2 types of background insulin

[Kiwid25]

I have always struggled to keep level blood sugars during night and often wake with sky high BG 13-20 MMOL.

Recently i decided to experiment with background insulin, taking humulin i in morning, levimir bedtime. Since doing this i have had almost perfect results at 95% of time in target, however clinician does not support me using 2 types of background and has said i need to choose just 1, even though 2 are giving me best control i've had in years.
Has anyone else used 2 types of background?

 

[Lucyr]

I’ve never heard of anyone using two types of basal at the same time

 

[rebrascora]

I'm not familiar with Humulin I but it can be used as a split dose similar to Levemir from what I have just read.
I would imagine you could get a similar result by adjusting the times and doses of just Levemir or possibly just Humulin I.

What doses where you taking of each of them and when and what do you take now? It may be that the Humulin has a slightly longer profile and is overlapping when you need it most but it may just be a question of changing the time you take one of the Levemir doses to get the same effect..... Many DSNs say that Levemir doses need to be taken 12 hours apart but you can vary that to get an overlap at times when you need it most and a lull when you need less. I used to take mine at 7am and 11pm for a couple of years for instance but recently I needed to adjust it back a bit as I started rising in the evening around Christmas time so I now take it 6.30am and about 8-9pm. My doses are not even either. I need far more in the morning than in the evening. It really pays to play around with the dosing and timings to get the best result and Libre helps a lot with that. Do you have Libre?

 

[Kiwid25]

Levimir was 24 8AM, 36 9pm but always waking in morning with high and libre did not show any hypos during night. I have tried adjusting pm doses, which work for maybe 2days but then back to AM highs.
I have also tried taking PM 4hrs earlier which had no effect. Also no effect if taken around 11pm. I know that my sugars spike between 3-5am.

Right now i take 18 humulin i at 8am, 32 levemir at 9pm.

 

[Kiwid25]

I’ve never heard of anyone using two types of basal at the same time

Dont worry, i am not offended .
I know it is not textbook what i have tried but surely if its working for me it should be ok. After almost 30yrs with T1D I am happy to adjust doses myself.

 

[rebrascora]

Levimir was 24 8AM, 36 9pm but always waking in morning with high and libre did not show any hypos during night. I have tried adjusting pm doses, which work for maybe 2days but then back to AM highs.
I have also tried taking PM 4hrs earlier which had no effect. Also no effect if taken around 11pm. I know that my sugars spike between 3-5am.

Right now i take 18 humulin i at 8am, 32 levemir at 9pm.

That's really interesting that you need quite a bit more at night, don't hypo and still go high in the morning and also that you need less total dose when using the combination.
I think you could use those results as good evidence that you need a pump if they won't allow you to keep the two basals.

 

[trophywench]

Lantus peaks approx 5 hours after injecting it so If you took it about 11pm or even a bit later, the max would hit about the right time for you wouldn't it? I'm not the biggest fan of Lantus usually cos if you have problems with it it really isn't worth it - but thought if you hadn't tried it, it perhaps might be worth doing so?

 

[DaveB]

Hi. Although we are all different, those Basal doses seem a tad high? I wonder whether there is any insulin resistance at play? Is your BMI in a good range? Have you tried changing you injection area? I found recently that I was suffering from lipohypertrophy and changing where I was injecting made a very large difference to my BS.

 

[everydayupsanddowns]

Levimir was 24 8AM, 36 9pm but always waking in morning with high and libre did not show any hypos during night. I have tried adjusting pm doses, which work for maybe 2days but then back to AM highs.
I have also tried taking PM 4hrs earlier which had no effect. Also no effect if taken around 11pm. I know that my sugars spike between 3-5am.

Right now i take 18 humulin i at 8am, 32 levemir at 9pm.

How frustrating that you have found a strategy that works, but you are meeting resistance because it isn’t ‘normal’.

The DUK ‘meds and kit’ suggests that Humulin I is the peakier of the two, and has more of a splurge of action followed by a longer gentler tail, whereas Lev’s activity is more evenly spread.

It’s odd that levemir should work so differently when paired with another dose of itself though. perhaps that is what your Dr is perplexed by. If anything you would have expected the days to be trickier with the less even Humulin, or at least to have to allow for humulin’s peakiness by adjusting boluses during the day?

 

[Inka]

Dont worry, i am not offended .
I know it is not textbook what i have tried but surely if its working for me it should be ok. After almost 30yrs with T1D I am happy to adjust doses myself.

I’ve used a basal insulin and my pump too, and I use two different types of bolus insulin. Also, when I take a pump break, I often inject my basal three times a day, allowing me to take the evening dose later and reduce the DP.

I don’t think it’s a problem at all, what you’re doing.