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Long Acting changed to 2x a day - I am confused

joules

Well-Known Member
Messages
71
Location
London, UK
Type of diabetes
Type 1
Treatment type
Insulin
Dislikes
Autoimmune issues
Dr's have suggested changing from Lantus to Levemir and to take 2 shots daily - morning and night. I was running with low sugars in the middle of the night previously, hence the change over. My previous dose was 18u Lantus for 24hrs and tried doing that both evening and morning times, though ended up still with hypo's at night. Dr's suggested to start with Levemir with 7u before bed and 9u in the morning several weeks back, which have been trying. Now my sugars are perfect all night long and then creep up between 7am (6mmol) > 12pm (12mmol) whilst fasting. Before bed, sugars are 6mmol. My dose times are 11pm and 8am now. Seems that taking 4u of Novorapid first thing keeps things fine. I would usually need 10u Novorapid for breakfast assuming my sugars are fine. Atm, need 14 instead to counteract this slow increase.

So, my question is, what do I do now? I am confused as this long acting split into 2 doses is a new way of thinking and am unsure if it's the night or morning doses that need increasing/decreasing.
Maybe it's just that my liver chucks out glucose first thing, so need the 4u of novorapid to counteract it... Anyone with this issue? It's too confusing.


Thank you
 
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Hi @joules I split my levemir, as I was running out of long acting towards the end of the day, I had to change my carb/insulin ration down for breakfast only - apppears you may have to up your ration for breakfast only, if your BS readings are fine for the rest of the day then so be it.
 
Thanks @slip for sharing. I think you may be right, though ideally, should be adding the 4u at around 6.30am to avoid the slow climb. Interesting as it literally takes around 1.5hrs for novorapid to actually do anything for breakfast and increased sugar levels.
 
Interesting that you switched to Levemir rather than splitting you Lantus dose, any reason?
I think Levemir has a more pronounced curve in its profile, you might try bringing your evening Levemir shot back to 6-7pm. This may cover your morning highs better (if profile peak is at 12-13 hours for you). It's all trial and error.
Good luck.
 
Thanks @zjed . Unsure myself and I do have a load of Lantus pens left in the fridge so could try that. Now I am even more confused, haha... So, where to go and when...? Sure, will try an earlier evening shot...
 
Depending on the dose size per kg of body weight, the curve varies and the duration of levemir does too. At low doses it really is pretty flat so if you are splitting the dose it works really quite well. It also doesn't last quite so long.

It's worth having a look at it to understand the profile and therefore work out what you expect to happen.
 
@joules Sorry if i confused the issue further, I'm just raising a couple of points which I would look at if I was in your situation. You should discuss these with your team before proceeding with any changes. Also, I wasn't suggesting you go back to Lantus, I was just curious about the reasons your Doctor recommended switching to Levemir.
I was just suggesting you could try varying the time of your evening dose by a few hours to see if that improves the situation.
 
@joules, if you struggle to get the balance right using levemir ask your DSN or Consultant about Tresiba, its a newish basal insulin that came out around 2 years ago and has a flatter profile than levemir & lantus, there's a few members on the forum who have changed to this insulin with great success so its worth enquiring about, the only issue might be that its more expensive than other basal insulins and some HCP's are reluctant to prescribe it due to the cost.
 
Hi, I've recently upped and split lantus in a bid to reduce bedtime and morning bms. My readings would be acceptable 2 hours after tea then slowly creep up to around 11-12 before bed. Dsn thought maybe lantus running out after about 18 hours, hence split dose. While my readings are very slowly improving, I find that I need a ratio of 1:10 novorapid with my evening meal, however the rest of the day I use 1:16. Dsn also suggested I might try degludec instead of lantus as it tends to last longer and can also reduce novorapid dose?
Diagnosed as type 1, 4 years ago aged 44.
This whole thing is like being on a long journey and frustratingly never reaching your destination.
 
@zjed , it's fine and thank you. Am willing to try anything to get this right. I am basically left to work it out by the team at the hospital. I tried bringing the dose back to 7pm and low and behold, before bed it was 7mmol, then at 7am 16.2mmol!!! Any thoughts on this?
Haha... at least I am not getting nighttime hypos anymore. Maybe i will try increasing this dose a little and see what happens, and will take it late so that the peak reduces the morning increase in levels. Will try this tonight. Failing that may try Lantus twice a day in the hope that the peak in the morning is more.
@ginny s , am thinking that a little more rotation for your doses could help perhaps as insulin can get stuck under the skin if injected in the same areas, stopping it from flowing freely to the blood stream..
 
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@joules
I have to say I usually inject lantus in my abdomen as I find injecting more than 4-5 units is quite painful in my thighs. For the last 2 mornings my fasting bg has been less than 7 which is amazing as I'm never under 9-10. Maybe, and I say this cautiously, I'm starting to get the hang of this. Recently did a Daisy course which helped hugely also. X
 
This is becoming really annoying as I have to wake at 4am to take 6u of Novorapid to stay on track.
Would it be ok to have 7u of Lantus at night and 9u of Levemir on the morning instead? I am under the impression that Lantus would reduce through the night as before where I was getting hypos as a 24hr long acting - thinking that splitting would be better, though levermir is making my sugars high.. grr. I have to get this sorted as I have not had a decent full night sleep in weeks
 
Hi joules,

I was put on Levimir from lantus a few years back now. I'm on the same as you morning and evening injections but much much higher doses! 34 and 47. It was lower than this but it's been put up to try and reduce my levels in the morning as they always run high reading between 13 to 18,19mmol.
I found it works alot better than the lantus for me and my body. Especially since its been upped as the sugars are beginning to be under 10mmol in the morning.
I think everyone is different with it, my sisters also a type 1 and uses lantus as the long acting as that works for her!!

The doctor told me that increasing the units in the evening would help to bring the sugars down, which it has. Maybe you should ask tour doc to explain it again to you, there's nothing worse than ending up confused about it all, because it won't help you!
Abbi
 
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