When does levimir peak?

Indiana91

Indiana91

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I seem to be hypoing at the same time every day. Between 3pm & 4pm I can bet money that I'll have a hypo.
I've adjusted my bolus for my lunch and it's still happening.
I'm starting to think that maybe my basal dose is too high.
My question is how long does it take for long acting insulin to peak? I'm on a split dose.

My hypos seem to be happening as my bolus is nearing it's end but I never seem to hypo at any other part of the day. It's been going on for a few weeks now and I'm getting really fed up with it!

I'm trying to lose weight and it's annoying me that I'm having to have to eat extra every day because of these hypos!!!

Thanks in advance.

Indiana x


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Spiker

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action curves.png

Also the size of dose makes a difference. What's your dose? Here's a graph showing a peak for detemir (Levemir) at about 12 hours. Of course you could go hypo before the peak - since you would then take some carbs it would obscure the peak.
 
Indiana91

Indiana91

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Between 9 and 10 am and pm

Indiana x


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Indiana91

Indiana91

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My dose is 36u am and 38u pm. It's all very confusing to me!

Indiana x


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Spiker

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The official DAFNE suggestion would be to adjust your lunchtime carb ratio. I'm still not sure I believe in different ratios for different times of day. I suspect they are a way of compensating for an incorrect basal profile.
 
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Spiker

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Indiana91 said:
My dose is 36u am and 38u pm. It's all very confusing to me!

Indiana x


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Click to expand...
OK those are big doses and might well last longer than 24 hours and have a later peak. All action durations of insulin are dose-dependent. It would be best to find an action profile graph that states the quantity of detemir injected, at least as a per kg of body weight. I don't have time to look right now but you could check google images.
 
Indiana91

Indiana91

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Thank you, I've got an appointment at the hospital tomorrow so I'm going to ask them as well. I prefer to ask you guys because you're more helpful.
I'm sick of all these hypos and how down they make me feel and I'm sick of feeling fat and helpless.

My moms just came home from work, looked at me and said that my clothes look tight. Like I don't already know :'(

Big fat downer!!

Indiana x


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Spiker

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detemir var dose.jpg


Here is a graph showing how the action profile changes with the dose. The dotted line would be around a 16u dose. The dashed line would be around a 32u dose, so similar to your twice daily doses. Keep in mind your twice daily doses will overlap each other as well. (Ignore the solid line, that's NPH). So at your dose level of 38u or so, the peak is nearer to 9 hours.
 
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phil55494

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When I was on Levemir, I could get that late afternoon hypo (usually as I was walking to the station for the train home after work).
Adjusting the morning shot of levemir to a slightly lower dose - only change by a couple of units and you need to keep the change in place a few days before you can be sure it has worked or not.
It is **** annoying when it happens and just keeps happening and you can't work out why it is all going wrong.
 
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Spiker

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Indiana91 said:
Thank you

Indiana x
Click to expand...

You're welcome. Good luck with the nurse tomorrow. Hypos are the total bane of trying to lose weight, aren't they? Makes it impossible. It seems reasonable to either reduce your morning levemir, or use a lower carb ratio at lunchtime. Either is worth trying. I hope you manage to eliminate the hypos and get back on track. x
 
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Daibell

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Hi. I found this profile image on the web a few months back: http://www.diabetesdaily.com/wiki/Levemir_Speed_Versus_Dose

This is slightly different from Spiker's graph and specific to Levemir but it shows how the profile varies with dosage. A small dose appears to peak earlier than the 12 hours for a large dose? Your dose is very large and might explain some aspect of the hypos? What is your morning fasting blood sugar?
 
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Spiker

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Awesome graph Daibell! That looks like in the general case levemir is peaking after 8 hours, and that's more true the larger the dose is.
 
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Indiana91

Indiana91

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Spiker said:
You're welcome. Good luck with the nurse tomorrow. Hypos are the total bane of trying to lose weight, aren't they? Makes it impossible. It seems reasonable to either reduce your morning levemir, or use a lower carb ratio at lunchtime. Either is worth trying. I hope you manage to eliminate the hypos and get back on track. x
Click to expand...

Thank you, it's really hard. I try hard all day and then the hypo happens and it all goes out of the window! Beyond frustrating! I'm not leaving tomorrow until I get some answers. Feel like I get palmed off a lot because I've had it for so long!

Indiana x


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Indiana91

Indiana91

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Daibell said:
Hi. I found this profile image on the web a few months back: http://www.diabetesdaily.com/wiki/Levemir_Speed_Versus_Dose

This is slightly different from Spiker's graph and specific to Levemir but it shows how the profile varies with dosage. A small dose appears to peak earlier than the 12 hours for a large dose? Your dose is very large and might explain some aspect of the hypos? What is your morning fasting blood sugar?
Click to expand...

Thank you,
The average bg reading for the first morning test is 11 so quite high. I really don't want a higher night time dose though and I go to bed at around 5.0 most of the time.
I've halved my lunchtime ratio and it still keeps on happening :(

Indiana x


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Spiker

Spiker

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Well, a 50/50 split is not written in stone (and neither is a 12 hour gap for a split dose). Maybe what would help here is a higher levemir dose at night time and a lower levemir dose in the morning.
 
Indiana91

Indiana91

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Type of diabetes
Type 1
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I used to be on a lower dose, it was 26u in the morning and 30u of an evening but after doing basal testing in the day I was told that I need to up my dosage, hence the high dose.
I'm going to have a serious chat tomorrow. My injection sites are terrible and these high doses aren't helping at all.

Indiana x


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