Advice on splitting levemir

[Emck]

I have recently moved to levemir from Lantus in a bid to combat some unexplained spikes.

My only issue is that I appear to suffer from both dawn phenomenon and foot on the floor syndrome .

I have been splitting my levemir 20u at bedtime and then 18u on waking. This had helped to calm my foot on the floor spikes (taking levemir around 11pm, which should be peaking just as I wake at 7.30am). However my dawn phenomenon has not improved at all.

I seem to have a greater need for insulin between 2am - 10am, so had to move from Lantau as the dose I required for these morning sugars was making me hypo every afternoon/evening.

Last night I tried to move my levemir forward to 8pm, the logic being that it would peak about 2-4am and that might control my DP. Success! It worked and my sugars were steady overnight! However, my post-breakfast sugars are now super high as I don’t have the required basal on board to cope with them!

Has anyone successfully split levemir to combat these problems? Do I need to increase my evening dose/decrease my morning dose? Do I need to take a dose at 8pm, 11pm and then morning? Splitting in 3 to have 3 peaks? I’m so confused!!

 

[Muneeb]

I believe Dr Bernstein recommends splitting dose into two, one before bed ~9/10pm, then the next dose 6 hours later to counteract DP. Obviously this means setting an alarm and getting up, but that depends on how much you want to control the phenomena.

 

[Fairygodmother]

I also have the wretched foot on the floor. It’s something I’ve used the bolus insulin to deal with as it occurs over a timeframe that’s less than the duration of mdi basal.
Huge applause for subduing the dp!

 

[Fairygodmother]

It’s possible that adjusting your morning ratio will help too.

 

[Emck]

Yeah, it might be that I need a bigger morning ratio now. I have taken a huge amount of humalog this morning to try and get the sugars down and it not helping. I can normally function on 1cp:4u for a bowl of cereal and a coffee pretty well. However this morning counting in corrections, I have basically taken 1cp:6u and haven’t managed to make my sugars drop by more than 3mmol!!

I’m seeing my dsn and dietician in a few weeks so will see what they suggest. However, my dsn basically said that the only think that will help DP is a pump, which I don’t qualify for.