Adjusting to Levemir, what’s your experience?

[Fairygodmother]

Hi everyone, I was having problems with Lantus not lasting for the full 24 hours and swooping from night-time lows to evening highs. Not a good place to be.
The consultant’s prescribed Levemir.
I find that it’s great overnight until 10 hours after I’ve injected, at which point it loses potency, and then there’s the hiatus before the next dose of Levemir gets active. I take 8 units am and 8 units pm. In the evening there’s sometimes another loss of basal action, sometimes not, depending, it seems, on whether I’ve over-corrected for the lunchtime mayhem that seems to be caused by the early morning gap.

Has anyone else encountered this gap?

I’ve only been trying to sort out the ways this new regime affects me for a few days now, and the recent cold spell hasn’t helped, but any experiences/suggestions would be gratefully received!

 

[Daibell]

My understanding is that Levemir doesn't last as long as Lantus. Many split it like you but I don't and just use the right Bolus ratio towards the end of the day - simples. Do ensure the Levemir is balanced. Are you carb-counting the Bolus?

 

[scotteric]

I find that it’s great overnight until 10 hours after I’ve injected, at which point it loses potency, and then there’s the hiatus before the next dose of Levemir gets active

This was exactly my problem with it. I ended up going back on my pump, I don't find any of the injectable basal insulins are able to provide round the clock steady coverage (including Tresiba) for me. You can taking your daytime dose earlier, but then you will have a gap at night. This might be easier to deal with though unless you eat late dinners which became a problem for me when I tried Levemir. Are you able to push for a pump?

 

[Fairygodmother]

Thank you both. I confess it’s a relief to know I’m not the only one who’s experienced this. I asked about a pump, and about Tresiba but it was suggested that Levemir would be best for me.

I’ve basal tested after adjusting the initial division of the 13 units of Lantus that I used to take into 5 night time and 8 daytime of Levemir, 5 units was insufficient for the night time. I suspect I’d have required more Lantus if it had lasted for the full 24 hours.

I’ve considered delaying the evening dose until 10 pm, and bolus to cover the gap there, but feel reluctant as it’d be 4-5 hours between the time the Levemir declined and the time it took effect again. However, I don’t want to have to wake at 6 every morning to bolus for the gap that’s there now.

Yes, I carb count. I’ve already needed to adjust ratios too.

I was feeling stumped! Hence my request for ideas.

I wish there were an insulin that suited that the medical powers that be were willing to provide!!!!

 

[EllsKBells]

@Fairygodmother for me Levemir was a living nightmare. It just didn't last and it was very unstable.

It's interesting that you're splitting that way round - have you tried putting one more unit on at night and one less in the day?

The main reason Tresiba isn't suitable for someone is if they are very active, particularly if their activity levels vary significantly from day to day, because it takes a while to see the effects of any adjustments. If that is not the case for you, then I suggest you go back to your consultant and ask for Tresiba, and if he refuses you start escalating. I'm good at complaining

 

[catapillar]

You could try splitting it 3 ways if you have noticable decline at the end of both your evening and morning dose, so taking it 7am, 3pm and 11pm? You could try increasing the dosage to see if that staves off the decline (the less basal your taking, the shorter the lifespan), but you might need to adjust your I:C ratio and keep hypo treatments handy if youre taking more basal than you need and that doesn't sound ideal

You could try using lantus, but splitting it am and pm. It lasts about 18 hours and lots of people split it to take 50/50 am/pm or 40/60 70/30 whatever works.

 

[scotteric]

I asked about a pump, and about Tresiba but it was suggested that Levemir would be best for me.

I'd push for a pump, it sounds like they are just trying to save the NHS money unless there are other details I don't know! None of these basals can accurately replicate your insulin needs throughout the day. All of them require some patchwork solution to get through periods where the dose is just too high or too low.

 

[catapillar]

If you want a pump and your consultant isn't being receptive I'd highly recommend getting in touch with input diabetes - http://www.inputdiabetes.org.uk - they are very helpful and will give you assistance with the best arguments to make you case for getting a pump to your consultant, and if that doesn't work they'll tell you of other pump friendly hospitals to get referred to.

 

[Fairygodmother]

@Fairygodmother for me Levemir was a living nightmare. It just didn't last and it was very unstable.

It's interesting that you're splitting that way round - have you tried putting one more unit on at night and one less in the day?

The main reason Tresiba isn't suitable for someone is if they are very active, particularly if their activity levels vary significantly from day to day, because it takes a while to see the effects of any adjustments. If that is not the case for you, then I suggest you go back to your consultant and ask for Tresiba, and if he refuses you start escalating. I'm good at complaining

I daren’t put one more on at night as I reach bs of 4 at peak action. I hoped I would get to try Tresiba, and I’m no longer as active as I used to be before I retired, though there are times in the year when activity peaks.

I hope I won’t need to complain but I’ll be back here again if I do.

 

[Fairygodmother]

You could try splitting it 3 ways if you have noticable decline at the end of both your evening and morning dose, so taking it 7am, 3pm and 11pm? You could try increasing the dosage to see if that staves off the decline (the less basal your taking, the shorter the lifespan), but you might need to adjust your I:C ratio and keep hypo treatments handy if youre taking more basal than you need and that doesn't sound ideal

You could try using lantus, but splitting it am and pm. It lasts about 18 hours and lots of people split it to take 50/50 am/pm or 40/60 70/30 whatever works.

Now that’s a thought that crossed my mind too. I’ve still got some in the fridge!

 

[Fairygodmother]

I'd push for a pump, it sounds like they are just trying to save the NHS money unless there are other details I don't know! None of these basals can accurately replicate your insulin needs throughout the day. All of them require some patchwork solution to get through periods where the dose is just too high or too low.

Yes, I tried. I really don’t know why a pump was thought unsuitable. Maybe it’s because I’m apparently one of the 33% whose beta cells are not completely destroyed and the few that are left are limping unpredictably on?

 

[catapillar]

Now that’s a thought that crossed my mind too. I’ve still got some in the fridge!

I was told by my DSN to split my lantus before I move to levemir because I was having nasty nocturnal hypos, so I took less in the evening and more in the morning. But the point is lantus can/does work as a split dose.

 

[db89]

Now that’s a thought that crossed my mind too. I’ve still got some in the fridge!

My DSN originally suggested splitting Lantus 12h apart and I've stuck with it since - I started on 50/50 but have ended up settling for 60% in the evening and 40% in the morning.

 

[Fairygodmother]

I’ll definitely look at splitting Lantus @catapillar and @db89. How much higher are your doses than mine? Just wondering what the half life of 8u might be.

 

[db89]

Mine are actually smaller due to my honeymoon (slowly starting to go back up over the last few months) so I can only really say it probably overlaps the 12 hours for me but doesn't quite reach the 18-24 mark.

When I've taken it at night only it keeps things in check overnight and into the morning but starts wearing off in the afternoon so I was seeing a steady rise into double figures before dinner. When I took it in the morning for a short stretch I was getting dawn phenomenon. I take less in the morning as I was seeing a predictable steady drop in late afternoon towards hypo levels instead of a rise when I took 50/50. Particularly annoying on workdays when I was having to remember to scoff something small unbolused for in order to drive. Like many other things with Type 1, it works how it wants to so I've had to experiment around it and your mileage may vary!

 

[catapillar]

I’ll definitely look at splitting Lantus @catapillar and @db89. How much higher are your doses than mine? Just wondering what the half life of 8u might be.

I can't remember what my basal dosage was, it can't have been more than 12 units, and would have been down to 8 some days. But I found levemir worked really well for me. I much preferred it to lantus because I was nervous of lantus causing hypos.

 

[scotteric]

Yes, I tried. I really don’t know why a pump was thought unsuitable. Maybe it’s because I’m apparently one of the 33% whose beta cells are not completely destroyed and the few that are left are limping unpredictably on?

I think a pump would be even more useful in that case since you can take micro units of insulin and make adjustments on the fly when your natural insulin production ramps up and down.

 

[Fairygodmother]

Yes, I think a pump would be great! I believe I have very few beta cells left but if they help at all then I’m grateful. I was surprised to read that so many of us still have a few.
It’s frustrating that some clinics and doctors are more willing to explore an individual patient’s needs than others.

 

[scotteric]

Yes, I think a pump would be great! I believe I have very few beta cells left but if they help at all then I’m grateful. I was surprised to read that so many of us still have a few.
It’s frustrating that some clinics and doctors are more willing to explore an individual patient’s needs than others.

The health care system still has the mentality that the pump is a device of last resort, for those who struggle with dawn phenomenon, night hypos or "brittle diabetes".

 

[porl69]

I was on Lantus for years and had nothing but trouble with it. I missed the Levimir and was put straight on to Tresiba which, so far, has been amazing. Am getting a constant blood sugar reading through out the night (thank you Libre)