Changing From Lantus To Levemir

Ermintrude775 said:

Hi

Just been to see the diabetic team today. My Hba1c was 58. My before bed bloods are running a bit high and I'm getting the same in the morning. The thing is when I've tested my blood during the night they've been good readings. I even went to bed with a blood of 14.8 (high I know but I'd been teaching karate) but 4-5 hour later I was 2.8

Anyway the doctor thinks I need more of the Lantus at night but thinks it's running out after 20 hours or so. She has suggested a switch to Levemir with 2 injections a day. In the mean time I am to increase my Lantus by 2 units to 22 to see how that effects my bloods. Btw I use novorapid at meal times

Any advise? Any pointer on what I should read. Just had a quick google and the information wasn't very helpful

Thanks

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If you're dropping from the 14s to the 2s just from the Lantus, I don't see how adding units is going to help. I know it sounds annoying to take 2 shots instead of 1, but it makes more sense and Levemir is a far superior insulin to Lantus. It's trial and error, but by taking different doses for day and night you can better match the insulin to your basal needs. You can also make adjustments every 12 hours which can be useful for adjusting for exercise, eating slow-digesting meals at night, etc.

So you are hypo during the night, which might explain why you have BS elevated levels when you wake. Have you told your diabetic team about that ? I agree that increasing the Lantus is not going to help. What is your feeling about what is proposed ?

Are you taking lantus at night? I had better night time readings taking it in the morning.

The danger with taking Lantus at night and increasing the dose is an even greater drop, and more dangerous hypo. Lantus surges after 4-6 hours, hence the nighttime hypos many who take it at night experience.
I suffered from these but found a change to Levemir has made it far easier to control bs. It’s not perfect, there are still those days when the gremlins strike, but I can now sleep easier knowing that it’s very likely to give me a flat bs profile.

Hi @Ermintrude775, The instance you give of the high pre-bed BSL and the hypo in early am may fit with the the karate exercise. The adrenaline released in response to the exercise can send BSLs up initially (at least in my case) with a hypo often 6 hours + later as the muscles refill their glucose stores from the blood. People either lower the appropriate insulin(s) to allow for this or eat more carbs sometimes before and certainly nearer the 5 hours mark. It may be that, as others have said, your were taking too much insulin. Of course one can only adjust the lantus once per day or thereabouts. If taking it twice daily there could be an amount of overlap of long-acting insulin which has its own problems.
So can you really trust the example you take as a true example of the time under discussion.?
I have not been prescribed Lantus but found Levemir useful because taken twice daily it seems to last the 24 hours (at least for me) with no obvious overlap issue and there is the facility to adjust the dose of long-acting insulin between day and night.
In my case eventually the bolus-basal regime was not sensitive enough to keep BSLs well enough controled and at the 45 year mark on insulin I graduated to an insulin pump. The past 7 years have been so much better.
Best Wishes with the changeover. I found that I needed less levemir at night than during the day, but that may be me. Certainly if you are exercising regularly in early evening you have an option, in discussion with your doctor to ease back the levemir dose at night. Night hypos can be horrific !!

@Ermintrude775 You might want to read this thread from a few years back:

https://www.diabetes.co.uk/forum/th...pefully-providing-some-lessons-learned.70039/

I changed from Lantus to levemir about 9 months ago and it is a far better insulin. 2 injections 1 before bed and 1 when I get up. Levemir is a much flatter insulin with no real peaks like Lantus, and so far my number of overnight hypos have dropped.

I did find though that my dose increased by about 20% from 32 Lantus to 20 Levemir in Morning and 26 Levemir at night. My control has also improved, though that could be due as well to taking more care of myself