Levemir - Once or twice a day?

Esther1411

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Hi Everyone,

Am wondering how many of you out there that use Levemir take it once a day and how many take it twice. I didn't realise that twice was an option but have been reading "think like a pancreas" and it mentions it in there. Also a few people on here have posted about splitting their dose. Until recently I have been doing quite well but after a few too many morning hypo's I reduced my Levemir to 18 units (from 20) which I take at 8 pm. Now my levels are creeping back up again and I'm not to sure what to do. I have started by extra testing and careful noting of levels/carb intake and Novorapid doses and then plan to get about a weeks worth and decide what to do. Would like to hear from anyone using Levemir on how many times a day they take it. Also any other comments/advice would be really welcome before I come up with my cunning plan.....

Thanks in advance to anyone taking the time to reply.

Esther.
 

noblehead

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I don't take it now Esther but did change over briefly to levemir a few years back, when I did I was on a twice daily dose. If I'm not mistaken very few users inject levemir once a day as it doesn't last much beyond 18 hours, perhaps some fasting basal checks would be more useful instead of recording carbs and insulin ratio's, this way you can identify when and how much your bg is rising and present this to your DSN to advise on.
 

alohanicky2009

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Been on levermir for a long time in excess of 10 years started once a day but didn t cover 24 hrs so inject twice a day, but consultant is thinking of switching me over to Lantus, I said I want to wait to see how my levels will be after I have done DAFNE course in a couple of weeks time,


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Daibell

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I am on once a day. Before my nurse added Novorapid I suggested splitting the Levemir to twice a day but she preferred to add the Rapid. She appeared to believe the manufacturers saying it lasts 24 hours and in fact showed me a technicolor chart 'proving' it (the power of drug marketing guys!). Now I've got Rapid as well it doesn't matter as towards the end of the day I just take the appropriate Rapid dose with dinner to compensate for the Levemir fading. It does appear that Lantus lasts longer than Levemir but is slightly more peaky and I've read stings a bit more.
 

nicolan6534

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Hi I split my Levemir into 2 doses, taking just over half on a morning and the rest on an evening. I've found this to be more beneficial than 1 dose.


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mentat

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Hi Esther,


From your description it sounds like your morning readings are the main problem? If so then you should see if you can work out why.

The most likely reason is that your sugars the night before have been changing. For instance, if you're high the night before you'll tend to be high in the morning. (Your body can keep digesting dinner while you sleep, so if you go to sleep only a few hours after eating it can be hard to work out what's going on.)

However, some people (like me) find that their insulin needs just wander around for no reason whatsoever. I take Lantus instead of Levemir, and over the past three weeks my Lantus needs have dropped from 10 to 3 units per day.

A common reason for changing dosage needs is the effects of the "Honeymoon period" where the pancreas continues to produce some level of insulin - you seem to be recently diagnosed so this could be what's going on. But all sorts of other factors like hormones, stress, the weather, sickness, exercise, and your weight can interfere with your body's insulin needs. I've never figured out what makes my insulin needs change, I just do my best to keep up.

With regards to splitting your dose - in theory your Levemir should keep your sugar stable if you cut out meals and rapid insulin. You can try skipping a different meal each day and watching how your sugar changes over that period. E.g. if you skip dinner and find your sugar is rising in that period, it's probably because your Levemir is running low and splitting your dose could help.

IMO one of the most important things in good control is keeping your sugars stable overnight - go to bed with good readings and wake up with good readings as much as possible. Since you spend 1/3 of your time asleep this is a great way to reduce your HbA1c without doing much work.


Cheers
 

Esther1411

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Hi Me again,

Thank you so much guys for taking the time to try to help me, I really appreciate it.

Thank you also Mentat and Diabell for the "skip some meals" suggestion (I'm guessing that is what "fasting basal tests" means) that really sounds like good fun !! LOL. Seriously though I have loads of meals that don't include any more than 20g of carbs would that count d'you think? Or does protein do something naughty too? For e.g. I might have two boiled eggs with a green salad for lunch then I wouldn't take any novorapid. So in theory my levemir should keep me on track right?

Also my DSN recommends that I should only adjust my dose if I have high/low readings 3 consecutive days in a row. Is that what everyone else does? (I love her by the way - she is awsome).

Yes I would love to keep my sugars stable overnight, but how d'you know? Me-thinks maybe I'm not, because sometimes I wake up feeling like rubbish and actually if I'm gonna have a hypo it's usually in the mornings.

I have changed one thing recently, well begining of september if that counts as recently I started back going to the gym. At first I felt great and no significant change in my BG levels ( so hopefully not that then) and now I still really enjoy it but my levels are a little messy...

Once again, any advice gratefully accepted.

Esther x
 

alohanicky2009

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Yes agree totally with DSNURSE and my own experience don't reduce or increase levermir unless three days readings are high or low and adjust by 1 unit , also ensure that there is no other probable reason why readings might have changed , stress cold or even recipe change in food. But again as you can see from the posts there are a lot of us who can vouch that Levermir does not cover us for 24 hrs and yes do a fasting basal to see if you are near the perfect dose, also I give just over half on am dose little less at pm


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mentat

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I'm low-carbing and I find that I need to count 50% of the protein in a low-carb meal as if it were carbs. E.g. 10g carbs and 30g protein is like eating 25g carbs only.

If you want to see what happens at night you can set an alarm at 1am one night, 4am another night, see what your sugar levels are at that point. The idea is to keep your sugar good for most of the night - it will inevitably rise for a couple hours in the morning but if you can get 6 or even 8 hours of good sugars each night you're doing yourself a lot of good. It's not much fun getting up to check, but you only need to do it occasionally.

If I get a hypo I don't wait 3 consecutive days, I reduce my dosage the next day just in case. If I get highs I will typically wait up to 3 days; if they're really high or get higher every day then I'll increase my dosage sooner.

Keep a sugar diary and see if there are patterns in it. Maybe your sugars are lower the day following a gym day?

Cheers
 

Esther1411

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Hello Me Again!

Right so definately need to do this fasting basal testing to find out whats going on then.

I'm kind of desperate (using the term loosely, I'm quite a laid back kind a gal) to get my stuff on a bit of a better trak as I'm going on holiday on tuesday and not only will there be a four hour time difference it will be quite hot and I will be staying in a hotel, which I always find quite difficult food wise, however very lovely in every other way! :D

So for the last two nights I have gone to bed at a round 8 then tested at 4 am last night 5.2 and 3am thursday night 5.3 - so all good.(don't have to set the alarm, wake up at all sorts of time through the night just randomly) Then both mornings have woken at 4.3 and 4.2 respectively this morning I was shaking like I was quickly heading to hypo, I didn't actually get there luckily I got up quickly and had my breakfast - so no problem there but if I had of been in hotel I wouldn't have been able to get my food quick enough - and anyway feel that is s bit low to wake up to.

SO if this carries on for tomorow too then the advice would be to lower my levemir? BUT my HBA1C has gone up not down, I am fairly confident about my carb counting and insulin ratio but have not been adding anything for the protein I eat (quite a lot) maybe I need to look into that.

MAYBE either I need to increase my ratio for fast acting insulin in the afternoon evening (although I tend to get my carbs in in the mornings if I can) OR my levemir is not covering me for those last four hours and that is increasing my levels.

Am I getting this right or is this a lot of waffle?? "golly gosh" this diabetes is a pain in the seating area!

Hope everyone has happy levels today and a nice weekend x
 

noblehead

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I would knock 1 unit off your night dose so that you not waking up in the low 4's, as you were shaking on waking it might have been you had gone hypo in your sleep. (google Somogyi Effect).

A fasting bg check is just that.......you don't eat anything. The advice is to just drink water in-between, so if you are testing to see how your bg fluctuates between breakfast and tea you would eat breakfast as normal (make sure it's low in fat) and then begin to test your bg 4 hours after eating, you would skip lunch altogether (including your insulin) and continue to test every hour up until tea-time, by rights if your basal insulin is set at the right dose it shouldn't increase or drop by more than 1.7mmol/l, if it does then you need to increase or decrease your basal dose. Best to do fasting bg checks on a day where your not going to be particularly stressed or more active than usual.

As for protein, it converts to glucose in the absence of carbs by around 50%, I find I need nearly as much insulin for low-carb meals with protein than I do for a meal with carbs and a moderate amount of protein and fat.
 

Esther1411

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wow I have a lot to learn!

Think I'm gonna have to leave the fasting testing until I get back from my holiday unfortunately. So probably gonna have to live with my messy numbers for a couple more weeks.

Noblehead (thanks for your response by the way) do you mean my levemir by my nighttime dose? Maybe I could drop that before I go to stop these morning lows - whatd'you think?? Even though I've been seeing some high numbers.

I don't think anyone has ever mentioned to me about using insulin to cover protein, but now that you've said it it does make sense, otherwise where would we be getting our energy from.

I'm going to take some reading for research to read on the beach (sorry to mention the beach to anyone not enjoying our oncoming british winter!). Any recomendations would be welcome, especially re. the protein thing, but anything I can learn from would be good.

Esther x
 

Daibell

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Hi. Yes, it looks like a small reduction in the Levemir might be needed? I find as others do that Levemir only last 18 hours max so I tend to take a bolus in the evening to match both the carbs via counting and perhaps a little bit more as the Levemir has worn-off and I don't split the dose. Your Levemir units seem slightly high and I wonder whether you are a bit overweight and have a bit of insulin resistance; only guessing. Perhaps reducing the breakfast carbs might help with the HBa1C?
 

noblehead

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Esther1411 said:
Noblehead (thanks for your response by the way) do you mean my levemir by my nighttime dose? Maybe I could drop that before I go to stop these morning lows - whatd'you think?? Even though I've been seeing some high numbers.

Well looking at your second last post Esther where you say you went to bed with a bg reading of 8 and woke to readings of 4.2 and 4.3 I would say you need to reduce your basal insulin further, a 4mmol drop overnight is quite a considerable drop.

Sometimes morning high's can be a result of DP, the Samogyi Effect I mentioned earlier and what you ate the night before, if you eat a high-fat meal the night before this can result in unexplained high bg readings the following morning, Gary Scheiner mentions this in the book you are reading but here's an explanation of it I found on-line:

http://www.mendosa.com/The-Fat-of-the-M ... lucose.htm
 

Esther1411

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Thanks Noblehead and Diabell,

Think I'm gonna drop the levemir by 1 unit tonight,(or maybe wait one more day) although I am convinced at the moment that this 18 hour thing is causing me issues and am reluctant to increase my novorapid especially at dinner time (by that I mean the evening meal) cause I HATE HYPOS, at the moment it seams like you either run the risk of having high levels or run the risk of hypos - yuk yuk yuk!!!

I have my carbs in the morning because I think the begining of the day is when I most need the energy. I am finding that I drop 2-3 mmol during my gym session so my reckoning was thats a good time to take on the carbs. I'm still fairly new so forgive my ignorance. I don't eat that much fat (NOT cause i don't like chocolate cake, cheese, chocolate, butter, chocolate...and ALL those yummy things), I am 9st and 5ft4.5, and almost 48 yo, and my last HbA1C was just short of 9 so what am I doing wrong - its so annoying

Esther x
:? :? :? :? :?
 

Glen

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Twice a day. 50/50 twelve hours apart.
 

mentat

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Hi Esther!

I did some more reading, and it seems likely that your Levemir does most of its work at night and doesn't do much during the day, so basically you have hardly any basal insulin during the day and rely on your fast-acting instead (have a look at this chart - Detemir means Levemir). I do think splitting your dose could help you. Having enough basal during the day means that having your meals a bit early or late will have much less impact on your sugars.

If you start doing a twice-daily Levemir, I don't think you'll need to reduce your nightly Levemir much. But you'll probably need to reduce your fast-acting dosages, since you'll have extra Levemir acting during the day. It will take some fine tuning and fasting tests to get it right and it's probably best to wait after your holiday!

I know what you mean about hypos; I know everyone experiences them differently but for me it's like I've been injected with a torture chemical by some military interrogators. A feeling I would not wish on anyone. And it messes me up emotionally for the rest of the day.


Esther1411 said:
I don't think anyone has ever mentioned to me about using insulin to cover protein, but now that you've said it it does make sense, otherwise where would we be getting our energy from.

We can actually get energy from carbs, fat, OR protein! However, blood sugars are mainly affected by carbs and protein.

All carbs that your body absorbs are converted to glucose. If you don't eat much carbs, the body converts some of the protein you eat to glucose (the remainder of the protein is used for cell-building purposes). Your body can break stored fat down into glucose if it really needs to (this results in ketones!) but the body rarely resorts to this in substantial amounts.

While all organs can get their energy from glucose, muscles and some organs can burn fat (actually, fatty acids), but the brain and several other organs can only use glucose. However, when your muscles burn fat instead of glucose, the liver doesn't need to release as much glucose into the blood, and the muscles don't take much of it out! This is part of the reason a low-carb diet simplifies diabetes management and tends to make sugars more predictable.
 

mon

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Hi Esther
Yes splitting your dose would definately give you more control in my personal experience. I was on Lantus for years which did not control blood sugars ( I did fasting tests and blood sugars consistently rising throughout the day) . After doing a dafne course they recommended I split my Lantus dose as most people get more control this way even tho its supposed to last 24 hours. I then switched to levemir and am taking 8 units pm 9 units am and things are much better now.


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paul-1976

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mon said:
Hi Esther
Yes splitting your dose would definately give you more control in my personal experience. I was on Lantus for years which did not control blood sugars ( I did fasting tests and blood sugars consistently rising throughout the day) . After doing a dafne course they recommended I split my Lantus dose as most people get more control this way even tho its supposed to last 24 hours. I then switched to levemir and am taking 8 units pm 9 units am and things are much better now.


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I was also told Lantus has a 24 hour profile-In my experience it didn't so I split it 50/50 and it made a good deal of difference-HCP's really need to take that on board as an option.
 

Matin

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I have levemir overdose, doing phycical work, felt hypo, blood pressure increased. After that, I tried to refix levemir dose,
But it is not following any pattern. Once 22+7 worked for few day, but for stress test(Cardio) my endo reduced the night time levemir to 12 only, after that it is not showing any pattern, more over I am having bad feeling, alwayes shaky., eye blurriness etc

Is levemir giving the reaction? Should I use it? Or it should be replaced by lantus or NPN? Will those two insulin work for me if levemir is ommitted?