Issues with Levimer - advice please

[O_DP_T1]

Hi guys,

I seem to be having a few issues with my BGL over the last 10 days, once my NovoRapid runs out my levels start to rise almost like there is no basel on board. e.g

If insulin on board is <1.5u then i see a slow rise once this gets to about <0.5u then it’s a quick rise.
Nothing has really changed, diet and training are the same as usual, last few days has been quite stressful at home though and I’m not ill.

What are m options

1 - Increase my basel by say 2 units and see
2 - Split basel dose
3 - Change to a different basel insulin

I’ve already changed 2 Levimer pens incase they were off and it’s made no difference.
I’m on Levimier once a day and take it at night.
Forgot to say I'm literately taking NovoRapid every 4-5 hours to stop the rises

Thanks in advance

 

[Deleted Account]

Given this sudden change, and you are not ill, it seems unusual that your basal requirements would suddenly change (unless there was something wrong with your basal which you have checked).

You mention it has been quite stressful at home, stress has a massive impact on my BG. So this may be the cause.

Alternatively, how about a 4th and 5th option:
4. change your NovoRapid? Whilst we think of it lasting 4 hours, there is a low level of bolus still active for longer. If there is something wrong with your bolus, this may not be lasting as long as usual.
5. Talk to your diabetes team?

 

[O_DP_T1]

@helensaramay hi mate, forgot to mention i changed both my Levimer and NovoRapid pens twice this week in order to rule our bad insulin. Already trying to contact my team.

Is there anything that can be done to control levels during/post stressful arguments?

 

[Deleted Account]

Is there anything that can be done to control levels during/post stressful arguments?

The flippant answer is "don't get too stressed!"

A more helpful answer is to increase your insulin. If you are going through a period of high stress, you may want to temporarily increase your basal but, if you do this, test and remember to reduce the basal once the stress eases.
This is much easier with an insulin pump - I increase my basal when I enter a meeting I expect to be stressful and reduce basal once I leave the meeting.

The only other option I am aware of is to do bolus corrections. It sounds as if you are already doing this.

I hope the stress levels come down soon.

 

[tim2000s]

The other thing to be aware of is that Levemir is best used twice daily rather than once daily, as its action tails off based on dose size, and if you have a relatively low dose, that can be a lot earlier. In fact, your clinic should be putting you on it twice daily to align with best practices (and clinically tested best outcomes).

 

[O_DP_T1]

@tim2000s So I'm on 16u of Levimer at the moment. Thing is even when the dose is fresh and bolus wears off I end up rising.

E.g last night

8:30pm BGL before dinner 7.6 take both bolus and levimer
8:50pm Eat dinner (60g C 20g F 45gP) nothing new here
10pm 8.8
11pm 6.6
1am 11.5 so take 3 units
6:30 am 12.5 ***

 

[dancer]

You said you changed your Levemir, but we're the new ones from the same batch (same lot numbers). Just a thought.

 

[O_DP_T1]

No from a different box, that had also crossed my mind

 

[Daibell]

Hi. It appears to be very rare that an insulin pen/cartridge is the problem. I find my insulin needs rise dramatically when on holiday mainly due to carb increase and I have to make a big increase in my Levemir; same for illness. Until you see the GP I might increase the Basal further. Increasing Basal is far less risky than the Bolus and you should of course still test frequently.

 

[O_DP_T1]

Yea I may just whack an extra 2u onto the levimer tonight and see

 

[Carajuk]

I have had this exact same issue. For some reason my basal requirement has increased dramatically. Was injecting Levimer twice a day, 9pm & 9am, 35u each time. After having the same problem as above, I have increased my basal by 4u each time. I am now up to 58u twice a day but this seems to nearly be about right to keep me level. Surely this is too much though and my diabetes team should be offering to change my basal insulin?

 

[evilclive]

I am now up to 58u twice a day but this seems to nearly be about right to keep me level. Surely this is too much though and my diabetes team should be offering to change my basal insulin?

Changing the type of basal won't really change the amount you need. Basic rule is you take what you need - some people take very little, some people take a lot, and it varies massively. I think I've seen people on that sort of dose here.

If you're getting insulin resistant, that's another thing, and your diabetes team should be able to help deal with that.

 

[Knightrider]

My docs told me years ago that Levemir doesn't last 24 hours. Which may be why it isn't holding for you. I take it morning and evening before bed. In fact I've finally got fed up with it and at last got Tresiba prescribed. So now just once in the morning. And far less 'clicks' required. Different world. Really lasts.

 

[Benny G]

Levimer works best as a twice daily split basal (edited by a moderator) but this does depend on patient' needs. If you set your alarm on your phone you can keep to schedule. I inject at 12:30 and 00:30. As Levimer is an intermediate action insulin you can change dosage and benefit the same day unlike the longer lasting basals like glargine, degludec, etc


If you are presently taking a single levemir shot you can easily switch to a split dosage for better coverage.
(Edited by a moderator to remove dosage values).

 

[Book_woorm]

Nobodies mentioned checking your injection sites for fatty lumps, these are a well known cause of insulin resistance. I hope your rotating where you inject. These lumps can be quite subtle you need to look at yourself in a mirror just looking down at your belly you might not see them. Also I hope you are not injecting Levimer and Novo rapid in adjacent sites. If you do then it shortens up the length of time that you absorb the Levimir over

 

[Ermintrude75]

I'm on Levemir twice daily and novorapid. I had a similar problem last month. Bloods were higher nothing obvious to cause it. Changed both my cartridges. Still didn't work. Increased my morning Levemir. Still high bloods. I ate a bowl of porridge blood sugars were climbing even with extra insulin on board. I changed my novorapid to one from another batch. Spent the rest of the day fighting to keep my bloods up due to the extra Levemir. Blood sugars returned to normal with my normal Levemir.

Levemir doesn't last 24 hours so speak to your diabetes team before splitting the dose.

Hope you get it sorted.

 

[Daibell]

A few further points. Yes, Levemir doesn't last 24 hours but I don't split. I compensate in the evening by changing the Bolus dose to make up for the Levemir action running out. This works fine for me and saves one injection and it also makes tweaking dosage easier. I'll be honest I've never been convinced of the need to split the dose even with the 18hr or less Levemir lifetime but each to his own. For those of us who are late onset T1 (LADA) the honeymoon period can be quite long and mine has been many years. The result of this is an ongoing need to increase insulin dosage over time. The need to have very large Basal dose can be due to insulin resistance thru excess weight but this is not always the case and some people just need to inject a lot more than others. If you do have excess weight then reducing the carbs may be needed.

 

[O_DP_T1]

Good call on the injection sites.. I do end up taking both in the leg, both in different legs though.

 

[emmay]

Hi @O_DP_T1
I have been using Levimir for several years now, I take it twice a day which I would suggest (talk to ur nurse first) for the first few years I took 4u at 9am & 6u at 9pm all worked wonderfully. This year however it’s all change I think because I have reduced my carbs significantly but I am down to 2.5u at 9am and 4 at night.
I know you say not much has changed with you but life, stress, worry can have a massive affect on ur BG. I hope this helps and I hope you have the confidence to adjust as I did it is trial and error but take it slow and steady. Em

 

[MeiChanski]

I was wondering if anyone could consider that we are some what insulin resistant due to the current season? During the colder seasons, I was changing doses because I was running slightly higher and not quite as active.
Also with split levemir, you can change either morning or night dose, for example: you might need 8 in the morning and maybe 10 at night.
As for injection sites, choose those nice meaty fatty areas.

I do know some diabetics who are on about 55-60 units of levemir.