Long acting insulin is weird

[Levy]

Hi all,

Things haven't been going too well for me for a long time, but now my ratios have been updated and I'm counting carbs again it's going a lot better.

I have started to notice something strange now though and I think it might have something to do with my long acting insulin. Looking back at my readings, my mornings seem all fine. They are stable and at lunch I almost always come out between 4 and 8, which makes me think both my short acting insulin (NovoRapid) and my long acting insulin (Levemir) are dosed right.

Then, during the afternoon, two hours after lunch my readings will mostly be stable, but then when I test again before dinner my levels have gone up to about 12. This makes me think that my NovoRapid is doing its job for my lunches, but somehow the Levemir might not be enough to keep the readings stable throughout the afternoon. The problem is, though, if I put up my dosage of Levemir, I will start getting hypos in the morning (I have already tried that).

Am I right in thinking that it is my long acting insulin that's the problem here? And if so, how do I solve it? I have been thinking about getting a pump a lot recently, but my nurses at the hospital aren't too keen on giving me one. Isn't it right that with a pump you can prevent problems like these because you can change the dosage throughout the day?

Thanks a lot for reading this!

 

[phoenix]

quick question, do you take all your levimir once a day or split into 2, morning and night?

 

[Levy]

Oh sorry, forgot to mention that! I split it in two, take one at 8 in the morning and the other dose at 8 at night.

 

[alaska]

I had something similar happening last year.

I was good through the day but in the evenings, the blood sugar would creep up to similar levels (12).

I noticed it seemed to be happening when I was working later at work than usual.

One idea for why levels may creep up like this:

The night time Levemir dose is beginning to run out (which they can after aboue 18 hours I believe), so by about 6pm we may start to be on just our morning dose of Levemir -half dose you could say.

There could be other reasons.

I'd be interested to hear other's thoughts on this too.

Ed

 

[Levy]

Hi Ed!

Thanks for your response, that sounds very logical, actually. How did you solve this?

I work from 8 until 4 every day, and I'm noticing these levels when I get home after work, which is about 4.30. After lunch I usually check around 2pm at which time they are usually fine. But yes if I take my evening dose around 8pm by the time it gets to 4pm it's been 20 hours!

Maybe I should start taking my evening dose later?

 

[alaska]

It might help by taking the dose later. I can't see too much harm in trying.

I've found that when I eat at my usual time -around 6-7pm the levels are normal. Perhaps this is because the short acting (Humalog) is partly making up for the lower levels of Levemir.

The solution was to try and avoid working too late

Should I need to work later, I try to remind myself to test around 7pm to see whether levels are beginning to creep up.

 

[Levy]

Thanks ever so much! I will try and take my Levemir at 10pm tonight instead of 8 to see if it makes any difference to my levels in the afternoon!

 

[noblehead]

Oh sorry, forgot to mention that! I split it in two, take one at 8 in the morning and the other dose at 8 at night.

Levy, increase your morning levemir by 1 unit to see if this resolves your problem.

Nigel

 

[Levy]

Oh sorry, forgot to mention that! I split it in two, take one at 8 in the morning and the other dose at 8 at night.

Levy, increase your morning levemir by 1 unit to see if this resolves your problem.

Nigel

Hi Nigel, sorry I thought I mentioned in my post that I had already tried putting up my dose in the morning but I only ended up getting low readings just before lunch time (after breakfast readings were still stable).

 

[noblehead]

Oh sorry, forgot to mention that! I split it in two, take one at 8 in the morning and the other dose at 8 at night.

Levy, increase your morning levemir by 1 unit to see if this resolves your problem.

Nigel

Hi Nigel, sorry I thought I mentioned in my post that I had already tried putting up my dose in the morning but I only ended up getting low readings just before lunch time (after breakfast readings were still stable).

Yes you did Levy! Why not try moving your morning levemir dose forward by 1 hours and see if this helps, often people find it is more to do with the timing of their basal doses than units injected. In the past I was on levemir insulin and I would split my dose by injecting my evening dose at 6pm and the remainder 14 hours later at 8am. Speak with your dsn should this not resolve things.

Nigel

 

[slimtony]

Hi Levy,

I had pretty much the same problem as you with Levemir tailing off mid-afternoon. Despite trying every which way with 2 shots, I eventually got around the problem by injecting 3 times a day with the jabs (roughly) 8 hours apart. As a starting point, I just divided my total daily Levemir dose (AM+PM) into 3. The fine-tuning will then be up to you. Although it worked really well for me, this approach is a little unorthodox, so it's probably best to talk it over with your diabetes specialist first.

 

[Snodger]

the other option might be to ask to try a different long-acting insulin? But perhaps you are happy with Levemir otherwise.

 

[Levy]

the other option might be to ask to try a different long-acting insulin? But perhaps you are happy with Levemir otherwise.

I used to use Lantus before but Lantus works really unpredictably for me (I could never say whether my blood glucose would go up or down or stay steady during the night it was always different) so I have changed to Levemir about 6 months ago and it has been loads better during the night since

It's just the afternoons before dinner time that I'm struggling with now :roll: