Changing from Levemir to Insulatard

jones_48 said:

Hi,

Does anyone have experience of changing from Levemir to Insulatard?
My levels are reading anywhere between 6 - 21, and seem to rise during the day and night. (If my blood is 12 when I go to sleep, it's 20 when I wake up, and is not really effected by a corrective novorapid dose during the night). I was on split Levemir - 7u morning, 6u evening. Now on split Insulatard - 7u morning and evening.

I'm now wondering.. should my novorapid:carb ratio stay the same, or will this will need adjusting too?
And is it common to need a higher dose of insulatard than levemir..?

Any advice would be appreciated!! Thanks

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Hi there. Hopefully those with experience with these insulins will see your post soon and comment, but in the meantime, I wanted to say - is your nurse/doctor giving you enough help to get your BGs down? How often are you seeing them and are they available to you by phone? Hopefully they can adjust things if needed.

jones_48 said:

Hi,

Does anyone have experience of changing from Levemir to Insulatard?
My levels are reading anywhere between 6 - 21, and seem to rise during the day and night. (If my blood is 12 when I go to sleep, it's 20 when I wake up, and is not really effected by a corrective novorapid dose during the night). I was on split Levemir - 7u morning, 6u evening. Now on split Insulatard - 7u morning and evening.

I'm now wondering.. should my novorapid:carb ratio stay the same, or will this will need adjusting too?
And is it common to need a higher dose of insulatard than levemir..?

Any advice would be appreciated!! Thanks

Click to expand...

That's quite an unusual direction to go - usually people are moved from Levemir to Lantus. Insulatard is an NPH insulin. This means that it has a more peaky profile than Levemir.

It's a long time since I used Insulatard, but when I moved from that to Lantus, I ended up using a similar amount. Likewise, going from Lantus to Levemir was a similar amount. Sadly that doesn't mean anything.

What you need to do is undertake a basal test. For a pump it is described here: http://www.salforddiabetescare.co.uk/index2.php?nav_id=1007 The principles are the same for testing injected basal.

Essentially you need to fast and test every 1-2 hours. Given what you have described:

jones_48 said:

(If my blood is 12 when I go to sleep, it's 20 when I wake up, and is not really effected by a corrective novorapid dose during the night)

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The one of three things may be happening. Either:

1. You are not getting enough Insulatard and you are therefore not staying low overnight
2. You are having too much Insulatard, and having a hypo in the middle of the night and having a liver dump pushing you up into the morning
3. Whatever food you are eating at night has a carb release like a pizza or chinese meal where you get a prolonged blood glucose rise that is not being managed by the short acting you are taking.

You can resolve for the first two by basal testing.If your basal looks okay then you can start looking at your bolus insulin and carb ratios.

By the way, I'm sur eyou know this already, but 12mmol/l is really far too high to be going to bed on. You should be aiming for something below 8.

Using insulatard might mean needing a bed time snack quite often a mid morning and afternoon as well due to the peak of it.
Glad to see your team are working outside the box to treat your rising blood sugar in the mornings. Yes you might find your bolus needs change ie less needed due to the timing of the insulatard peaks.
The old adage springs to mind.......... it's trial and error. Make sure you have plenty of hypo treatment available as well.

Going to bed at 12 and still waking up hypo just seems to me that the levemir was too much. However now you have reported that you are going higher in the mirnings..indicating more need for an increase at night....

How much do you change any doses by at a time? Have you got 1/2 unit pens? Has your doc or DSN given you guidelines on increasing by say 1/2 a unit every 2nd or 3rd night?

Ok.. Ask for 1/2 unit pens as a starter. You are on low doses and just 1/2 a unit can make a big difference. Make sure you ask for two different pens and you also ought to have a back up pen as well.

I would then be changing by a 1/2 unit at a time and not a whole unit.

Could you give us an idea if what your actual readings have been over the past 48 hours? It would be easier to help...

What doses currently of basal? You need to up them...
When you are above 12.0 don't forget that your corrections won't be wirking so well and you may need more than if you were correcting at a level of 10.0.

You know me as well... I like to see how much insulin you are giving and how many carbs etc....and times..

I always back to recording everything in a log book if my levels change for any reason....its giving easier access to see patterns of rises..

jones_48 said:

View attachment 15744

I think I've attached a screenshot of my readings over the past few days ?
I know they're bad but I've never changed basal insulin before and it's thrown everything off I might have to contact the DSN and will also ask about 1/2 unit pens - they would be better for my novorapid too.

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What app is that? The difficulty for anyone, including your DSN, is that it doesn't include times of the doses, or what those doses are/food is. That makes it much harder to understand what's happening. Based on my experience of CGM, keeping a record of what you've eaten, what you've dosed and the times is really useful for properly digging in to the data and being able to understand what is happening.

For example, looking at this, it looks as though there are two things going on.

1. It looks as though your basal isn't high enough.
2. It's hard to make out whether your I:C ratio is correct, or whether, simply, you haven't quite got the carb counting right at the meal time.

Coming back to my earlier post, do the basal testing and see what it shows up. That will make it easier to determine what is happening with 2. As an aside, if your basal is too low, then it makes it really difficult to get your I:C ratios right as part of the insulin is being used to counter the missing basal.

Listen to Tim2000s...

I would use a log book.. You may find that hormones or workdays / leisure days etc are more visible to give clues more identifiable..

By way.. What is the app??

jones_48 said:

My I:C ratio was good on Levemir which is why I was wondering whether it should stay the same with different basal

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In theory it shouldn't be that different, but if your basal level isn't right then it would throw any I:C out, which is why you need to check Basal first. Once you've got that right, it may bring the I:C ratio back in line.

jones_48 said:

I have an iBG Star meter so that's just the app that it uses to download & display my readings, I can see the times when I click on them but obviously that's no use for you!
donnellydogs ive never been on a pump? But I get what you're saying and can use a diary similar to the one used for the cgm.
My I:C ratio was good on Levemir which is why I was wondering whether it should stay the same with different basal -.-

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My mistake.... Huge apologies....
Have you worked out how many units of basal you have in one day and compared that how much total units of bolus you have?

What does it currently work out to compared to when levels were better?

For me I find that as my basal changes in the cooler weather that my bolus will also change...because my body seems to like a routine of a 30/70 ratio.

For example today because I'm not working then I had to out my basal up by 1/2 a unit this morning. I normally give a 2 unit bolys as well to counteract the rise when I get up. Today On my days off I will also have to increase my bolus...to 21/2 unit when I get up to keep my ratios in line.

It may be that your balance of basal is slightly out currently.

@jones_48, those are some very strange results. I'm wondering whether what you are actually seeing overnight is the Somogyi effect, which would result in highs in the morning if you went low overnight as the liver dumps to get your bg levels up?

The thing that's tricky with all of this is understanding what's driving the results. A 30 in the morning is clearly bad, but again, there could be a whole load of reasons. Given that you increased your Insulatard dose, the one that springs to mind is Somogyi, combined with Dawn Phenomenon, as an early hours hypo could result in a liver dump, accentuated by the dawn phenomenon.

Without testing two hourly throughout the night, we can't really help. Likewise, your rise from 11-15 two hours after your bedtime injection could be down to what you ate earlier, and have nothing to do with the insulatard. Without a full set of data to observe timings, glucose levels, food and jabs, it's nigh on impossible for anyone to give you good guidance.

I'll come back to the same point. If you haven't basal tested overnight to see what is going on, there's very little that anyone can do to give you any help. You need to eat your last meal at 6pm, then do your injections as normal from there overnight. Test every one or two hours and see what result you get. Or get the hospital to issue you with a temporary CGM. Without that, it will remain a mystery.

As your day carbs are right. In an odd way it is still highlighting as tim2000s and I are trying to say. Basal test overnight and see what your bgs are..have a light carb meal at say 6pm or carb free if possible and then nothing else till morning.
Then test 2 hourly until the morning.
This will show what time your levels start to rise or indeed if at some point they are lowering.. It would then also help to determine if the food you eat may be impacting on your night time levels.....
Ie I can't eat anything pasta, rice, bread. Courgettes, celeriac, takeaways because I too will end up in the 20-30's in the morning.
It could be liver dump, it could be food but there is a cause...