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How to split Levemir dose

Discussion in 'Insulin' started by Gmitch-uk, Mar 20, 2013.

  1. Gmitch-uk

    Gmitch-uk Type 1 · Newbie

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    Hi, I have been on a single dose of Levemir for a couple of years now and things have been ok until now. :(

    I have noticed that my BG's are creeping up through the day and I need to increase my Novo Rapid with meals or even take an extra dose to keep control.

    My BG's are good in the morning ( betwen 5 and 6), but at around 6-8 pm they can get up to 12!!.

    I an currently taking 50 units at 10 pm and now want to try and split he dose to give better control through the day.

    Does anyone have experience of how to start??
    Is it best to lower my evening one first and then start the next morning with the second dose?
    or should i keep the evening one at 50 and then have say 25 in the morning and then start with 25 at night???

    Thanks
    Graham
     
  2. blueeyed81

    blueeyed81 Type 1 · Well-Known Member

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    Hi, ive been on levimere for a couple of years and have split doses, ive always had split basal injections since being diagnosed 14 years sgo, before you try anything id go talk to your gp or dsn just to be on the safe side, they will either agree with you and change something or change your bolus ratio, its always best to be safe than sorry.

    :) Kelly.



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  3. judy.suirane

    judy.suirane · Member

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    Hi Kelly
    Just a question as I'm new to all this. I am on levemir 20 units at 10pm . My mornings are great with by under 6. My pre bed levels fluctuate between 6 and 15! It seems the levemir has run out after supper. Should I be takng a split dose of 10 units one at 10 pm and one at 10 am? Confused!!

    Thanks
    Judy


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  4. blueeyed81

    blueeyed81 Type 1 · Well-Known Member

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    Hi judy, if your not sure then speak to your diabetes team first before making any changes to your doses.

    Kelly

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  5. fig

    fig Type 1 · Well-Known Member

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    Hi Graham
    I had been doing this for a few years but i found the 2 doses seemed to cross over as they both worked for more than 12 hours with me, i found it helped but was never perfect and i could never predict when it would be low or high so wasn't great for me but better than once daily dosing. I am now on a pump but only just started so i hope it can cure my problems cutting out the basal injection all together. When i changed to twice daily levemir i was advised to give a half dose in the evening then inject the remaining insulin in the morning, then continue splitting it morning and night. Good luck, i hope it works for you but you should probably tell your doctor you intend to do it just in case you have any problems.
     
  6. Spiker

    Spiker Type 1 · Well-Known Member

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    Judy I think your are correct, your Levemir is running out towards dinner time, some 20 hrs after injection. Levemir really doesn't last 24 hours. I don't know why anyone is advised to take it only once a day unless they are still producing their own insulin in sufficient quantity to make up the deficit. Even Lantus doesn't last 24 hours except at very high doses. The duration of action of all insulins is dose dependent - the more you inject, the longer it takes to finish working.

    Your plan to split to twice a day at 10pm and 10am is a good one. Contacting your DSN about it is also a good plan.

    Some people find it helps to stagger the times of the two injection so they are not 12 hours apart, in order to counter the "dawn phenomenon". This worked for me for example. I took basal insulin last thing at night and first thing in the morning, so at 8 and 16 hour intervals rather than 12 and 12. The overlap gave me higher basal insulin overnight which sorted out the dawn rises.

    But the first problem is those evening highs. One problem at a time. Worry about any dawn phenomenon later - you might not have any. 2 x 12 hr injections is a good pattern for Levemir.
     
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  7. Lynne211

    Lynne211 · Member

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    it's LEVEMIR AND YOU'RE
     
  8. Lynne211

    Lynne211 · Member

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    WHAT DO YOU MEAN BY 8 AND 16 HOUR INTERVALS, WHAT DOES THAT MEAN IN TIME. ONE SHOT AT SAY 7AM AND THE OTHER AT 11PM?
     
  9. Lynne211

    Lynne211 · Member

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    IT'S YOU'RE
    WHERE DO YOU GET FACTS TO SUPPORT YOUR CLAIM "the more you inject, the longer it takes to finish working" IT LASTS AS LONG AS IT LASTS...TAKING MORE DOESN'T MAKE IT LAST LONGER, IF YOU TAKE 1 TYLENOL OR 1 TYLENOL IT STILL ONLY LAST 4 OR 6 HOURS? Also, the reason one splits a dose and it's typically for those who inject a large dose, it pools underneath the skin, the larger the shot the longer it takes to get absorbed properly by the body and evenly, too. There's been study after study splitting the dose for people who take a smaller dose doesn't improve anything.
     
  10. Shiba Park

    Shiba Park Type 1 · Well-Known Member

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    To turn your question round, where do you get your facts to support your claim?

    Shiba.
     
    • Agree Agree x 1
  11. mike@work

    [email protected] Type 1 · Well-Known Member

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    @Lynne211

    Taken from

    http://www.diabetes-book.com/laws-small-numbers/

    "Dr. Galloway then measured blood sugars every few minutes and adjusted the glucose drip to keep the patient’s blood sugars clamped at 90 mg/dl. How long would you guess the glucose infusion had to be continued to prevent dangerously low blood sugars, or hypoglycemia?

    It took a week, even though the package insert says that regular insulin lasts only 4–12 hours. So the conclusion is that even the timing of injected insulin is very much dependent upon how much was injected. In practice, larger insulin injections start working sooner, last longer, and have less predictable timing."

    I have tested myself with both Levemir and Hypurin Porcine Isophane, and bigger doses gives a bit longer action-time. On the other hand: One also have to take into account all other matters that can influence action time for Insulin, such as where it is injected and so on. And then there is the obvious problem, that bigger doses, can start to give very powerful hypos.
    And please, no need to shout...

    Edited to insert tag and to correct some typos.
     
    • Agree Agree x 1
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