NovoRapid and Levemir combination

[tresadern]

My advisers have suggested I take novo rapide before meals with the dose depending on pre meal sugar readings and the size and content of the meal. Fair enough and although I don't calorie count (I'm too thick) I think I'm getting better at getting the dose right. My 'team' also advises a rigid regime of 30 units of levermir every night before bed irrespective of my pre-bed reading. But much to their consternation I refuse flatly to do this and instead, based on experience, I inject 5 units of levermir for every point that the pre-bed reading exceeds 5 (to suit the 5-7 recommended range). For example if pre-bed reading is 10 then I inject 5x(10-5) =25 units. For a pre -bed reading of 12 I take 5x(12-5)=35 units. This seems to work very well and my waking readings are 5 to 7 most of the time. If my pre-bed reading is low, say 3 or 4, I skip the levermir to avoid a hypo. (On my formula, taking the recommended 30 units on a pre-bed reading of 4 would give a theoretical waking reading of minus 2! which, if my body didn't alert me I wouldn't see. I did stick to the rigid 30 units at night for a while and did experiencee 3 night time hypos and don't want another.
I'm sure the rigid levermir regime is well thought out, medically sound, well tested and researched. But I will stick to my guns and take the other professional advice I keep reading that diabetes control should be self managed.
Any views etc would be greatly appreciated.
Tresadern

 

[LaughingHyena]

Re: Novo rapide and levermir combination

I'm type 1 on Levimir and Novorapid. Novorapid dose for me is based on my meal but my Levimir is more stable. I have a fixed amount morning and evening. I do adjust down a unit or two if I know I'm going to be especially active, and up a little if I'm getting a pattern of high readings.

I've not heard of adjusting the Levimir each day dependant on your bedtime reading, intersting.

I've been told it's very important not to miss one of my levimir doses, as having no insulin can lead to problems, maybe this is different for a type 2 who is still making some of thier own but the times you skip the dose would worry me. I would end up with a super high breakfast reading if I did that.

 

[Pneu]

Re: Novo rapide and levermir combination

Tresadern... the short answer is if you are doing something for you and it works and you have good blood glucose control then I see no reason why you should change.. it's different yes but that doesn't make it 'wrong'...

My concern here would be if you have 'poor' control say an HbA1c of 7%+.. you are then starting to increase your risk of complications and I think then it maybe that learning a new way of doing things might be a bit of a pain but in the end will give you a better outlook health wise.

Just to explain how things 'normally' work...

There are two things that cause your blood glucose to increase:

1. Your Liver that releases glucose constantly 24 hours a day 7 days a week... this is to 'power' your body.

2. Carbohydrate that you eat that is converted to glucose to be stored in your body.

The amount of glucose that is released by your liver is pretty constant and therefore you can inject one dose of insulin (Levemir) to cover this over a 24 hour period... now there is a bit of fussing around to get this right but generally once you have it right then you should have very stable background blood glucose.

The second insulin you inject (Novorapid) is used to cover the carbohydrate that you eat... It acts very quickly just to bring your blood glucose back to normal and will be all used up within 4 - 6 hours.

So the idea is to get your background (Levemir) insulin correct and just adjust the rapid (Novorapid) insulin to cover what you eat.

 

[Jung the foreman]

I started on Levemir 2 years ago @ 4 units in the morning and 4 in the evening, I'm now AM 100u morning and another 100u PM plus up to 30u of Novorapid per meal depending on pre-meal reading and food intake.

Levemir, has never given me a hypo, but Novorapid most certainly does if I get the dosage wrong (the opposite being that my BG levels remain too high)

I've never heard of Levemir being injected in the same way as Novorapid, as Levemir is a background insulin.

Good luck

 

[Robinredbreast]

My advisers have suggested I take novo rapide before meals with the dose depending on pre meal sugar readings and the size and content of the meal. Fair enough and although I don't calorie count (I'm too thick) I think I'm getting better at getting the dose right. My 'team' also advises a rigid regime of 30 units of levermir every night before bed irrespective of my pre-bed reading. But much to their consternation I refuse flatly to do this and instead, based on experience, I inject 5 units of levermir for every point that the pre-bed reading exceeds 5 (to suit the 5-7 recommended range). For example if pre-bed reading is 10 then I inject 5x(10-5) =25 units. For a pre -bed reading of 12 I take 5x(12-5)=35 units. This seems to work very well and my waking readings are 5 to 7 most of the time. If my pre-bed reading is low, say 3 or 4, I skip the levermir to avoid a hypo. (On my formula, taking the recommended 30 units on a pre-bed reading of 4 would give a theoretical waking reading of minus 2! which, if my body didn't alert me I wouldn't see. I did stick to the rigid 30 units at night for a while and did experiencee 3 night time hypos and don't want another.
I'm sure the rigid levermir regime is well thought out, medically sound, well tested and researched. But I will stick to my guns and take the other professional advice I keep reading that diabetes control should be self managed.
Any views etc would be greatly appreciated.
Tresadern

Hi Tresadern I too take NovoRapid and Levemir. I have been carb counting for nearly 2 years now and adjust my NovoRapid accordinly. Bedtime is Levemir and my 'usual' amount is 16, but if my BS is a bit higher then I have 1 or 2 units more, to bring it down during sleep) and if it's on the low side I have a small snack and still take my 16. If I take less, then it tends to shoot up at breakfast, but I have never, ever skipped Levemir ( but I did take the wrong insulin, only once, at night in over 20 yrs of type 1) so that is one time I didn't take Levemir, but not delibratley.

 

[Anonymous]

Hi there, if it works for you it works.
But I think that it might make things more difficult for you since changing the basal dose affects your bolus need as well. Learning how much bolus you need for different foods must be nearly impossible if you change your levemir dose daily. Also, after changing the dose the effect isn't usually seen before a couple of days has passed.
The Levemir is what should keep your bs at a steady level during the night and between meals. The basal should never be skipped - this one you take even if you're ill or is fasting for other reasons.

 

[tresadern]

Thank you so much for the posts so far - an interesting mix reinforcing the medical advice and the freewheelin' 'if it works, go for it'! Interestingly, after posting my bit I checked my bedtime reading - 26! Earlier I'd had a large pizza and a couple of mars bars (I know, I know!) but clearly didn't take enough rapide before this excuse for a diabetic meal. According to my formula, I should have taken 105 units of levermir, but I chickened out a bit and took 95. Effectively I modified the formula to 5x(bedtime reading - 7) where 7 is the upper end of the 5-7 'desired' range. The result was a reading this morning of 2.2 - a mild hypo (for me) soon sorted by lucozade. I must confess my total misapprehension and lack of understanding of the objectives of levermir and its purpose - I clearly have some homework to do and some listening to the pros - I'm not too proud to eat my words. I'm also wary of possible adverse long term effects some of you have highlighted. But last night's experience clearly shows that enough levermir can reduce sugars quite substantially in the short term (that's what insulin is for isn't it?) and that my formulaic approach seems quite reasonable. Then again........... perhaps the right dose of rapide before bed could have done the job just as well!!!!!!!
My brain hurts!
Tresadern

 

[LaughingHyena]

My brain often hurts with working out all the doses and possible things that could be affecting my sugars. Too many possibilities :crazy:

 

[Anonymous]

Hi again, just want to recommend some books on insulin use that I think are great:
Ragnar Hanås: "Type 1 diabetes..." and "Think like a pancreas" by Gary Scheiner - the two of them will get you sorted.
Best of luck to you!

 

[tresadern]

Thank you fenix92. I have 'think like a pancreas' and agree it's excellent - I've even recommended it to my 'team'. I shall re-visit it and check out Ragnar Hanas. Thank you again.
Tresadern