Splitting Levemir

[CLP]

Hi

I have a question re splitting levemir. I take levemir and novorapid and am on small doses. I only take 6 units of Levemir each day. I take this at 10pm and its starts running out around 5pm (ish) and my BG starts to rise. This is making getting decent BG results in the evening very difficult. Even if 2 hours after tea my BG is ok it goes up as i've no background insulin to keep me level. I'm increasing my Novorapid and have taken extra about 2 hours after tea / or done some exercise to try and control this but its very hit and miss. I'm starting to get frustrated with it :x

I asked my DN about spltting the dose but she is very against this as she says I'm taking too small a dose and she's not sure how this would work. She seemed to think that going to bed at 8 or thereabouts was ok. Her definition of ok is NOT mine!

Has anyone sucessfully split such a small dose of basal insulin?

Claire

 

[totsy]

hya,
i always thought levemir was twice daily but i take lantus but cant really help with this,im sure one of the more experienced levemir takers will be along soon and answer your question

 

[jopar]

Levimer is designed as a once a day isnulin, but it lends itself to splitting better than lantus which can also can be split...

But going back to split or not?

There is another option here rather than splitting, if you levimer is running short what about changing the time of it... Take it ealier so that the tail ends falls into a part of the day ?

I can see what your nurse see's about splitting as you'll looking at a 50/50 split 3u/3u or a 60/40 split 4u/2u but with thinking about it, it's still possible to do this and if it's something that you need to do then you need to do... If it's a case of that the small amount of insulin and sinsivity to insulin is casuing control issues, then prehaps a insulin pump might be worth a consideration...

Even though 8 might seam high for going to bed, it should allow for a drop over-night that stops you having a night time hypo.... Do you know on adverage how much drop you have over-night as this will depict how safe it is to seek a lower bg going to bed?

 

[fergus]

I take 4 units of Lantus at night and 4 in the morning. It's not Levemir but the profile is very similar and neither work for 24 hours.
I'm shifting onto Levemir next week and I'll start on the same splits at the same times.

I met a guy called Vigo Bruch at a presentation last night. He's the MD of Novo Nordisk in the UK and a very nice bloke too by the way. He was quite certain that Levemir should be used as a split dose, not a once-a-day thing.

Also, he tells me that they will soon introduce an ultra-long acting version with an absolutely flat profile which in trials works for almost 2 days. Something to look forawrd to?

fergus

 

[CLP]

Thanks for the replies.
Jopar - I'll need to think about moving the timing. I suppose if after lunch it was running out at least I'm not eating at the time. Re my night time drop its usually around 2 points, unless my tea has been particularly high protein or higher than normal fat. So really I need to be between 6.5 and 7 to comfortably go throught the night. I had an oat biscuit at 4am this morning as I was 4.0 when I woke! (This is because I took 2 units of novorapid and did some exercise to bring me down after tea.. this time went too low as bedtime reading was 5.8.). Not really considered a pump.. don't really like the idea of having something attached to me all the time.

Fergus - I'll tell my DN that the MB of Novo Nordisk says that Levemir definately should be split. See what she says! With your 4 / 4 split do you sometimes find that you run a little lower than normal (ie when the first dose coincides with the second) and a bit higher when you are only on the one dose of 4? I'm assuming that splitting the dose doesn't give you a stable amount of insulin all the time? Just wondering what sort of affect this has. 1 injection every 2 days would be good, although not sure I'd want to go on it till it had been well and truly tested.

Claire

 

[Trinkwasser]

I take 4 units of Lantus at night and 4 in the morning. It's not Levemir but the profile is very similar and neither work for 24 hours.
I'm shifting onto Levemir next week and I'll start on the same splits at the same times.

My years of reading other people's experiences suggests Lantus *can* last anywhere between about 16 and 30 hours, so for some (many?) it can be a 24 hour insulin.

Levemir isn't and AFAIK was never designed to be.

I'm racking my brains now to remember if people who have made that changeover need to increase or decrease Levemir over the Lantus dose. I have little doubt you're sensible enough to test rigorously until you're stable on your new regime.

 

[Jay3109]

I think I posted on another thread that I decided to split my Levemir 10 units am and 18 pm. I take these at 6 and 18.00hrs roughly (no real problem with half an hour either way although my DN said to ensure 12 hours between doses). This was (I hasten to add) at my suggestion rather than the DN but at least she had no problem with it as a concept.

However, the OP does take a very small dose so it may well be that splitting will make very little difference. If anyone knows any more about the super long acting version that Fergus mentioned, I would love to hear about it...

 

[iHs]

Hi folks

Because of some of the comments about Lantus on this forum, I asked my DSN through my GP to change me over from using Lantus once a day before bedtime to using Levemir. My DSN had no hesitation as she was also trying to get her type 1 husband to change to Levemir too. She did say though that I would probably have to use it twice instead of just once like Lantus.

On Lantus I used 17-19 units before bed (depending on what my bg was) and was able to wake up in the morning with a bg somewhere between 3-5. Using Levemir I started off using 18 units before bed but then carefully added some Levemir in with my morning bolus. Over a few days I settled on 12 units before bed and 12 units before breakfast. So in general I would say that people will need to increase the doseage of Levemir.

As for bg control and hypos, there is only a very small difference between the action of Lantus and Levemir. Mood wise, I am still the same nice, happy person that I have always been so there is no difference at all.

 

[jopar]

tranwisser

Levimer is and was designed as a once a day 24 hour injection http://www.novonordisk.com/images/diabe ... June07.pdf the same as lantus... these two have different profiles with the lantus with a very small peak and a lot flatter line than that of Levimer... Lantus is also supposed to have a shorter tail off, where as Levimer starts to tial off quite early compared to the lantus...


The easiest way to control diabetes T1, is use a long acting insulin to give a flat basal line, so that quick acting insulin is used to deal with food being eaten.... that the theory behind it all...

In practive, it is very difficult or near impossible to achieve a flat basal with injection and long acting insulin as the liver flutuates its delivery of glucose into the system at different times... So what you end up with, the insulin creating a flat line and the basal haing a wave around this line, so at some points you can be in the situation that you have too much insulin and at other times too little insulin in your system... this can casue problems with how much a dose you require to take to combate the carbs that you are eating... If you are eating at the same time every day, then this would be easier to deal with as you would just adjust your insulin to carb ratio... But if you have different times meals times, then it becomes a hit and miss affair to whether this factor needs to be included it not....

Because of the profile of action with Levimer it does tend to lend it self a lot better than Lantus in splitting to over come the different basal needs in a 24 hours period to create a flatter basal profile for the individual...

As to the 48 hours insulin, not sure about it at all if it last that long if you have problems or need to adjust it's going to take ages before you would kown whether the adjustment made was working or not...

If I take my own basal rate on my insulin pump, which the dose amount is not only delivered throughout a hour, but dose can be adjusted as well, on my 1st profile for a normal day I have 7 changes of dose within a 24 hour period to give a flat line basal... Not something you can achieve on long acting insulin injections either on 1 or 2 jabs a day...

 

[suzi]

Hi Guys ,
thought i'd put my pennies worth in, my 10 yr old has just started the Dafne regime, just done 1st wk, and he takes 20u of Lantus at bedtime(which he hates as he says it stings like h**l) morning readings good at 5-7, lunchtime 10-15 bad, teatime 15-20 worse and bedtime 7-10 great. Don't wish to increase humalog with meals as were carb counting pretty well and don't wish to bring on any hypos. With lunch usually 6- 8u and dinner 7-9u. My thinking is that the Lantus is running out around 4pm(19 hrs after taking it) going to ask DN on tues to either swap Lantus for Levimar or to split the dosage. Any thoughts welcome
Suzi x

 

[iHs]

Hi Guys ,
thought i'd put my pennies worth in, my 10 yr old has just started the Dafne regime, just done 1st wk, and he takes 20u of Lantus at bedtime(which he hates as he says it stings like h**l) morning readings good at 5-7, lunchtime 10-15 bad, teatime 15-20 worse and bedtime 7-10 great. Don't wish to increase humalog with meals as were carb counting pretty well and don't wish to bring on any hypos. With lunch usually 6- 8u and dinner 7-9u. My thinking is that the Lantus is running out around 4pm(19 hrs after taking it) going to ask DN on tues to either swap Lantus for Levimar or to split the dosage. Any thoughts welcome
Suzi x

Hi Suzi

Yes you are correct in your thinking about Lantus. It doesn't in any way last for 24hrs. I found that I needed 2 units bolus per 10gram carb in morning, then 2.5 units bolus per 10grams carb lunchtime and then by evening meal I needed 3.5 units bolus. Lantus probably tails off approx 12-15hrs after it has been injected. I got by every day by using part of the bolus to also act as my basal along with whatever effect Lantus was doing.

You could try splitting the Lantus as you have already got it, but you will then have to play about adjusting the bolus.

 

[jopar]

Hi suzi

Are you taking the Lantus straight from the fridge to inject? Insulin can sting if injected cold, if it's stinging at room tempreture this is more likely to be caused by PH balance or the presritives in it... Levimer does have a slightly different PH balance and preservitives so apparently doesn't cause the stinging problem...

I don't use Levimer due to being on a insulin pump, but when I did, I used to inject twice a day on a slightly off-set time to get the best it was to offer me... But my husband finds that his levimer gives him no problems with injecting his requirements once in the evening?

 

[totsy]

Hya,
Just a thought but i take my lantus once a day on a morning and my morning fasting is always 3.9/5.2 but when i was taking it on a night it didnt seem to last the full 24hrs

 

[suzi]

Thanks,
Lantus always at room temperature, think its the PH that causes the sting, result just now a perfect 6, but then he did have 8u at lunchtime plus he's been playing football, plus i made him inject in his leg, he prefers tummy. Will think about changing times of Lantus, remember Andrews only 10 and Diabetic almost 3 yrs, would be reluctant to ask him to inject more than 4x a day. He's been on this bolus regime for a week now so i don't think we're doing to bad, but always room for improvement.
Many thanks
Suzi x

 

[Katharine]

Trinkwasser said to Fergus:

I'm racking my brains now to remember if people who have made that changeover need to increase or decrease Levemir over the Lantus dose. I have little doubt you're sensible enough to test rigorously until you're stable on your new regime

.

Lantus is more potent unit for unit than levemir. The formula is one unit lantus = 0.75 units levemir.

 

[suzi]

Dr is going to change Andrews Lantus to Levimar in about 3wks, doesn't think it's fair to inject Lantus when its causing so much discomfort, on the verge of refusing to do bed time injections! So hopefully by then i'll have perfected the carb/units, then have to stand on my head and change what i'm doing all over again, oh what fun to look forward to.
I appologise for the sarcasism, would just rather do it all now, i know little steps, but feel as if i'm taking 1 little step forward and 3 big steps back :roll:
Suzi x

 

[lionrampant]

Interestingly, I'm taking more Levemir in total than lantus.

 

[Katharine]

That's right Lionrampant. Most people will need 3 units levemir for every 2 units of Lantus that they took.

 

[Jules11]

Just started Levimar 4 weeks ago; started on 10units now 36 units am 6 units pm and glucose levels getting higher and higher .
Type 2 desperate for some help