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Do I need to lower my Levemir dose?

drahawkins_1973

drahawkins_1973

Well-Known Member
Messages
452
Type of diabetes
Type 1
Treatment type
Insulin
I'm recently diagnsoed as type 1 diabetes. I am currently taking 10 units of levemir long acting insulin with my pre-dinner Novarapid dose at about 6:30 in the evening. For the first week after my diagnosis my levels seemed to be levelling out all through the day but over the past 3 days I have been getting low sugar readings at about 10 am in the morning (3.8-4.3). This is about 3-3.5 hours after my breakfast insulin. My pre-bedtime readings have been slowly dropping over the past few days and last night I awoke at about 2am with a sugar level of 3.3. Do I need to drop my Levemir to say 8 units in the evening?

My sugar reading at 2hours after eating all seem to be good within 6-9.

Any advice welcome.

Thanks
Andrea
 
I spoke to my DSN and she advised me to lower my morning Novarapid a little and to reduce my evening Levemir 2 units so hopefully that will sort me out!

Thanks
 
drahawkins_1973 said:
I spoke to my DSN and she advised me to lower my morning Novarapid a little and to reduce my evening Levemir 2 units so hopefully that will sort me out!

Thanks
Click to expand...
[SMILING FACE WITH OPEN MOUTH][THUMBS UP SIGN]


Sent from the Diabetes Forum App
 
Hi. Sounds like the right approach from your DSN. I'm just on Levemir 10 units at bedtime and my DSN said to aim for around 6 mmol before breakfast i.e. fasting test. I'm actually nearer to 4 but we both agree that's OK as long as I watch for hypos. Other posters have suggested previously, sensibly, that you try to get the Basal right first i.e. around 6 fasting and then tweak the Bolus as needed
 
drahawkins_1973 said:
I spoke to my DSN and she advised me to lower my morning Novarapid a little and to reduce my evening Levemir 2 units so hopefully that will sort me out!

Thanks
Click to expand...


I would go with that unless you want to try reducing the levemir first and see how you get on, as your newly diagnosed your in a phase called 'The Honeymoon Period' (google to find out more) where your insulin requirements and bg control may be up and down.
 
Hi again,

Followign everyone advice I lowered my morning novarapid dose and also my Levemir dose that I take with my evening meal. However I'm still low before lunch (4.1) and yesterday evening I dropped 5 mmol (8.3-3.3) within 1.5 hours of eating. I hadnt eaten anything particluarly different from other evenings or done any physical exercise so am a bit confused.

Is my body making its own insulin when I inject, is this the infamous Honeymoon period I have read about?? should I continue to lower my doses?

Thanks for all your help, really appreciate being able to talk to everyone about this!
Andrea
 
Hi Andrea,

Have you yet started carb counting and adjusting your Novarapid based on a calculated Insulin-Carb ratio for each meal throughout the day? Because that is what you will need to do to get good control.

Here is some useful recommended reading that should help you to get educated on what is required to get good blood glucose control ...

One of the key issues to overcoming the initial shock of knowing you are a Type 1 diabetic and having been diagnosed with a lifelong condition, is to gain as much knowledge as possible. For managing diabetes .. knowledge is power.

As you gain more knowledge then your initial fears will subside, you will gain in confidence and ultimately you will realise that this condition can be controlled so that you can indeed live a long and healthy life and it should not stop you doing anything you wanted to do.

That has been my attitude, and although I've been T1 for 43 years, diagnosed in the late 1960s when the medication and technology was very basic compared to today, I've never let my condition restrict what I wanted to do in anything .... relationships, family life, career, travel and leisure pursuits. I took my diabetes seriously, I controlled by diabetes and didn't let it control me! So after more than four decades I have none of the complications that can occur from poorly controlled (high) blood glucose over an extended period. Gaining knowledge, and then using it to maintain good blood glucose levels, was key to my strategy.

So where to start to gain this knowledge?
Documents available on the internet:-
Note: ALL adult T1 diabetics should be using carb counting in order to get good blood glucose control.

Note: Ensure that you consult your DSN before making any changes to the current insulin and diet regime. They are medically trained to answer your queries and should always be consulted on such issues, particularly in the early days during the steep learning curve.
I hope you find these references useful, and I wish you every success on your long journey ...

Documents available on the internet:-

A. An introduction to carbohydrate counting and insulin dose adjustment
An excellent introductory document from Diabetes UK that covers all aspects of diabetes, and the method of carb counting, insulin adjustment and insulin-carb ratios is covered in Chapter 2 (Carbohydrates) and Chapter 3 (Insulin). Even if you are not doing carb counting, you should definitely read this!
https://shop.diabetes.org.uk/store/lite ... -book.aspx

B. Basal Testing … how to check your Lantus or Levemir dose is correct
In the absence of food, exercise and mealtime/bolus insulin, basal insulin should hold the blood sugar steady. Any significant rise or fall in blood sugar during a fasting basal test probably means that the basal rates need to be adjusted - even if the blood sugar winds up near normal by the end of the test. This document shows you how to check it.
http://www.diabetes-support.org.uk/info/?page_id=120

C. Adjusting your Insulin when results are too high or too low:
A detailed guide, with plenty of examples, to assist you in making required insulin adjustments. Download it and print it out so it is readily at hand after blood sugars have been made & recorded.
http://www.diabetes-scotland.org/ggc/do ... Change.pdf

Books you should consider purchasing (particularly the first two books):-

1. Carbs & Cals: A Visual Guide to Carbohydrate & Calorie Counting for People with Diabetes (Chris Cheyette)
Buy this excellently illustrated book that provides clear pictures, portion sizes & weights plus carbohydrate values of nearly every food you might need.
http://www.amazon.co.uk/Carbs-Cals-Coun ... b_title_bk

2. Type 1 Diabetes in Children, Adolescents and Young Adults (Ragnar Hanas)
A comprehensive book with great detail in all aspects of managing diabetes with emphasis on children. This is easily the best book I have ever read about managing Type 1 diabetes, so if you only buy one book …. this is the one.
http://www.amazon.co.uk/Diabetes-Childr ... roduct_top

++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++

3. Using Insulin: Everything You Need for Success with Insulin (John Walsh)
“The best material available written on a subject that can be complicated and daunting. "Using Insulin" is an essential requirement for anyone who has either just started insulin therapy or who has changed to a basal/bolus approach as the preferred treatment”
http://www.amazon.co.uk/Using-Insulin-E ... 973&sr=8-1

4. Think Like a Pancreas (Gary Scheiner)
“Dozens of books offer advice on managing diabetes, but few focus specifically on the day-to-day issues facing those who use insulin. This book covers how to successfully master the art and science of matching insulin to the body's ever-changing needs”
http://www.amazon.co.uk/Think-Like-Panc ... a+pancreas

Best of luck ..

JontyW
 
I would suggest getting your Levemir dose correct before adjusting your Novorapid doses. hope this helps.
 
dave howard said:
I would suggest getting your Levemir dose correct before adjusting your Novorapid doses. hope this helps.
Click to expand...
Dave is correct .. this is where you need to start ....

Basal Testing … how to check your Lantus or Levemir dose is correct
In the absence of food, exercise and mealtime/bolus insulin, basal insulin should hold the blood sugar steady. Any significant rise or fall in blood sugar during a fasting basal test probably means that the basal rates need to be adjusted - even if the blood sugar winds up near normal by the end of the test. This document shows you how to check it.
http://www.diabetes-support.org.uk/info/?page_id=120

Jonty
 
Makes absolute sense as I couldnt make head nor tail of what was happening with my mealtime sugars. I've lowered my Levemir dose and I'm getting much better consistency now. I guess I need to keep a close eye on this as levels are likely to change when newly diagnosed?

But I definitely feel much more in control now!

Thanks everyone, its really great to be able to ask and get advice, mch appreciated :thumbup:
 
Just a quick update.

After reading all the info I lowered my levemir dose and am now taking 7 in the evening. This seems to be working really well for me. My pre-meal levels are have been consistently between 4.5 and 6 mmol and my bedtime about 7.

This means I've been able to monitor my novarapid doses better and I'm finding I'm only up to about 7- 8 two hours after eating.

So for now, all seems to be good...althgouh I know this is likely to change so I'll keep an eye on everyhting but now I feel like I'm much more able to understand what is happening.

cheers :D
 
That is really good news Andrea and I think you are now moving up the learning curve.

Please ensure that you download and read the links that I sent, and purchase the two recommended books also .. knowledge is power.

Jonty
 
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