Issues with Levimer - advice please

[Justin04]

Hi guys, having been in Levemir I originally got put on a single evening dose by my endo. Lasted about a month before they split the dose. Looking at the OP’s timeline though, I don’t think the split is the answer. Levemir claims 18hrs longevity, I believe it’s more like 14, but from 830pm to 630am is 10 hrs so it would definitely be working still. Like you said @O_DP_T1 increase a couple units and see what happens. Insulin requirements change from time to time, and sometimes for no reason at all. Happened to me several times while I was on MDI.

 

[kitedoc]

I agree with @tim2000s and @evilclive,
And as a T1D, not as professional advice or opinion: we cannot give you actual medical advice.
Proper standard use of Levemir = ( Edited by a moderator) once or twice dailydepending on patient' needs.
Something is causing your need for more insulin. That maybe stress and /or something else.
In my personal experience hanging the insulin type without dealing with the cause of the problem
is not likely to solve anything.
Usually your DSN will have made a plan with you for sick days - days when you have something causing insulin not to be
working so well - you have already done the usual things like change insulin ampoule and batch:
is there an emergency number to call?
is there a plan re insulin dosage adjustments as for sick days?
For example: my plan when on Novorapid/Levemir (and this is an example, your requirement could be quite different) was:
rule out insulin being de-activated (as you did), leaking ampoules, pens,;(pump and cannula issues for others) etc -
Check BSL and ketones: if BSL > 15 mmol/l, blood ketones > 2 mmol/l - head to hospital
Check BSL and ketones in 1 1/2 hours, if only s/c Novorapid check ketones and BSL in 2 to 2 1/2 hours
then: General rule of thumb for me (and not necessarily anyone else was):
Continue BSL checks every 2 to 4 hours.
(Edited by a moderator to remove specific dosing advice).
Just to give you an insight into effect of stress:
During Uni exam time my insulin requirement (bolus + basal per day) would double i.e up 100%.
So please get hold of your DSN/doctor asap to help solve this puzzle you have
and please ensure you work out your sick day type plan with them - it can save a lot of hassle !!
Best Wishes

 

[urbanracer]

In my personal experience hanging the insulin type without dealing with the cause of the problem is not likely to solve anything.

Changing the type of basal won't really change the amount you need.

I can't agree with these comments. I changed from Abasaglar to Levemir last year and my basal requirement has been steadily increasing (from 12 to 20) ever since the change, and it's still not controlling my levels well. In terms of my activity levels and diet, nothing in my life has changed in way that would explain the increased dose requirements.

Whilst there would be a proportion of the diabetic population who can switch insulins without a change in dose, it makes sense to me that if the insulins are of a different makeup then they may not perform the same way for all users.

 

[Brunneria]

Hi Everyone,

As I am sure you all realise, giving medical advice is against our forum rules, and where insulin is concerned, this can be particularly dangerous.
Several posters on this thread have made statements about Levemir usage, from stating that it should be used twice a day, to suggesting dose amounts when blood glucose is at specific levels.

Here is the Levemir's own information on the subject:
https://www.levemirpro.com/dosing-and-administration.html
and
https://www.medicines.org.uk/emc/files/pil.5536.pdf

Both sources clearly state that Levemir can, and should, be used once or twice a day, depending on individual circumstances, and health care advice.

Therefore any specific statements on this thread suggesting otherwise should be disregarded.
@O_DP_T1 Please consult your health team for their advice on this, so the situation can be tailored to your circumstances. I realise that you are probably very well versed in insulin dose adjustment and more than capable of making your own decisions, but some of the advice on this thread is more along the lines of 'it works for me, so you should do it too' rather than 'find out what works best for you'.

 

[kitedoc]

I can't agree with these comments. I changed from Abasaglar to Levemir last year and my basal requirement has been steadily increasing (from 12 to 20) ever since the change, and it's still not controlling my levels well. In terms of my activity levels and diet, nothing in my life has changed in way that would explain the increased dose requirements.

Whilst there would be a proportion of the diabetic population who can switch insulins without a change in dose, it makes sense to me that if the insulins are of a different makeup then they may not perform the same way for all users.

Perhaps I am missing something @urbanracer but I was not inferring that one insulin could be exchanged for another at the same dosage. just that switching before ascertaining, in his situation, all the possible reasons/causes first is not usually a useful move. Particularly when there is one possible lead/cause already - stress.
And in your case I do not know why you changed or were changed insulins or what a full investigation of the discrepancy in doses might reveal.
And maybe @eveilclive's statement should read - will not necessarily change the amount you need.

 

[urbanracer]

Perhaps I am missing something @urbanracer but I was not inferring that one insulin could be exchanged for another at the same dosage. just that switching before ascertaining, in his situation, all the possible reasons/causes first is not usually a useful move. Particularly when there is one possible lead/cause already - stress.
And in your case I do not know why you changed or were changed insulins or what a full investigation of the discrepancy in doses might reveal.
And maybe @eveilclive's statement should read - will not necessarily change the amount you need.

Stress may be a contributor or even the only reason for the OP's high glucose levels but what I'm saying is that the insulin type cannot be discounted as being either wholly or partly the cause of the problem.

In the summer of 2017 (and after almost 3 years on Glargine) I developed severe myalgia in both shoulders but had no idea what was causing it. Then early in 2018 I started to get systemic rashes and anaphylaxis. I cannot remember what alerted me to the fact that these are all listed side effects (in the 1 in 10,000 category) of Glargine, but I pursuaded my endo' to let me try something else and so I'm now on Levimir and all my issues have (thankfully) cleared up.

It is my perception that Glargine controlled my backgound glucose levels more effectively than Levemir does now but I don't think I can go back to Glargine based insulin. Some days I feel as though Levemir isn't actually having any affect on my glucose levels at all.

 

[kitedoc]

Stress may be a contributor or even the only reason for the OP's high glucose levels but what I'm saying is that the insulin type cannot be discounted as being either wholly or partly the cause of the problem.

In the summer of 2017 (and after almost 3 years on Glargine) I developed severe myalgia in both shoulders but had no idea what was causing it. Then early in 2018 I started to get systemic rashes and anaphylaxis. I cannot remember what alerted me to the fact that these are all listed side effects (in the 1 in 10,000 category) of Glargine, but I pursuaded my endo' to let me try something else and so I'm now on Levimir and all my issues have (thankfully) cleared up.

It is my perception that Glargine controlled my background glucose levels more effectively than Levemir does now but I don't think I can go back to Glargine based insulin. Some days I feel as though Levemir isn't actually having any affect on my glucose levels at all.

Sorry to hear you had such troubles with Lantus. And glad its cessation has saved you from such horrific symptoms.
Could antibodies to Lantus be cross-reacting with Levemir and affecting its efficacy??
It sounds as though you are still titrating your Levemir dosage which must be frustrating ++.
How high do you go and is a higher than 20 units, 30 units etc a bad thing if you finally obtain control?
Is going onto an insulin pump with a short-acting insulin another option?

 

[O_DP_T1]

Hey folks,

So I've upped the dose by 2u and it appears to be abit more stable. Lets see how this week goes.

 

[urbanracer]

Sorry to hear you had such troubles with Lantus. And glad its cessation has saved you from such horrific symptoms.
Could antibodies to Lantus be cross-reacting with Levemir and affecting its efficacy??
It sounds as though you are still titrating your Levemir dosage which must be frustrating ++.
How high do you go and is a higher than 20 units, 30 units etc a bad thing if you finally obtain control?
Is going onto an insulin pump with a short-acting insulin another option?

Previous increases led to short term improvements for a week or so then I went back to higher glucose levels. I am considering another increase but am also wary of forever increasing insulin levels. I can cope during the day with an extra bolus shot although it's not ideal but overnight rises from 8mmol at bed time into the mid-teens around 3am, are more difficult to deal with.

The myalgia started before I began using the Libre so I'm confident that these 2 things are not connected and that Abasaglar was the root cause. BUT, I do have a niggling suspicion that the Libre adhesive issue contributed to the rashes etc. Maybe I had more than 1 thing going on. I am being referred to an immunologist and if they determine that I am in fact allergic to Abasaglar or longer acting insulins generally then maybe I can discuss an insulin pump with my endo'.

 

[kitedoc]

@urbanracer, best wishes for some resolution.
Anyone would be cautious but I guess see what you are your endo might consider about Levemir doses.
And having a fallback plan of a pump is at least reassuring !!