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Switch Levemir from once to twice a day

Discussion in 'Type 1 Diabetes' started by georgehT1, Mar 12, 2018.

  1. georgehT1

    georgehT1 Type 1 · Newbie

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    Hi all

    I'm brand new here, so please go easy on me

    I have been on Novarapid and Levemir for the past couple of years after being on Novamix (apparently incorrectly) for the 8 years before that. I have been doing great, and my levels have never been better (On Novamix I was handling it terribly). I have also dropped about 3 stone by going to the gym and taking care of myself in the last year, but recently my levels are all over the place again, and have been for a few weeks.

    I believe my Levemir is not lasting the full 24 hours, and a couple of hours before I inject before bed my levels remain very high after injecting a calculated and common amount of Novarapid at dinner time. My diet has remained largely unchanged, and I cannot really attribute the high levels to anything else. Once I inject my Levemir my levels seem to plummet a bit which results in me having to have a snack, which can make my morning levels high. I can also regularly wake up with extremely low levels, bordering on a hypo. I cannot find a balance.

    I'd like to try moving to a twice a day Levemir, but are there any risks and is there a good method of instigating the change?

    Are there any known reasons why this might occur, for example does it have anything to do with my metabolism changing due to the weight loss?

    Many Thanks
    George
     
  2. DCUKMod

    DCUKMod I reversed my Type 2 · Master
    Staff Member Administrator

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    Hi @georget1 - - I'll tag my colleague @Jaylee . He might have more recollection of T1s splitteing their Levemir than I do.

    Good luck with it all. Diabetes is such a balancing act.
     
  3. TheBigNewt

    TheBigNewt Type 1 · Well-Known Member

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    I think Levemir is pretty much always a twice daily injection.
     
  4. Daibell

    Daibell LADA · Master

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    Hi. I don't split my Levemir and my nurse agreed. Many do split but I don't see the need as I just tweak my evening Bolus up a bit to compensate for the lack of 24hr effect. It sounds like your Levemir isn't properly balanced as it shouldn't show a noticeable BS reduction in the way you describe. What do you mean by 'common amount' with regard to the NovoRapid? It should be adjusted for each meal (carb-counting) so there wouldn't be a common amount?
     
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  5. Seacrow

    Seacrow LADA · Well-Known Member

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    Firstly, really well done for the weight loss. This will almost certainly have changed how sensitive you are to your insulin since it is a significant amount of weight lost. So, your novorapid:carb ratio may have changed and judging from your comments the amount of basal (Levemir) you need may have changed as well. Other possible factors include illnesses, infections, stress of any sort and many other things (even the weather!).

    The insulin: the doctor looks at a standard activity profile of the insulin, and says to himself, this insulin lasts 24hr because the graph says it does. The profile is created by the company who manufactures the insulin, and this is the important part, by averaging the results from many people. What the company tend not to state is how variable these results were.

    It is entirely possible that Levemir is not lasting the full 24hr for you, it doesn't for many people. I think a lot of people on here would just go straight ahead and split the dose starting right now, but if you are not very confident (and changing insulin dosing always has risks) get backup from a doctor or nurse. If you have a good record of what you eaten, what you have injected and the blood glucose tests take it all in to an appointment and show what you aren't happy with.

    As a t1 on insulin, if you aren't happy with your gp or surgery nurse adjusting your insulin, you can go to a hospital clinic (or you may do so already). They would definitely work with you to adjust your insulin, possibly even on a day-to-day basis. They can also get you access to courses like dafne, which can help.

    Actually splitting the Levemir dose can be as simple as taking the 24hr dose, waiting 24hr, taking half the 24hr dose, waiting 12hr, taking half the 24hr dose (your new 12hr dose) and there you are, taking half the old dose every 12 hours. Hope that makes sense.

    Sarah
     
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  6. Grumpy ole thing

    Grumpy ole thing Type 1 · Well-Known Member

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    Hi @georgehT1, I split my HumalinI when I had results similar to yours, but I still struggled, so changed to Levemir again on a split dose. My Dafne lead helped me with the split and subsequent change to Levemir. I take mine at 9.30 (am and pm), slightly more at night than in the morning. HumalinI, even a tiny dose, used to give me a peak and I ended up being late for work, so I changed it to after I'd arrived. I carried on the same pattern after the change to Levemir. Levemir doesn't seem to peak for me (possibly because the doses are smallish), but as the pattern works I haven't changed it. Good luck with the split x
     
  7. georgehT1

    georgehT1 Type 1 · Newbie

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    Sorry if it was unclear. By common amount I meant that it was the same number of units for the same meal as I have been doing for the previous year without any problems. When I started on the Novorapid I was taught carb-counting and got my conversions right, but using the same ratios of Carbs to insulin is now not working, and I believe it is attributed to my Levemir not lasting
     
    #7 georgehT1, Mar 13, 2018 at 9:33 AM
    Last edited: Mar 13, 2018
  8. georgehT1

    georgehT1 Type 1 · Newbie

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    I will try splitting my Levemir tonight and see what happens.
    I would try and speak to my diabetic nurse/specialist, but waiting times are a couple of weeks, and I have to fit it around work, but I will organise an appointment.

    Am I correct in thinking that between my nighttime Levemir and when I test again in the morning I want these numbers to be as close together as possible, and that will tell me that I have this amount correct? What do I do about my morning Levemir then, as I will likely not get a clear trend when I measure again before bed due to eating meals and using Novorapid changing my levels as well.
     
  9. slip

    slip Type 1 · Well-Known Member

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    Depending on how cautious you want to be, it might be better to split your basal in half and knock 1 or 2 units off - obviously depends on how much you currently take - and then adjust up or down after a few days depending on results.

    The only way to be confident your basal dose is correct is to do a 'basal test' - basically don't eat and keep testing, if you do a search for 'basal testing' you'll find a link thats very informative, sorry I can't remember the link off the top of my head, someone on here will though!

    I will say you might like to take a look at Abbotts Freestyle Libre, a good bit of kit for basal testing, but equally good on a day to day basis for spotting trends and for when you're making changes. Depending on your location you may even get it prescribed o_O

    Edited to add the link: https://mysugr.com/basal-rate-testing/
     
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