hi all, can you help (levemir in the night)

[blue-baboon]

Hi everyone,

Quick intro
Been a type 1 diabetic for approx 20 years
currently on novorapid/levemir as a basil/bolus scheme
levemir 52ml @ 11pm
novorapid 1ml per 5g of carbs


Right, basically I think my levemir lasts more than 24 hours.
Looking on the web, this doesn't look common at all, so I'd thought I would ask the greater good for some knowledge.

Daily it seems to work fine and I stay pretty level, i.e. if I miss lunch my blood glucose levels will stay then same sort of value with not much fluctuation.
This would suggest to me that the levemir dose is correct?

but every morning I wake up feeling rough.
last night test before bed 8.9 (11pm).. woke myself up at 2am and tested with a 2.2

would splitting the dose (2 x 12 hourly) actually help with this?
or should I look into changing over to lantus or other?

any advice would be great.
cheers

Steve

 

[AMBrennan]

2.2 mmol/l is a hypo, and night-time hypos are a sufficiently serious concern that the recommendation is to reduce basal dose immediately if there are night-time hypos. I'd definitely suggest asking your HCP for advice.

Having said that, splitting the dose will always result in a less extreme action profile.

Somewhat naively perhaps, I'd have said that the basal insulin is "too strong" after injecting, and about right for the rest of the day.
Since it's my prerogative to ignore medical advice (consulting your doctor before making changes to your insulin regime) - risking my own health in the process - and since a split can hardly make things worse, I'd probably have tried a 50% morning/40% evening split with intensive monitoring.

 

[Dillinger]

Hi,

I take Levemir and I split it - I think that there is a lot of anecdotal evidence that most long acting insulins don't last as long as their manufacturers would like us to think.

With you though you it slightly puzzling as to what is going on. When do you take your evening Novorapid? Perhaps you are taking too much Novorapid in the evening to compensate for the Levemir wearing off? Also, don't forget the bolus ratios can often change throughout the day.

What are your early evening/pre dinner levels like?

I find that 2 or so hours after my evening bolus my blood sugars will be pretty much stable throughout the night; i.e. the Novorapid won't be having much further effect. So if it's high I can carefully correct or if it's in range I can just leave and be pretty confident that it'll be in that range when I wake up.

Have a google for the action of Levemir - this is one I've just found although it's not very helpful as it claims Levemir has a completely flat action over 24 hours which I find hard to believe.

http://www.diabetes.org.uk/Documents/Ma ... lchart.pdf

Possibly there will be more nuanced versions of that.

I take my Levemir split 50/50 12 hours apart i.e. at 8:00 am and 8:00 pm. I also eat late (after 8:00 pm) so will have my evening Novorapid at the same time as the Levemir.

Maybe worth giving it a go and setting the alarm to wake you up every couple of hours to check where things are?

Night hypos are the great worry of course so you don't want to risk them for very long.

Best

Dillinger

 

[jopar]

If you waking every morning feeling rough, it's likely that you having a night-time hypo..

You've already tested at 2.2mol/l overnight which quite a nasty hypo..

What you need to sort out is your levemir set too high..

Personally before spiltting I would lower my levemir by max 2 units a time, adjust wait a couple of days to determine what reaction it has..

The first two nights of the adjustments I would at least set my alarm clock for 3am and 6am, also if early night 11pm.. So that I could track my BG...

If you find that you cure the night hypos's but the next dinner time/afternoon or evening your BG's start going up, this would be an indicator that you need to split your levemir dose.. The will give you more flexibility to adjust your dose, to suit your morning and evenings a lot better..

As what could be happening, is that your levemir is tailing off in the evening, you'll not noticing this, because you've got it set too high, so night time hypo's and a perceived perception of levemir lasting more than 24 hours...

 

[noblehead]

Steve,

As AM suggests this is something you should discuss with your HCP before opting for a split dose or a complete change to lantus.

I've tried levemir unsuccessfully despite trying once a day dose then splitting it 50/50, 60/40 and goodness knows how many other adjustments to get my bg right, with lantus I find it lasts the full 24 on a single dose and has a flatter profile than other basals I've tried, I would have to go back 6 -9 months or more since I last had a night-time hypo and this (despite some reservations about it's safety) is why I stick with injecting this insulin.

As a suggestion try reducing your dose for tonight and test 2 to 3 times throughout the night and obviously throughout the day as well, it may well work and stop the night hypo's and still produce good daytime bg levels....that said I would still seek some guidance from your DSN on this matter!

 

[blue-baboon]

thanks all, lots of info there.
conveniently I've got my check-up in a few weeks so I'm going to do a lot more logging over the next week or two so they can hopefully help (though they've not been able to help the last few times I've been with this issue)

think I will drop my levemir a bit as I feel like these hypos are happening every night (though I just was not sleeping well)
obviously checking as I go

also I think I need to change my injection sites more, though its hard to inject in a lot of places
i.e. arms, how do you inject into your arms? you cant squeeze it yourself

 

[blue-baboon]

p.s. for tea today
tested with a 4.9mmol/l

 

[blue-baboon]

ok,
so I had 120g of carbs (nom nom I like lots of food, bad me)
I shot up 22ml novorapid
note: would have been 24ml but I reduced it so I would higher for bed else I would just have to eat again.

Now 2+ hrs later my blood gluc is 7.2mmol/l

all good so far

 

[blue-baboon]

1 hour later again (3+ hours after food)

tested with a 7.5 mmol/l

 

[blue-baboon]

ok so last night I had 49ml of levemir
and also ate some more food (approx 40g carbs)

tested again at 2am with a bm of 7.9
this morning my bm was 9.8

 

[blue-baboon]

2 hours after breaky I was 10.5
now, before lunch I am 5.4
ok so it does look like the levemir was too much, yes?

p.s. Sorry for using this as a diary

 

[noblehead]

Was your 40g of carbs late last night without quick acting insulin?

 

[blue-baboon]

quick update,
i've now moved to 2 levemir injections.
11pm (28ml) and 11am (~10ml ? ).

currently the night times look ok so far, last night:
11pm 16 (I know, a little bit high
3am 16.5 but it proves the point that
8am 16.9 I stay level enough)

now ill work on the day time dose