol is up due to the diet probably, but priority #1 is blood sugar control.