levemir split???????????what levels????

[megan]

hi,

anyone have any ideas on what to do when splitting levemir.

I have just switched from lantus to levemir. have had very bad sugars. am now on first day of split that has been self prescribed. cannot ask dr's or nurse as of no help at all. Its my life and I don't like it being played with.

my husband is being very supportive and we are writing down all that is happening. I did testing every 2 hours last night. after having 10 units of levemir at 8.30pm. bloods stayed at 15 to 16. took correctional of only 2 units novorapid at 5 am to attempt to keep bloods down a little without over correcting as new medicine regine.

took second dose of 18 units levemir at 8.30 am this morning. corrected properly and bolused for breakfast. thought that now I had on board my 28 units of levemir that things might start to level out.
but it didn't. stayed high for the rest of the day. had to correct at lunch time and in the afternoon.

good for dinner, but can already feel it going up. am now coming to my second round of the new levemir routine. does this mean it will get better for tommorrow or am I doing something wrong?

please help. I have ordered the John Walsh insulin book that has been recommended.
I have been on the DAFNE for about 5 years now. I was on lantus last week. am on novorapid as well.

really not sure how to proceed.

 

[timo2]

hello megan,
you'll need roughly 20% more levemir compared to the same dose of lantus.
You may need to alter the ratio between morning and night - it tends to be
a bias toward the morning dose (example: add up you total daily dose and
then split 60% morning 40% evening ).
Remember these numbers are only rough, but I hope they're some help.

You may also want to forget DAFNE while you're tweeking your basal
insulin - stick to a higher set mealtime dose and take the carbs you
need to deal with it.

good luck,
timo.

 

[loopy-loo]

Hi,

I have recently switched from insulatard to levimir. Previously (on the insulatard) I split my dose between every 12 hours and took roughly half for the daytime dose. ie: 10units at night (just before bed)and 5 during the day (generally at the same time as lunch).

I have been on levemir for about 3 wks now and have been taking exactly the same dose as before, ( but without the need for snacking, which I had with the insulatard)and after a rough couple of days when I seemed to be running slightly high - things seemed to have settled a bit now.

I also self - prescribed the split, but I did mention it to my consultant when I had my annual review, and he said it was exactly the right thing to do.

Give yourself a few more days, hopefully thing will even out.


Good luck

Have just read Timo's reply and realise it may be the complete opposite but hopefully you can find some common ground somewhere!

 

[timo2]

I did say the figures were rough, no two diabetics are the same.
make any adjustments slowly and dont stress out about it.
(because stress will mess your sugars up even more).

 

[sugar2]

What Timo said really!
I am on split levimir too, but I went from lantus to split levimir with my consultants help. I would give it a day..and then increase the levimir doses...or course, do it slowly! I can not remember exactly what the levles were...but I do remember that they started me on a dose, that they knew was not really enough, rather than starting to high...and having me live in "hypo land" for a few days. The other thing to look at, is when you take the doses...I have mine at a bot 7 am, and 10.30 pm...although I think my consultant reccomends doing the second levimir dose with my evening meal...I haven't, as my current regime works for me. The reason I swapped was because my basal lantus seemed to be running out at night :?: Just thought I should mention this, so you know where I was starting from! Good luck!

 

[martinbuchan]

What a great topic. I was just about to start this myself.

Was on LANTUS 66 units. Swapped to Levemir initialy 20/40. Increased doses slowly due to a variety of reasons, to 30 morning and 70 at night (infection in foot and off work). Was told to take one third of total dose in morning (this is to combat late morning insulin resistance I was told). HBA1c went from 6.5% to 5.9%. I want to control overnight BS to limit any exaserbation of my neuropathy. I suspect that the bigger dose at 6pm will be more suitable than the other way round.

Interesting that one poster states you have to increase dose by 20% compared to Lantus (might explain the psuedo-myth that levemir is less weight inducing).

I also find my daytime BS is good due to work demands. I will probably increase the proportion of my levemir to the evening bolus. Now reduced my morning BS to 5.0-5.5. (was running at 6.0 for a couple of weeks prior to the change in ratio of basal dosing). I find that I alter the morning basal dose to reflect the kind of day I am going to have eg 30 units for a lazy day, 20 units for a day in operating theatre.

my diabetologist might give me a trial of Insulatard. And even actrapid for certain meals (I think novorapid is too short acting for curries). I am quite interested to try different regimes but am aware my diabetes has never settled since diagnosis 18 months ago. Also want byetta or sitagliptin but that raises a whole new set of questions.

I wanted to change from Lantus because of weight gain and becasue I was topping up novorapid after the main bolus injection with the evening meal. However, upon reflection, I was under dosing with novorapid. When I was on sick leave I was much more experimental with bolus doses. I now get a bit annoyed with myself if a 2 hour post prandial BS is more than 6.0 .

Interesting topic.

 

[timo2]

although two dose basal regimens are ultimately better than single dose, they
can be a real pig to set up right.
It's interesting to see a night time bias on the split from people so far.
I think the reason others run a higher morning - lower evening dose is if
they have problems with night time hypos. Also having more basal insulin
during the day could make any adjustments to the
rapid doses(as with DAFNE) a little more forgiving.
But I guess it's horses for courses.

 

[kareeta]

Hi All

I have tried this regime twice unsuccessfully. I don't think I gave it enough time to settle down though as four or five days with really high results made me go back to one levemir at night. I gave up because everytime I get to day five of highs I get an infection, usually thrush (sorry for tmi)

Anyway I have asked to join the next Dafne course and I'm hoping to run the split 3rd time luckily alongside the course, may as well use the expertise !

Fingers crossed I will do as well as some of you seem to be doing, sick of ever increasing the night time injection and still waking up at 15/16

 

[megan]

what a fantastic debate. I've not been feeling very well for a few days and so have now only just come back onto this.

Thank you for the great responses. It gives us all something to work with. I was told several years ago about insulin resistence and that I needed less insulin, but not how to actually do it. I reduced my doses and got terrible sugars and after a less than a week I gave up on it as I felt awful and it wasn't working.

I have been reading all the advice from these forums and others and have had some advice from else where from some kind people willing to listen. I have cautiously proceeded. its been frightening going to bed on new unchartered territory not knowing whats going to happen. but I set my alarm clock to do tests through the night.

Basically even when my sugars have been consistently high before a meal, I have at present stopped taking a correctional bolus and taken the novorapid I need to cover the meal.
I wasn't sure about it, but it was explained to me it would be the only way for me to combat the insulin resistence.
two days on and I am noticing a couple of small improvements. don't know how long it will last, but what i do know is that despite what some of the blood results have been, there has been consistency that I can now work with. I can identify which insulin I need to tweek first.
also, not correcting has brought me some improvements.
wow..... its sounds very odd but it seems my body is starting to make better use of the insulin I am giving it.
I was also advised though that this could take 2 -3 weeks and to take care and ride through some of the highs. the ketone blood stick will come in handy for this of course!

I feel more positive already. Its tiring though......... but hey where theres a will theres a way!!!

am at moment on 16 : 16 levemir split 8.30 am and 8.30pm. mostly 2 units for 10g novorapid. but am occasionally toying with 1.5 units for 10g with higher boluses of novorapid.

after the lantus switch I had 2 days that my novorapid intake was incredible with correctional. now I have managed to get it back down so my total insulin in the day is approx 60.

thanks guys.....will let you know how it goes :wink:

having support makes a world of difference, with like minded people with the same goal.

 

[LittleSue]

Sorry I've come late to this discussion. I switched from glargine to levemir and then split the dose when I started DAFNE. Unlike others I needed 14 of glargine but was hypoing nightly on 8 of levemir. Took about 3 weeks of testing during the night to get it settled but worth it in the end. Currently take 4 units am and 3.5 units bedtime. I've found that BG stays level (within 1mmol) until around 5am when they rocket, but at least if high at b'fast i know they've not been like that all night. Maybe the levemir is wearing off, I know lower doses don't last, but if I increase the dose I go hypo instead so this seems a reasonble compromise..

 

[rainbow fish]

hope its ok to take the tread in a slightly different direction...

I am on 24 units of levemir in the evening, what would be the indications that it would work better in two smaller doses? At the moment the BSLs are fairly stable throughout the day but need to drop down a couple of points to be ideal. I know I need to adjust the metformin and or the levemir, so would be interested to know if splitting the dose might do the trick before I head back to the doctor on Wednesday.
cheers
bruce