Levemir Split Doses

Diabet1c

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12
Type of diabetes
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Think I was starting to panic a little when I read how little Levemir some of the earlier posters were taking. I take 21 units on getting up typically around 7 am followed by 27 units at bedtime typically 10pm
I was as well but a friend of mine started off taking 7 units but then gradually increased so i just kept that in mind
 

Peterinkiel

Member
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21
Type of diabetes
Type 1
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Hallo and good evening from Kiel in Germany,

First don’t panic.
Please refer to my earlier post explaining how Levemir should only be a part of your treatment.

Your current dosages appear to be very high, but you should be using a rapid insulin to correct high BG )blood gliucose)Levels when necessary..

Talk to your diabetologist on the subject of basal insulin as part of your treatment.

Read my earlier post in this formal and then reply to me if you need more information.
 

smc4761

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1,039
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Hallo and good evening from Kiel in Germany,

First don’t panic.
Please refer to my earlier post explaining how Levemir should only be a part of your treatment.

Your current dosages appear to be very high, but you should be using a rapid insulin to correct high BG )blood gliucose)Levels when necessary..

Talk to your diabetologist on the subject of basal insulin as part of your treatment.

Read my earlier post in this formal and then reply to me if you need more information.


I already take Novo rapid Bolus insulin typically 3 times per day, breakfast, lunch and evening meal on top of my Levemir. Having been type 1 for over 37 years I find that my insulin doses have increased over the years. I was previously on lantus as basal until about a year ago, taking 34 units once per day, now I am on around 48 units Levemir in total over the 24 hours
 

Peterinkiel

Member
Messages
21
Type of diabetes
Type 1
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Insulin
Thanks for this important additional information.

It appears you may be still taking too much Levemir, if you regularly take 3 doses per day.

Do you have a high carbohydrate intake?
Do you measure your BG at least 4 times a day?
What levels do you have? Are you able to keep your levels under 6 mmol for most of the day or do you have dips (hypos) or high levels often?

The answer is normally to take 2 doses of Levemir per day and to compensate for high levels using Rapid insulin 3 to 4 times a day.
 

smc4761

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1,039
Type of diabetes
Type 1
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Thanks for this important additional information.

It appears you may be still taking too much Levemir, if you regularly take 3 doses per day.

Do you have a high carbohydrate intake?
Do you measure your BG at least 4 times a day?
What levels do you have? Are you able to keep your levels under 6 mmol for most of the day or do you have dips (hypos) or high levels often?

The answer is normally to take 2 doses of Levemir per day and to compensate for high levels using Rapid insulin 3 to 4 times a day.


No it is only Levemir 2 times a day morning and bedtime as well as 3 injections of Novo rapid.

Carbs intake is around 100 g per day and now having a Freestyle Libre I check around 12/15 times per day. I only reduced my carbs to a lowish carb diet about 2 months ago and have found I am having issues with Dawn Phenomenen on a regular basis as well as having highish BG during morning, around 8/9. From mid day until around 2am my BG are normally fairly good at 6/7
 

Peterinkiel

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21
Type of diabetes
Type 1
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Insulin
No it is only Levemir 2 times a day morning and bedtime as well as 3 injections of Novo rapid.

Carbs intake is around 100 g per day and now having a Freestyle Libre I check around 12/15 times per day. I only reduced my carbs to a lowish carb diet about 2 months ago and have found I am having issues with Dawn Phenomenen on a regular basis as well as having highish BG during morning, around 8/9. From mid day until around 2am my BG are normally fairly good at 6/7

Thanks again. My feeling is that you are doing exactly the right thing and you are beginning to settle into a well balanced pattern.

This is clearly good news and you should be happy with the results of your careful treatment.

Only one point troubles me and that is the fact that you are only consuming 100g of carbs per day. This is hardly enough to keep you going.,

Check this figure and let me know. Are you certain that it is not underestimated!

Keep up the good work. Believe me, it is well worth the trouble.

.
 

smc4761

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1,039
Type of diabetes
Type 1
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Thanks again. My feeling is that you are doing exactly the right thing and you are beginning to settle into a well balanced pattern.

This is clearly good news and you should be happy with the results of your careful treatment.

Only one point troubles me and that is the fact that you are only consuming 100g of carbs per day. This is hardly enough to keep you going.,

Check this figure and let me know. Are you certain that it is not underestimated!

Keep up the good work. Believe me, it is well worth the trouble.

.


Now definetley 100 g or thereabouts. Muesli and milk for breakfast typically 50 g, salad, cold meats/ tuna for lunch around 15 g
and chicken/meat/fish plus lots of veg for evening meal, about 20 g with a snak before bed of around 10 g. I have virtually cut out all potatoes, bread rice and pasta and as a result have lost almost 5 kg in 10 weeks
 

Peterinkiel

Member
Messages
21
Type of diabetes
Type 1
Treatment type
Insulin
I have 30 units at night and 3 in the morning!

Hello billy badger,

Your Levemir dosage seems completely unbalanced. Try taking two doses of approx the same amount, one in the morning pre-breakfast and one in the late evening, then check your BG Levels every two to three hours. This will avoid high BG during the daytime, but be careful to adjust your evening dose to avoid a possible middle of the night hypo. You don’t mention your dosage of bolus or rapid insulin, which is equally important.

Do you have any highs or lows with your current dosages? And what about s your carb and ntake, and when?
 

Fairygodmother

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Think I was starting to panic a little when I read how little Levemir some of the earlier posters were taking. I take 21 units on getting up typically around 7 am followed by 27 units at bedtime typically 10pm

It’d be interesting to say what age we were when we were diagnosed too: a recently published Harvard study has found that people who became T1 after the age of 18 - I think it was 18 but please forgive me if I’ve remembered this inaccurately - had some surviving though compromised beta cells. I wonder if this explains some of the differences.
Interestingly, the study called us all T1 despite the various other types that the U.K. recognises.
I was diagnosed when I was 20 and have always been treated and defined as T1. I take 16.5 units of Levemir daily, split into almost equal doses.
 

Ledzeptt

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When I was first diagnosed (as an adult), I was only prescribed Levemir at first. I wasn’t given Novorapid on a MIDI regime until I became accustomed to Levemir (and everything else that comes with Diabetes). Therefore my initial dose was much higher than it is now as a purely basal/background dose.
 

billybadger

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Messages
135
Type of diabetes
Type 1
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Insulin
Hello billy badger,

Your Levemir dosage seems completely unbalanced. Try taking two doses of approx the same amount, one in the morning pre-breakfast and one in the late evening, then check your BG Levels every two to three hours. This will avoid high BG during the daytime, but be careful to adjust your evening dose to avoid a possible middle of the night hypo. You don’t mention your dosage of bolus or rapid insulin, which is equally important.

Do you have any highs or lows with your current dosages? And what about s your carb and ntake, and when?

I know! It wasn't always like that, used to be 10 units at night and 3 in the morning, but following a virus, I developed a habit of going high in the early hours of the morning, despite going to bed in target and also needed more QA at meal times. Under guidance from my consultant and DSN we gradually increased the night time dose until I ended up with a nice flat, in target CGM trace through till breakfast. Seems to be working surprisingly well, had to adjust my QA bolus doses back down a bit, but now they seem to be sweet too, only getting lows when my activity levels are up. Due for a HbA1C check at the beginning of August so will see if this new, slightly odd unbalanced, approach works :)
 
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Peterinkiel

Member
Messages
21
Type of diabetes
Type 1
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Insulin
I know! It wasn't always like that, used to be 10 units at night and 3 in the morning, but following a virus, I developed a habit of going high in the early hours of the morning, despite going to bed in target and also needed more QA at meal times. Under guidance from my consultant and DSN we gradually increased the night time dose until I ended up with a nice flat, in target CGM trace through till breakfast. Seems to be working surprisingly well, had to adjust my QA bolus doses back down a bit, but now they seem to be sweet too, only getting lows when my activity levels are up. Due for a HbA1C check at the beginning of August so will see if this new, slightly odd unbalanced, approach works :)


Good to read your reply and interesting content. Thanks.
It is so helpful when you give so much detail, surprisingly missing from so many forum posts. Like you, I had to experiment with my Levemir and Rapid dosages to obtain a satisfactorily result. You say you use a CGM system. Purely out of interest could you let me know how you find your system and how well you adapted to it’s use?

I have been using a Dexcom G5 CGM system for nearly one year and found it most helpful. The only real problem areas have been with sensor/transmitter system nsertion, which I put down to a design fault. This appears to have been a problem for other users too, since Dexcom have completely redesigned the applicator design in the newly announced G6 model.

Keep up the good work and keep on posting to the forum.
 

billybadger

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135
Type of diabetes
Type 1
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Good to read your reply and interesting content. Thanks.
It is so helpful when you give so much detail, surprisingly missing from so many forum posts. Like you, I had to experiment with my Levemir and Rapid dosages to obtain a satisfactorily result. You say you use a CGM system. Purely out of interest could you let me know how you find your system and how well you adapted to it’s use?

I have been using a Dexcom G5 CGM system for nearly one year and found it most helpful. The only real problem areas have been with sensor/transmitter system nsertion, which I put down to a design fault. This appears to have been a problem for other users too, since Dexcom have completely redesigned the applicator design in the newly announced G6 model.

Keep up the good work and keep on posting to the forum.

I have recently been using the Libre to get patterns and CGM trends, not as pinpoint accurate as the Dexcom, but enough to get a good idea of what is going on between finger prick tests and easy and painless to apply :)
 

smc4761

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1,039
Type of diabetes
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It’d be interesting to say what age we were when we were diagnosed too: a recently published Harvard study has found that people who became T1 after the age of 18 - I think it was 18 but please forgive me if I’ve remembered this inaccurately - had some surviving though compromised beta cells. I wonder if this explains some of the differences.
Interestingly, the study called us all T1 despite the various other types that the U.K. recognises.
I was diagnosed when I was 20 and have always been treated and defined as T1. I take 16.5 units of Levemir daily, split into almost equal doses.


I was almost 20 when I was first diagnosed. If you could manage to post a link to the study i would be most interested to read, as I have not heard this before
 

smc4761

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1,039
Type of diabetes
Type 1
Treatment type
Insulin
I know! It wasn't always like that, used to be 10 units at night and 3 in the morning, but following a virus, I developed a habit of going high in the early hours of the morning, despite going to bed in target and also needed more QA at meal times. Under guidance from my consultant and DSN we gradually increased the night time dose until I ended up with a nice flat, in target CGM trace through till breakfast. Seems to be working surprisingly well, had to adjust my QA bolus doses back down a bit, but now they seem to be sweet too, only getting lows when my activity levels are up. Due for a HbA1C check at the beginning of August so will see if this new, slightly odd unbalanced, approach works :)

Interesting to read how you split your dose. I was taking around same amount morning and evening of Levemire, but I am finding that my overnight and up until around lunchtime area remaining highish. Think I will try adjusting again taking more overnight and less for mornings
 
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Fairygodmother

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I was almost 20 when I was first diagnosed. If you could manage to post a link to the study i would be most interested to read, as I have not heard this before

This is the text I found the information in - I apologise if I’ve misinterpreted it: I’m not a scientist.
I said it was Harvard, but now not sure. Either way, I found it interesting.
http://care.diabetesjournals.org/content/38/6/979
 
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Fairygodmother

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There’s also the finding that the number of beta cells we’re born with varies.
 

scotteric

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Pump
This is the text I found the information in - I apologise if I’ve misinterpreted it: I’m not a scientist.
I said it was Harvard, but now not sure. Either way, I found it interesting.
http://care.diabetesjournals.org/content/38/6/979

I could be way off, but the people I see posting about how amazing Tresiba works for them are usually newly diagnosed or diagnosed later in life. When I was first diagnosed I got by on a single dose of Levemir a day likely due to residual insulin production, and suspect this is why a single dose of Tresiba/day works for them, but I could be wrong.
 
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