Levemir Problems

[Adele99]

Background- Type 1 diabetes for 35 years. Long term damage CAD, PVD , peripheral, cardiac +autonomic neuropathy , eyes so far minimal background damage , and kidneys holding up fine.

Wondering if anyone can advise me on the theoretical effect of Levemir. Have read Levemir is a long acting background insulin.

My question is if someone has a BS reading of say 10 , at midnight , takes their advised 8 units of Levemir, has 2o carbs from toast and went to bed, ideally if the Levemir worked as it should in theory , what should their blood sugar reading be in the morning under normal circumstances? This question is assuming that their fast acting insulin + meal was about 5 hours prior at say 7pm, and no snacks were eaten inbetween.

Am asking on here as the Diabetic support in my area aren't mcuh use and very difficult to get through to.

thanks in advance for any replies.

 

[Mileana]

If your Levemir is adjust right, it will keep your blood glucose pretty close to stable over night. That means that if you go to bed with 10 and then DON'T eat anything, you should wake up with say 9.5-10.5 after 6-8 hours.

The way to test whether that is the case is basically to set the alarm clock every 1-2 hours through a night or two. Test your blood glucose, jot it down if your meter doesn't have a memory function, then look at them in the morning. You can expect a bit of a drop until 4-5 am, then a slight increase - but you don't want to find that you're dropping several mmols. For this test to work and not just measure your last meal, though, you want to omit the evening snack if you deem that at all safe for you. Or keep something sugary by the bed while you test, should you find something you don't want to see (lows).

Now, if you basal (Levemir) is stable, and you then add 20g of carbohydrate without any Rapid insulin to cover those carbs, your blood glucose level will go up. I would expect to see something like 14-15, maybe 16 mmols in myself in that scenario.

If you wake up with a lower blood glucose than that, it is an alright indication that you need to do above (slightly annoying, but very helpful test) to determine whether your basal is set too high.

If you wake up at 14 etc, you will still really want to test as the dawn phenomena might be bringing your levels up. Dawn phenomena is where the body gets you ready for a new day and releases growth and stress hormones to get you on your feet - this also causes an increase in blood sugars.

I would really do the test and then determine.

Unless you have been told otherwise by your team or your GP, sensible goals for evening numbers, I think I have heard referred to as around 6 mmol. You would then expect to wake up somewhere around 5-6 in the morning. The situation may be different for you with your heart and other conditions - I've heard mentioned that you want your blood glucose slightly higher when having those issues, but it isn't something I know much about. On that topic, I would ask whoever you're working with on your diabetes to inform you what goals you should be working towards.

I hope this information is useful for you.

But test, test, test.

 

[AMBrennan]

Now, if you basal (Levemir) is stable, and you then add 20g of carbohydrate without any Rapid insulin to cover those carbs, your blood glucose level will go up. I would expect to see something like 14-15, maybe 16 mmols in myself in that scenario.

If you wake up with a lower blood glucose than that, it is an alright indication that you need to do above (slightly annoying, but very helpful test) to determine whether your basal is set too high.

Firstly, this all assumes that Levemir is correctly adjusted; if that was the case the you wouldn't get 10mmol/l before the Levemir injection 5 hours after a meal so this assumption really doesn't make any sense.

Secondly, you're ignoring glucose lost through urine, and I'd expect it to be closer to 11 mmol/l.

As for OPs question: 5 hours after a meal your BG should be back to fasting levels, so your Levemir doses are clearly not right for you. Based on this, I think what you're trying to ask is what 8u Levemir in partiular, which you've been told to take by your nurse, will do to you in particular, and unfortunately we can't predict that - everyone's insulin requirements vary greatly. Unfortuantely it's mostly trial and error.

 

[Adele99]

Thanks for your replys. Used a theoretical dose and BS levels just to get an idea of how Levemir is supposed to work in theory.

Have a slighly complicated situation - erratic delayed digestion from gasroparesis which now causes huge blood sugar swings. Can never really anticipate what my BS level will be before I check it, which I now have to do umpteen times a day, sometimes every hour.

But Levemir does appear to have a fast effect on my BS, and seems to last around 7 or 8 hours. Last week 8 units of Levemir with a midnight BS of 23 (not uncommon) caused me yet another insulin coma.

I've tried reducing the dose to 2, 4, 6 8 and also actually not taking any over the past 3 years , to see if I can get a more stable result in the morning. Effects were inconsistent too. Either too high which has a dreadful effect on my circulatory problems or too low, and it's not easy trying to be at the same starting point when trying to adjust the nightime Levemir to gauge the effects, due to the gastroparesis , and other day to day life situations which aren't always the same.

Anyway thanks for your info , back to the drawing board I guess and onwards and upwards.

 

[noblehead]

Adele,

Your 'inconsistent' levels using levemir does suggest that you may need to change your basal insulin for an alternative, get in touch with your hospital diabetes clinic or ask your gp to write a letter to say that you need to be seen asap.