Levemir: Request for information

Hello everyone! I hope that you are doing very well!
I need your insight on this one.

My current basal insulin is Tresiba and I must admit I am very satisfied with it.
It is a very steady insulin, no peaks, no side effects, usually producing predictable results from one meal to the next, doesn’t sting or hurt upon injection. I only have good words about it.

However, my insulin needs are higher in the morning and considerably lower in the evenings (keeping in mind that I am very active during the day). I inject 18 units of Tresiba every morning which works very well for me during the day however, in the evening, my blood sugar drops considerably.

Even in days where my blood sugar is out of control (like last Sunday, where the change to winter time disturbed my readings), at 19:00 I was as high as a 16, had a salad, did not basal at all, and by 24:00 my blood sugar had dropped to a 9. By 03:00 I was at 7.4.

During less active days my readings are very stable, 24:00hrs readings - fasting readings are very similar, almost identical.

My dietician (who believes that 18 units might be too much for my weight) suggested that Levemir could help me with my case by splitting more dosage in the morning at 07:00 am and less in the evening at 21:00 am.

Can you give me information on Levemir please? How does it work? Does it have any side-effects? Are you happy with it?
I must admit I am reluctant to this change in the sense that Tresiba works alright and “if it is not broken why trying to fix it.”

Thanks ever so much in advance.
Regards
Josephine.

Juicyj said:

Hi there,

I too am on Tresiba, I was on Levemir but I became resistant to it, so was injecting more and more levemir but it wasn't bringing my blood glucose down. I find Tresiba much better as it's a flat profile, and doesn't matter if I miss my injection (which sometimes I do) as it lasts about 42 hours, it's one injection a day too, Levemir I was on 2 injections.

I also find my insulin requirements am/pm change alot, but I simply adjust my quick acting ratios and drop to 1 unit of quick acting to 10g of carb after 1pm, but in the morning I take about 2 units to 10g of carb.

Why change if you can adjust your quick acting ratio ? Just change your quick acting ratio to counter the pm trend, what ratios are you on currently ? J

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Hello, thank you for your reply.
I am still on a prolonged honeymoon period and I manage my blood sugar levels through a (very) low carbohydrate diet which serves me well (and do not wish to change my diet - I find that low carbs diets do wonders in blood sugar management). I am about to participate in a Dafne course next week so, theoretically, I will find out about my ratios then however, if my calculation is correct, a general ratio would be 1:15 to 1:20.

The problem seems to be in the fact that sometimes (not always) the Tresiba keeps me well balanced during the day but is dropping my levels during the night. Personally, I suspect that the problem may be in delayed onset hypoglycemia due to exercise.
My dietician believes that splitting to a lower Levemir dosage in the evening will help in providing some peace of mind.

But... I am reluctant.... I like the Tresiba to be honest...
And I do check during the night anyway (despite if my basal is Lantus, Tresiba or Levemir).
So, I feel that a change might be somewhat un-necesssary....?

Daibell said:

Hi. I've been on Levemir for 2 years. I've had no side effects and not seen any reported on the forum. It's the NICE preferred Basal (perhaps it's cheap!). It doesn't last 24 hours, so many split it. I only take one dose at night but as I have a low-carb breakfast the 6-8 hour Levemir peak means I can avoid NovoRapid for breakfast. For evening I just use the necessary rapid ratio to balance the failing Levemir; works fine for me and saves 2 injections from the 5-a-day. You didn't mention the Bolus in your post. Once you get the carb-counting right it may be the Basal problems you have will recede anyway.

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Hello and thank you for the feedback.
You mention that Levemir has a peak in between the 6th and 8th hour from the time of injection.
So, does this mean that although Levemir is a basal insulin, its profile isn't completely flat, is this correct? ( I was experiencing something similar when I used Lantus; I had also noticed a peak although, Lantus is described as a basal insulin with a flat effect).