Splitting Levemir - what?

[Blackie22]

Hi all,

I've been Type 1 for a couple of years now. I'm currently on Novorapid and Levemir (30u at night).

I'd never heard of splitting doses until visiting this forum. My BG control is OK... but would splitting the dosage of Levemir perhaps help me attain lower numbers throughout the day, and if so, I assume I keep taking Novorapid, but maybe reduce it? What would other users who split Levemir recommend?

I've no health problems and eat a healthy, low-carb diet. I find that regardless of how well I eat - even if its extremely high in fibre (ie. just a plain piece of rye bread - the one that 's flat and rectangular and comes in sealed packets - yeah, I like it!), my blood sugar just creeps up and up. For example, I'll wake up around 7.30am and BG might be 6.5. I'll have two plain pieces of the above 'bread' for breakfast and inject, say, 6u of Novorapid. There's nothing in the bread for christ's sake, but come 11am I'm in the double figures! I've taken to attending the gym everyday to sort this out. Its not the insulin that's the problem - I still have low's, so it does work.

However, I'm starting a new job next week so won't be able to work out in the morning. Obviously I don't want to transform into the diabetic monster by 11am, so do you think splitting Levemir might help keep number's down?

Any advice welcome!

Any advice would be greatly appreciated.

 

[loopy-loo]

Hi Blackie22

Have you read the switching levemir am pm post, (submitted not long ago). This may help you?

Regards

Lindsey

 

[Dennis]

I've no health problems and eat a healthy, low-carb diet. I find that regardless of how well I eat - even if its extremely high in fibre (ie. just a plain piece of rye bread - the one that 's flat and rectangular and comes in sealed packets - yeah, I like it!), my blood sugar just creeps up and up. For example, I'll wake up around 7.30am and BG might be 6.5. I'll have two plain pieces of the above 'bread' for breakfast and inject, say, 6u of Novorapid. There's nothing in the bread for christ's sake, but come 11am I'm in the double figures!

Hi Blackie,
When you say there's nothing in rye bread, according to the calorie counter book it does contain 30g carbohydrate per 100g, so it's not the benign food that you think it is.

 

[Geoff]

Hi Blackie, before you start to think if splitting your Levemir dosage is the way to go, you need to get your single dosage set at the right level for your daily need.

You say that you are using 30 units one time at night, and you can be 6.7 mmols/lt first thing in the morning? Is this an average number, or are you sometimes higher than 6.7 mmols/lt?

The other thing that I noticed in you post was that you think you may need to reduce your rapid insulin if you split your Levemir. Levemir is a basal insulin, it is used to set your background insulin needs throughout the day/night when you are not eating, it stops your blood glucose rising in the absents of your pancreas not doing this job, it has nothing to do with what you eat for your normal meals throughout the day, this is what your NovaRapid is for.

To be able to get good control with theses two insulins, you need to understand fully their action on your blood glucose, the Levemir I have explained, to get the best out of Novarapid you need to be able to match the correct value of Carbohydrate that you eat to the amount of rapid insulin needed to cover it, this is you insulin to carb ratio, do you know how to count carbs?

 

[sofaraway]

splitting may help you, I don't split my basal. but generally I've seen that people start with 50/50 split 12 hours apart and work form there.

I think the key thing is learning to carb count as geoff said. from your post it doesn't look like you do already. Ask your DSN if there is a DAFNE or equivelent course you can go on or get an appointment with your dieticain. it can take a bit of practice but once you get the hang of it, it's pretty straightforward

 

[lionrampant]

50/50 is too unbalanced, as I've learned from both experts and recent experience.

It should be weighted in favour of your night time dose. I.e. More at bed than in the morning.

 

[Geoff]

lionrampant it is not so straight forward as that. I started splitting 50/50, but found I have to adjust mine the less at night, 4units and more in the morning, 14 units to get the right cover throughout the 24 hour period. So as with most things diabetic, there is no black and white answer.

 

[lionrampant]

Regardless, it's a much safer route than a straight 50/50 split as a starting point.

 

[sofaraway]

just interested to why it would be unsafe to split 50/50 ?

 

[l0vaduck]

lionrampant it is not so straight forward as that. I started splitting 50/50, but found I have to adjust mine the less at night, 4units and more in the morning, 14 units to get the right cover throughout the 24 hour period. So as with most things diabetic, there is no black and white answer.

Me too. I take less at night than in the morning - 3.5 at night and 4 in the morning - not a huge difference in absolute terms but a significant percentage and that half unit makes a difference.

When I first split mine, I was inclined to do it gradually over time, taking one unit in the morning, then two, and so on, but the DSN advised me to do the split all in one go. In order to do this I had to start with a much lower dose than normal at night, which made me very high the next day and I felt terrible! If I hadn't been doing DAFNE at the time I'd have done it my way, even though it would have taken a while to get it right.

 

[lionrampant]

Hang on, are you two still in your honeymoon period?

 

[Geoff]

Hi lionrampant, I have been post diabetic now for 3 years, but my Diabetologist said to me recently that he believed that I was still making some insulin. I find this to be incredible, but it could be true as I can eat up to 35grms of carbs for breakfast, but need no rapid insulin to cover it, as 21/2 hours later my bs is back to within 0.5 of a mmol/lt, that it was pre-breakfast, but alas I can not do this later in the day, as then my I:C varies between 1:12 and 1:9. My present bs average is 5.5mmol/lt and my Hba1c is 6.1

 

[lionrampant]

Unless your background insulin is more aggressive than Mike Tyson, I'd assume you're still making something! :lol: