Changing my levemir, any advice appreciated

Hi Linda,

I am on Novorapid and Levemir and also found that the Levemir didn't quite last the 24hours. My diabetic nurse suggested doing exactly what you have done by splitting it into 2 doses and so far - no further issues. I actually take 8 units at 9:30pm and 7 at 9:30am. I don't have a half dose pen at the mo but this seems to work fine for me.

The nurse does rate Levemir highly but has found a few people who experience the same ups and downs as us and by splitting the dose has ironed out the problem.

I'm sorry I can't offer any advice on the insurance company but wish you luck with that too.

Hope this helps

Best regards

Dave

Hi Angeldust,
Have you considered an animal long-acting insulin to replace Levemir? Worth noting that adverse-effects of analogue insulins include gastro/stomach probs
Jus

Hi Linda

Levemir is a much nicer to use basal than Lantus and many diabetics find that their hypo awareness improves a bit through using it, so hang on with it for a while.

With regards to using it 12hrs apart and doing a straight 50/50 split, that will start you off but to put it to the test, the best way to find out how effective it is, is to see how much bolus insulin you need to use per 10g carb. If you find yourself needing to use 3 or 4 units bolus to 10g carb, then that will be a small indicator that you need to increase your basal up by about 1 unit at a time until you start to get a more normal ratio of Novorapid for the average adult. Many people in their attempt to get their bolus levels ok also start to manipulate their basal doses as well and start to do 60/40 splits or even odder (as I did). My basal dose Levemir was 14u morning (8am) and just 6u at 9.30pm. My insulin to carb ratios (Novorapid) was 1:4 br, 1:7 lunch, 1:4 eve meal. These ratios enabled me to get my bg level targets somewhere ok by testing bg every 2.5hrs and I was able to stay reasonably even all day although there were times when things went a bit belly up but that's life.

Although the above is all about Novorapid working ok with Levemir, I was wondering if you have considered asking to be put on a pump as you will be able to meet the NICE criteria due to your profession, eratic control of bg levels and also gastroparesis ?

Hi Linda

Levemir is considered to have a 30% less action than other basal insulin’s (be it Lantus or NPH (Isophane) insulin’s) so some users find they do have to increase the dose more.

Good evidence however there is more flexibility with Levemir – you can increase dose each day rather than waiting 3 days to see if it helps. Apparently the higher the dose ratio the steeper the peak action which can be useful to curb high BG times when of course you have figured out when that is :lol: :lol: .

Whilst many users split their dose equally I think realistically you need the flexibility of what works for you.
You mention your dose “I’m on a huge dose compared to what other people here seem to be”.
I always get extremely concerned that at times this forum feels like a competition to see how low a user can get their insulin doses.

Fact: Boffins & scientists can only really guestimate how much endogenous (as in produced within the body) a non- diabetic makes.
It is guestimated but also open to debate to be the equivalent of ½ to 1 unit per kilo of body weight in a 24 hour period. However with exogenous insulin (the stuff we inject) the doses can vary considerably.

Fact: there will always be insulin users on less insulin than you and insulin users on more insulin than you – my analogy is when you’re at the airport observing the luggage of travellers – you always think your luggage is huge until you go and check in :lol: :lol: :lol: :lol:.

My concern would only be when injected insulin doses are increasing and increasing and still BG control is not good because it’s potentially a time to consider a change of insulin and/or insulin pump.

Sorry for the pre amble – I just don’t want you to compare yourself with other Levemir users when it comes to doses. Other factors come into play which can include how long someone have been using insulin, how sensitive their body is to a particular type of insulin, whether they are still producing any exogenous insulin, what life style they have, what food choices are open to them and other health issues.

Having gastroparesis a real challenge for you as well & I wonder if your basal insulin is having to soak up some of the work the bolus would be doing in a diabetic without gastroparesis – hence your basal dose might be higher.

Also if you are finding it difficult to eat I suspect your body is liver dumping – I appreciate you have a challenging time.

I also have a theory regarding Lantus and what happens to some users when they change insulin – as we know Lantus has the habit of staying in its depot under the skin when injected and not doing anything.
As you mention that the Levemir appeared to be working well to begin with I would guess there was still Lantus depots in you – I went through what can only be described as a honey moon period (albeit 39 years late :lol: :lol: :lol: ) when I came off Lantus and went back on animal insulin – & I am convinced it was the Lantus depots that were dormant decided to work.
Hence once the Lantus has gone from you, your body was left with the Levemir and then you analysed and discovered Levemir only lasted in you 20 hours.
In fairness Levemir was never marketed as a 24 hour basal analogue it was marketed as a 1-2 a day injection basal.

Also your Levemir dose depends on your bolus/basal total daily dose (TDD) i.e. some users find a compete 50/50 split others prefer a 60/40 split or a 40/60 or a …..etc etc. its what works for you.

Are you feeling better off the Lantus though?

Hang in there - I would say its early days & when changing any insulin regime its not always a quick easy process.
I also concur with iHs regarding exploring the possible pump option.

Best wishes

Txx