Levemir - change to once a day?

zicksi101 said:

I'm on a levemir split at the moment - 3u in the morning, 17u before bed.

My sensitivity to the morning levemir has been improving again and I am considering using it just the once a day. The problem I've sometimes had on higher morning doses of levemir is a late afternoon hypo after 3pm. My lunch time quick acting insulin still takes longer than I'd like to "work" because I need to be mindful of the drop - which is within the 2mmol/l basal tested range but closer to the threshold than desirable.

It's something I've been thinking about recently as I've come down from 5u to 3u, I do wonder if taking once a day Levemir and possibly needing to adjust Novorapid ratios during the day may in fact be a simpler insulin profile to manage?

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The question is really how long does the Levemir last for you? For many, the issue with one Levemir before bed is that rises are seen late afternoon/early evening as the Levemir "runs out". If you are confident it will last you the 24 hours, there's nothing wrong with trying it, but if you are getting hypos in the afternoon, it's also possible that you just need a different I:C ratio at lunch time.

I give my levemir at 4pm as afternoon and evening see highest bgs for me so by taking at that time it just about lasts untill breakfast .Zics its only by giving it lots of thought and then trying a split dose or a change of timing that you can work out whats best for you as we are all individual in our needs

zicksi101 said:

Thanks for the comments. In any case I'll need to be careful with this and do lots of testing.

The issue I've been having is late afternoon drop which also shows up on the late afternoon basal test, yesterday BG dropped from 6.5 three hours after the lunch time bolus to 4.4.

I've tested the evening basal too and I know that it isn't enough insulin to cover the fasting state after 22 hours. So it's a bit of a catch 22.

I am willing to accept a spike 1-2 hours after food, but would prefer not to simply accept a high that stays that way for 4-5 hours, as I have done so in the past and it has lead to poor hba1c. So to be clear what I'm considering is using bolus to form part of the basal rate to avoid a spike later, which as I understand it is how an insulin pump delivers the basal rate, and I just wanted to see if anyone else is doing the same on MDI and what their experience is.

I would be very surprised if no one else does this deliberately, but there doesn't seem to be anything in the books about it.

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No, there's nothing in the literature. What many people do is something similar to handle dawn phenomenon. I used to split my lantus dose am and pm as I needed much less over night. I then had dawn phenomenon, so when I got up at 5am, I was taking a Novorapid shot to counter the rise, prior to my morning Levemir at 7am. It worked alright, but also was the reason I got a pump.

zicksi101 said:

Thanks for the comments. In any case I'll need to be careful with this and do lots of testing.

The issue I've been having is late afternoon drop which also shows up on the late afternoon basal test, yesterday BG dropped from 6.5 three hours after the lunch time bolus to 4.4.

I've tested the evening basal too and I know that it isn't enough insulin to cover the fasting state after 22 hours. So it's a bit of a catch 22.

I am willing to accept a spike 1-2 hours after food, but would prefer not to simply accept a high that stays that way for 4-5 hours, as I have done so in the past and it has lead to poor hba1c. So to be clear what I'm considering is using bolus to form part of the basal rate to avoid a spike later, which as I understand it is how an insulin pump delivers the basal rate, and I just wanted to see if anyone else is doing the same on MDI and what their experience is.

I would be very surprised if no one else does this deliberately, but there doesn't seem to be anything in the books about it.

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Hello,

If it were me - I'd just stick with the split dose and use @tim2000s's advice wrt using a smaller I:C ratio for your lunch bolus dose. Depending on what time you have your breakfast, you may have a small stacking effect that is causing your mid afternoon dip. Unless you're eating breakfast 4-5 hours before lunch then you can still have some bolus insulin working in your system. A reduced ratio should help for that. Likewise it may be too much basal as it roughly coincides with Levemir's (although it doesn't claim to have one) peak action time. Certainly from my experience.

Levemir is a good insulin, but it is so poor at living up to it's "once a day" claim. As Tim said, many of us use bolus to counter DP shortly after waking. It's the best method. I messed around with staggered basal split doses for a while but a small 1-2u correction works to cover highs for that period of time, for whatever reason. It may also work for your needs, having a go won't hurt - it may be a preferable option for you! The end result is that you'll still need an extra injection. So your split basal dose or one extra bolus injection works out the same; unless you take the extra bolus at the same time as your typical bolus for a meal?

Keep us posted
Grant