Levemir night lows and reducing doses

[emmalou1990]

Hi everyone - just had a question if anyone has ever had to change their Levemir by quite a bit? I typically eat a fairly low carb diet of c. 100-140g a day but have lost a few kg (nothing major) due to a bit of stress and I’m guessing I’ve cut back on snacks a bit. I’ve been on Levemir for a year and a bit after Lantus lows and it generally works well for me. I’ve gone from taking 18u in the morning and 12u at night to 16u and 9u at night, and my bloods are still dropping by c. 4-6 mmol at night and if I have a few glasses of wine this is even greater and this never happened before. I’m setting alarms through the night and checking a few times, and reducing the basal gradually until it stops, but I find it’s quite a shift thats happened in the last few weeks! Any experiences or advice would be great. I’m spending the next few days basal testing as it seems I now hardly need insulin at night but I guess the small weight loss has really caused a shift from the routine! I have my diabetic appointment in two weeks so will take the results to them. Thanks

 

[StewM]

Hi everyone - just had a question if anyone has ever had to change their Levemir by quite a bit? I typically eat a fairly low carb diet of c. 100-140g a day but have lost a few kg (nothing major) due to a bit of stress and I’m guessing I’ve cut back on snacks a bit. I’ve been on Levemir for a year and a bit after Lantus lows and it generally works well for me. I’ve gone from taking 18u in the morning and 12u at night to 16u and 9u at night, and my bloods are still dropping by c. 4-6 mmol at night and if I have a few glasses of wine this is even greater and this never happened before. I’m setting alarms through the night and checking a few times, and reducing the basal gradually until it stops, but I find it’s quite a shift thats happened in the last few weeks! Any experiences or advice would be great. I’m spending the next few days basal testing as it seems I now hardly need insulin at night but I guess the small weight loss has really caused a shift from the routine! I have my diabetic appointment in two weeks so will take the results to them. Thanks

In short, Basal needs changing through out time is not unusual at all.

 

[Jaylee]

Hi everyone - just had a question if anyone has ever had to change their Levemir by quite a bit? I typically eat a fairly low carb diet of c. 100-140g a day but have lost a few kg (nothing major) due to a bit of stress and I’m guessing I’ve cut back on snacks a bit. I’ve been on Levemir for a year and a bit after Lantus lows and it generally works well for me. I’ve gone from taking 18u in the morning and 12u at night to 16u and 9u at night, and my bloods are still dropping by c. 4-6 mmol at night and if I have a few glasses of wine this is even greater and this never happened before. I’m setting alarms through the night and checking a few times, and reducing the basal gradually until it stops, but I find it’s quite a shift thats happened in the last few weeks! Any experiences or advice would be great. I’m spending the next few days basal testing as it seems I now hardly need insulin at night but I guess the small weight loss has really caused a shift from the routine! I have my diabetic appointment in two weeks so will take the results to them. Thanks

Hi,

Alcohol can stunt liver production of glycogen which could affect more rapid drops during the night?
You would need to talk to your team. It maybe possible the evening dose could be overlapping with the working profile of the morning dose?
When do you time your basal doses? When are the hypos occurring? & when was your last evening meal?

I would agree with @StewM that basal needs can change. So checking the foundations, starting with the Levemir is the first thing to look at.

 

[emmalou1990]

Hi,

Alcohol can stunt liver production of glycogen which could affect more rapid drops during the night?
You would need to talk to your team. It maybe possible the evening dose could be overlapping with the working profile of the morning dose?
When do you time your basal doses? When are the hypos occurring? & when was your last evening meal?

I would agree with @StewM that basal needs can change. So checking the foundations, starting with the Levemir is the first thing to look at.

Thanks @Jaylee! I do think there is some overlap going on so am interested to see the basal test results. I think i've just always needed less overnight as i had this same issue with Lantus despite taking it in the morning and reducing doses to avoid overnight lows. Currently I take Levemir at c. 7.30am and around 9pm, and have dinner around 7/8pm most evenings. I just can't remember having this much of a reaction to a small amount of alcohol though (few glasses of wine), and previously have drank a lot more and taken more Levemir and had no issues. Maybe something hormonal has changed (i'm 31) and my tolerance is different. The hypos are typically at c. 3am but the Libre shows a constant decline from midnight, so it's mainly I wake up it's just hit below 4 but then a spike will start one hour later when the Levemir wears off and hit 8.

 

[searley]

To me without knowing the full situation etc that 30 units in a day may simply be too much... the most I ever took was 30 units and I'm slightly overweight and eat poorly

If your care team is leaving you to adjust your own doses you just have to keep lowering every few days until you find the right level.. otherwise have a word with then see what they say

But your requirement will constantly change

 

[Jaylee]

Thanks @Jaylee! I do think there is some overlap going on so am interested to see the basal test results. I think i've just always needed less overnight as i had this same issue with Lantus despite taking it in the morning and reducing doses to avoid overnight lows. Currently I take Levemir at c. 7.30am and around 9pm, and have dinner around 7/8pm most evenings. I just can't remember having this much of a reaction to a small amount of alcohol though (few glasses of wine), and previously have drank a lot more and taken more Levemir and had no issues. Maybe something hormonal has changed (i'm 31) and my tolerance is different. The hypos are typically at c. 3am but the Libre shows a constant decline from midnight, so it's mainly I wake up it's just hit below 4 but then a spike will start one hour later when the Levemir wears off and hit 8.

Do you use Novorapid as a bolus insulin? What I see is sometimes Novorapid can have a lick in the tail in the 4th or 5th hour after taking it? (If your evening meal is around 8pm?)
There is the possibility your basal is also kicking in too?

At a rough guess..

 

[emmalou1990]

Do you use Novorapid as a bolus insulin? What I see is sometimes Novorapid can have a lick in the tail in the 4th or 5th hour after taking it? (If your evening meal is around 8pm?)
There is the possibility your basal is also kicking in too?

At a rough guess..

Yes I am on Novorapid and agree about the kick! Annoyingly sometimes it does this and sometimes it doesn't - I also often find if I correct before 4 hours (never before 3) are up then I can easily go low, and need to stop doing this, even when it's a very small correction of 1-2 units.

 

[emmalou1990]

To me without knowing the full situation etc that 30 units in a day may simply be too much... the most I ever took was 30 units and I'm slightly overweight and eat poorly

If your care team is leaving you to adjust your own doses you just have to keep lowering every few days until you find the right level.. otherwise have a word with then see what they say

But your requirement will constantly change

Thanks @searley, I do think that maybe i was on a too strong dose before and will discuss with them in a few weeks. Thanks

 

[jonathan183]

I find there is a difference of 4 or more units in each dose after I have been exercising for a couple of days, for me it starts reducing on the 3rd day of exercising. I also found what I eat can affect both bolus and basal requirements, so log what I eat as well as doses so I can look back over the previous couple of days if needed.
I sort out my own dosing adjustment ... I drop units quickly and raise them slowly which seems to work for me

Might be worth keeping a log of what you eat as well in case there is some interaction

Hope you get it sorted soon

 

[emmalou1990]

I find there is a difference of 4 or more units in each dose after I have been exercising for a couple of days, for me it starts reducing on the 3rd day of exercising. I also found what I eat can affect both bolus and basal requirements, so log what I eat as well as doses so I can look back over the previous couple of days if needed.
I sort out my own dosing adjustment ... I drop units quickly and raise them slowly which seems to work for me

Might be worth keeping a log of what you eat as well in case there is some interaction

Hope you get it sorted soon

Thank you!