2 doses of Levemir?

[scoobysnack]

Hi

Just responding to something Abi mentioned in a post about taking to Levemir doses in a day. Does anyone do this? And if so how do they find it? Sounds interesting - to me the basal unit is the hardest thing to adjust because you don't see the immediate results you do with Novorapid. I'd be very interested in anyones experience of trying this as I haven't experimented with it much. I've always taken 14 at night (and 3x10 novarapid daily).

thanks

 

[Abi]

Some people find that once daily works fine for them. Interestingly I was advised to take it twice daily from the very beginning- I tend to often eat quite late and levemir can fade well before 24 hours is up- so it was felt that twice daily would be better as there would be no gap when both long acting and fast acting insulins are running out. I think that those on higher doses are more likely to get 24 hour coverage. If you are finding that your blood glucose is difficult to control in the evenings, or that your levels drift up if you delay your evening meal then twice daily levemir may work better
Lantus is thought to last longer and many health care professionals I have spoken to have said that needing to split the dose of lantus, is rare. I spoke to an Aventis rep recently who said that it may fade before the 24 hours is up in people on smaller doses. DSNs have said that people on very large doses may be better splitting it. I notice from various forums that in reality a lot of people seem to take it twice daily and have read reports of it's duration varying from 11 hours to 26 hours

 

[scoobysnack]

Interesting. If you were to split it would you half the dose? No diabetic specialist has ever even mentioned this to me. Hypo's for me are more common in the mornings and I never really feel relaxed until i've had lunch. My control is pretty good generally though, but some evenings I find i'm high and take the Levemir early (or a small dose of novarapid if it's very high). Thanks for the info, think i'll look into this.
Tim

 

[Abi]

I notice that you are on fixed doses of novorapid- do you eat set amounts of carbohydrate at each meal ?. Your high evening readings may be due to levemir running out, but could also be related to variable carb intake - if this is the case - you need to work out ratios and adjust novorapid accordingly

 

[Lady J]

It is very common for people to need to split their Levemir dose (and yes, you split it in half).

This is because Levemir (and for some people, Lantus, too) doesn't always last the full 24 hours meaning that by hour 19 or 20 it is starting to wear off and they are going a bit high and struggling to correct with rapid acting.

I'm on Lantus myself and havne't found the need to split the dose, but it's very common and works wonders for some people. Incidentally, if I ever forget to take my Lantus dose in the evening before bed, I simply take half the dose the next morning!

LJ

 

[Lady J]

Snap Abi!

I was about to say the same thing. You are on a fixed dose of Novorapid?

How do you manage that in terms of carb intake? Most people adjust their dosage of Novorapid in accordance with how much carb they are eating at a particular meal, which provides for much more flexibility in diet.

If you're not already carb counting, I'd encourage you to speak to your DSN about this, or look at this online carb-counting course which is free...

http://www.bdec-e-learning.com/



LJ

 

[scoobysnack]

I admit i haven't even looked into carb counting. As I said i'm pretty good most of the time. I tend to eat the same things so the variation in diet doesn't really demand it. But I will look into that too, thanks.

 

[Lady J]

You should definitely give it a go. Depending on where your diabetes clinic is based, you could enquire about the possibility of attending a DAFNE (dose adjustment for normal eating) course.

The idea, as the name suggests, is based on adjusting the dosage of your rapid acting insulin in accordance with what you eat, in order to acheive must tighter control over the diabetes. Therefore, for a smaller meal with less carbs - such as a salad - you would shoot less than, say a meal with more potatos or bread.

Even if you can't go on a course, I would strongly advise you look into this or ask your DSN for advice.

LJ

 

[sugar]

Yup...I split my doses too...on teh advise of the consultant. I started off on 50/50 but found that I needed more at night...although I do adjust it, and my novorapid to acount for my blood sugar and carb intake.
You said that yo had pretty good control...so if that is preety good bordering on exce;;ent, I would be tempted not to change anything..but if it is pretty good, but could be improved quite a bit, it is definately worth a try.
Like Sarah said though...probably worth getting your drs opinion though...although it ofetn seem that through this forum, I sometimes know more than they do!!!!!

 

[Rick]

Scooby,
My doctor talked to me about this last year when I was discussing my triathlon training with him and he told me that quite a few diabetic athletes take two separate doses of levemir but I couldn't drag the information out of him because as my own levemir control is good (though this month's been rubbish and really annoying after a faultless January!) good he told me not to change anything. So, I guess, if you're doing well then leave it alone.

 

[SWMHO1]

I take 2x10 unit doses of Levemir, plus 3x10 units Novorapid daily. I decided to take the two doses of Levemir as I was injecting 20units each night, and this formed a pea shaped lump under the skin, plus it was a little painful. After some discussion with my specialist nurse, we decided to try the new method. 2 months in and I'm feeling great, and back in control...

 

[mikeyuk]

I split my doses as I wasn't getting full coverage (always high by the time I got home from work) and to better control the dawn phenom.

However I do seem to be taking a lot, 18 in the morning and 12 at night which is 30 units. Im fit enough and BMI is 20 or so, does this seem a lot to anyone else?

 

[Jay3109]

I split 10 morning and 18 evening. It was my suggestion to split to my DN who said (in a slightly bored way) 'oh yeah that might be a good idea if you want to' :roll:

 

[mikeyuk]

Why do most people seem to take more in the evening, wouldn't the rising dose be higher to counterattack Dawn Phenom?

 

[hazey276]

I take Levemir twice a day, i take 22 units morning and evening, i had to do this as i was running out whilst taking it over a 24 hour period. I also have Novorapid three times a day in 10, 10 and 15 units, breakfast, lunch and tea. I do, carb count, with the help of the people on this site and never snack between meals. (And no i'm no angel and i fall off the wagon sometimes but i try very hard not to). Hope this helps

Warmest regards

Hazey

 

[iHs]

Hazey

Can I ask you if you don't mind, how high or low do your bg levels go mid morning and mid afternoon?

 

[hazey276]

Hi iHs, sure i don't mind. My levels are normally around the 4.5 to 7.5, which i know some people would say it is on the high side at 7.5 but i am very much still in the experimental stage even now. For instance bread doesn't really affect my levels that much but the much advertised pasta, rice and especially "potato's" send my levels sky high. Before i went on the split dose (Levemir) my evening levels were in the 10 to 13 region.

Hope this helps, if you need any other info don't be afraid to ask

warmest regards

Hazey

 

[iHs]

Hi iHs, sure i don't mind. My levels are normally around the 4.5 to 7.5, which i know some people would say it is on the high side at 7.5 but i am very much still in the experimental stage even now. For instance bread doesn't really affect my levels that much but the much advertised pasta, rice and especially "potato's" send my levels sky high. Before i went on the split dose (Levemir) my evening levels were in the 10 to 13 region.

Hope this helps, if you need any other info don't be afraid to ask

warmest regards

Hazey

Hazey

If your bg levels are between 4.5 to 7.5 two to three hours after you have eaten breakfast or lunchtime meal, then on a bolus of 10 units, I would say that you need to eat a small snack to avoid going hypo before lunch or evening meal. Bolus insulin can stay active for a good 4-5 hours depending on how much is injected and of course how much carbohydrate is eaten.

Has your consultant or dsn advised you against snacking?

 

[Trinkwasser]

I just met someone elsewhere who got a maximum of seven hours out of Levemir. So much for once a day dosing! Fortunately Lantus works for him.