Levemir question

[Bluemarine Josephine]

I split my levemir into 2 doses - midday and just before bed
I've always found this work well

however I have a question which may or may not be related to the levemir

Today I had my lunch at around 12.30

My glucose level was 7.3 before so I was quite happy

I've been stuck at work and I haven't eaten - so it's been around 5 hours since I last ate. I've had plenty of water in between but I just checked and my glucose was 2.9.

I've always thought that the levemir (in this case the one I took last night) would stop these lows from happening and would help keep my glucose levels stable?

What would be the reason for it going low? Is there something to it or am I just missing something really obvious?

If your levemir dose is correct then i suspect that either you miscalculated your mealtime bolus and injected more fast acting insulin or you did exercise that you didnt consider in your calculation for your bolus. Are you cerain that your ratios are correct?

 

[Cassandra13]

I split my levemir into 2 doses - midday and just before bed
I've always found this work well

however I have a question which may or may not be related to the levemir

Today I had my lunch at around 12.30

My glucose level was 7.3 before so I was quite happy

I've been stuck at work and I haven't eaten - so it's been around 5 hours since I last ate. I've had plenty of water in between but I just checked and my glucose was 2.9.

I've always thought that the levemir (in this case the one I took last night) would stop these lows from happening and would help keep my glucose levels stable?

What would be the reason for it going low? Is there something to it or am I just missing something really obvious?

Levemir reduces the amount of lows because in its action profile is flat (rather than having a peak and decline line lantus does) This means that it gives you consistent background basil insulin. If you are dropping if you go a long time without eating, it might mean that you just have too much background basil insulin and would just need to slightly reduce your levemir amount. Once you have the right amount for you, then it should stop you from fluctuating between meals.

 

[Robinredbreast]

Agree with you Robinredbreast that splitting Levemir is a personal thing. I was just responding to Bluemarine's comment that DAFNE said to take Levemir longer than 12 hours apart. We are all different and respond differently to meds. Bluemarine was concerned that taking her Levemir 1 and half hours later than usual would have a detrimental affect. I don't think I have mislead Bluemarine, but if I have then hopefully a moderator will give feedback.

I'm sure you haven't misled anyone it's just that not everyone does split their Levemir. I did ask about it and I was told just to leave it. as I take a small amount.

 

[Bluemarine Josephine]

Hi Bluemarine, I'm surprised that DAFNE has said your evening injection is as late as 10.00pm. Usually the Levemir is split 12 hours apart, so your late evening injection is overlapping with your morning injection. If this is working well for you then all is good. I personally take Levemir at 7.30 am and 19.30pm, this gives me the knowledge that Levemir is working slowly throughout the night as I do a blood test before bed to ensure it's within range, and in the morning, which tells me that my blood sugar is still within range. I have on occasion been late with the evening injection and this has had no effect either way. As I said if your regime is working well for you then carry on with what you are doing. There is no need to worry that your evening injection is late as long as you test before bedtime you'll be okay.

Thank you for your reply. I will ask them if i can split the doses with a 12 hour interval like you do. The way you do it makes more sense to me.

 

[Bluemarine Josephine]

Levemir reduces the amount of lows because in its action profile is flat (rather than having a peak and decline line lantus does) This means that it gives you consistent background basil insulin. If you are dropping if you go a long time without eating, it might mean that you just have too much background basil insulin and would just need to slightly reduce your levemir amount. Once you have the right amount for you, then it should stop you from fluctuating between meals.

Completely agree with you Cassandra. I also suspect his basal dose may be high.

 

[tim2000s]

Levemir reduces the amount of lows because in its action profile is flat (rather than having a peak and decline line lantus does) This means that it gives you consistent background basil insulin. If you are dropping if you go a long time without eating, it might mean that you just have too much background basil insulin and would just need to slightly reduce your levemir amount. Once you have the right amount for you, then it should stop you from fluctuating between meals.

Sorry to disappoint, but Levemir has a peak absorption, just like Lantus. The more you take, the greater this peak is. I'll add the absorption curves later. It is much flatter than NPH insulin though.

In the poster's comment, he mentions five hours after eating going low. Without knowing where he was at two hours we can't tell which insulin caused the low. He could have overdosed at lunch (remembering that short acting a can last five hours) or it could be too much basal in his system. Either way, more information about ratios, food eaten, carbs consumed and intermediate levels would be required to make a reasonable determination.

 

[Kevlar87]

@Bluemarine Josephine @tim2000s thanks for the replies guys

I'm starting to test more regularly so I'm slowly working things out. However I just woke up with 13.9!? :'( The only thing I can think is that my midday levemir basal yesterday needs to be upped! It's so frustrating and demoralising after a few weeks of good control :/

 

[Cassandra13]

@Bluemarine Josephine @tim2000s thanks for the replies guys

I'm starting to test more regularly so I'm slowly working things out. However I just woke up with 13.9!? :'( The only thing I can think is that my midday levemir basal yesterday needs to be upped! It's so frustrating and demoralising after a few weeks of good control :/

Stick with it! It is definitely a trial and error process at first! If you woke up high, then I think your bedtime dose needs to be adjusted instead of the mid-day dose? Increasing the mid-day dose might just lead to more lows in the evening.

 

[Bluemarine Josephine]

I agree with Cassandra.
The first thing to look at is if your background insulin doses are correct.
Once these are correct, everything else (like bolus ratios) falls nicely into place.
Make sure you test regularly and observe the patterns.

You woke up with a 13.9. What time did you go to bed and what was your level then.
Also what time did you have dinner and how many Cps and bolus did you take?

For example, if you woke up with a 13.9 but your bedtime level was 18 then clearly the dose is too high but, if you went to bed with a 7 then it is too low.

Gives us a few more details please.

 

[Kevlar87]

Hi guys,

Sorry for the late reply. I'm in Paris so the last few days have been really bad and I haven't had much time to sit down

@Bluemarine Josephine I went to bed at around 11pm with a bm of 8.3 so I guess you're saying that my night-time bolus needs to be higher?

@Cassandra13 Thanks for the tips!

 

[Bluemarine Josephine]

Hi guys,

Sorry for the late reply. I'm in Paris so the last few days have been really bad and I haven't had much time to sit down

@Bluemarine Josephine I went to bed at around 11pm with a bm of 8.3 so I guess you're saying that my night-time bolus needs to be higher?

@Cassandra13 Thanks for the tips!

Your bolus (Novorapid) which you take with your meal, lasts an average of 5 hours (less for some people and more for others.) In order to assess what is going on, you need to examine carefully your overall evening plan, not just your bedtime number

To give you an example, if your dinner was at 18:00 and you bolused (took your Novorapid at 18:00 with your dinner) by 23:00 when you went to bed with a nice 8.3, your Novorapid was not active anymore, so your high number of 13.9 in the morning is because your basal (Levemir) dose is low.

But, if your dinner was at 21:00 and you went to bed at 23:00, you might be at an 8.3 but, you still had Novorapid on board up until 02:00 in the morning and if you calculated less Novorapid in relation to the carbs in your food, (so less Novorapid than what you needed) then you could be at 13.9 by 02:00 in the morning and, as a result, your basal (Levemir) kept you nice and steady at the 13.9 level. In this case, your basal (Levemir) in not the problem.(it actually works nicely) ; your Novorapid miscalculation is the problem.
However, all the above are hypothetical scenarios because I do not know what you did.
I dont know what type of food you had (complex carbs or not, amount of fat etc), what your ratios are, when you had your dinner, how much Novorapid did you inject etc.

What I would suggest are the following:

1. Do a basal test.
2. Do not take advice regarding your insulin doses from a forum or a website.
Do your basal test and discuss your findings with your doctor/diabetes nurse. Each person is different and reacts differently to insulin. You can hear what people have to say but, only make dose adjustments after you speak with your doctor.

 

[slip]

To give you an example, if your dinner was at 18:00 and you bolused (took your Novorapid at 18:00 with your dinner) by 23:00 when you went to bed with a nice 8.3, your Novorapid was not active anymore, so your high number of 13.9 in the morning is because your basal (Levemir) dose is low.

just reading through this repsonse and my initial reaction was 'this just isn't true in this example!'.....and then I read the rest of the post and @Bluemarine Josephine is spot on with her explaination and advice.