rebrascora
Well-Known Member
- Relationship to Diabetes
- Type 1
- Pronouns
- She/Her
This is something which has been occupying my mind for a while and has perhaps come to a head as a result of a comment by @trophywench which I very much appreciate by the way because I think it warrants further discussion and understanding on my part....
As many of you know I use split dose Levemir and I love it's flexibility for my rather haphazard lifestyle. I was started off on I think about 8 units a day (have to say I really can't remember whether I took it in the morning or at night but prior to my DAFNE course 8 months later I was taking 14 which they told me to split evenly, so 7 morning and 7 evening. I had a few issues with hypos during my DAFNE but attending 9-5 and trying to feed muck out and exercise the horses before and after was a big change to my routine, so I assumed that was the problem. Gradually after I came back off DAFNE I started to experience nocturnal hypos particularly after exercise and I gradually had to reduce my evening dose down to 0 and was still experiencing slight nocturnal hypos after exercise but daytime were steady. Then my basal needs started to change and I progressively needed more and more basal insulin, particularly during the day but more at night too. I had 2 spells where this happened and then it settled down to about 20-24 units during the day and anywhere between 0 and 7 during the night depending on exercise, particularly repeated consecutive days of exercise, going back up to 7 if I was sedentary for a week or more due to a minor injury. Anyway, my current basal is very steady during the day at 22 units and most days just 2 units at night, but my nighttime dose is particularly sensitive to exercise and I still occasionally hypo with no evening dose after consecutive days of exercise.
I have looked at the 3 dimensional graph of Levemir's activity and my daytime basal is probably lasting about 18 hours, so when taken at 7am which it normally is, it should be pretty well running out at 1am and it would suggest that that is just the tail end of the dose so minimal activity. If I have no evening dose, then presumably my muscles are responsible for dropping me into the red after that.... usually about 4am.
Now getting to the point that @trophywench made about her Levemir doses also being much larger through the day than at night, but when she changed to a pump, her basal profile did not match that disparity and she needed a much more uniform amount than the Levemir doses had suggested..... at least I think that was the point she was making. Am I therefore wrong in making the assumption that my basal needs are very different and the Levemir is lasting longer and flatter and that graph is warping my understanding or are some people's basal needs (perhaps those people on pumps could comment) significantly different during between the day and night.
I feel that I regularly comment on Tresiba being problematic for people like myself who appear to need much more during the day and often little to none at night and I would hate to think that I am advising people wrongly because it is my understanding which is at fault.
I genuinely do love my Levemir because I can adjust it so easily and it responds so well but sometimes it is tricky finding the right dose and there is an element of guess work when it comes to my evening dose.
I should also say that I frequently skip meals so it is very easy to see that my daytime dose is spot on although I do sometimes get a rise in the evening and need to take my evening dose earlier for a short spell and then it settles down to bedtime dosing again but otherwise I seem to need the large daytime dose and very little to none at night or I hypo.
Just curious on other people's thoughts. Do others that had a disparity with split dose Levemir and then went on to a pump, find that it was some sort of illusion and there wasn't really a disparity in their basal needs between day and night after all. Obviously you can only comment on your own body and how it works ..... or is there a flaw in my logic or how I am interpreting what I am experiencing?
Apologies for the very long winded post. Gold star to anyone who managed to follow my train of thought!
As many of you know I use split dose Levemir and I love it's flexibility for my rather haphazard lifestyle. I was started off on I think about 8 units a day (have to say I really can't remember whether I took it in the morning or at night but prior to my DAFNE course 8 months later I was taking 14 which they told me to split evenly, so 7 morning and 7 evening. I had a few issues with hypos during my DAFNE but attending 9-5 and trying to feed muck out and exercise the horses before and after was a big change to my routine, so I assumed that was the problem. Gradually after I came back off DAFNE I started to experience nocturnal hypos particularly after exercise and I gradually had to reduce my evening dose down to 0 and was still experiencing slight nocturnal hypos after exercise but daytime were steady. Then my basal needs started to change and I progressively needed more and more basal insulin, particularly during the day but more at night too. I had 2 spells where this happened and then it settled down to about 20-24 units during the day and anywhere between 0 and 7 during the night depending on exercise, particularly repeated consecutive days of exercise, going back up to 7 if I was sedentary for a week or more due to a minor injury. Anyway, my current basal is very steady during the day at 22 units and most days just 2 units at night, but my nighttime dose is particularly sensitive to exercise and I still occasionally hypo with no evening dose after consecutive days of exercise.
I have looked at the 3 dimensional graph of Levemir's activity and my daytime basal is probably lasting about 18 hours, so when taken at 7am which it normally is, it should be pretty well running out at 1am and it would suggest that that is just the tail end of the dose so minimal activity. If I have no evening dose, then presumably my muscles are responsible for dropping me into the red after that.... usually about 4am.
Now getting to the point that @trophywench made about her Levemir doses also being much larger through the day than at night, but when she changed to a pump, her basal profile did not match that disparity and she needed a much more uniform amount than the Levemir doses had suggested..... at least I think that was the point she was making. Am I therefore wrong in making the assumption that my basal needs are very different and the Levemir is lasting longer and flatter and that graph is warping my understanding or are some people's basal needs (perhaps those people on pumps could comment) significantly different during between the day and night.
I feel that I regularly comment on Tresiba being problematic for people like myself who appear to need much more during the day and often little to none at night and I would hate to think that I am advising people wrongly because it is my understanding which is at fault.
I genuinely do love my Levemir because I can adjust it so easily and it responds so well but sometimes it is tricky finding the right dose and there is an element of guess work when it comes to my evening dose.
I should also say that I frequently skip meals so it is very easy to see that my daytime dose is spot on although I do sometimes get a rise in the evening and need to take my evening dose earlier for a short spell and then it settles down to bedtime dosing again but otherwise I seem to need the large daytime dose and very little to none at night or I hypo.
Just curious on other people's thoughts. Do others that had a disparity with split dose Levemir and then went on to a pump, find that it was some sort of illusion and there wasn't really a disparity in their basal needs between day and night after all. Obviously you can only comment on your own body and how it works ..... or is there a flaw in my logic or how I am interpreting what I am experiencing?
Apologies for the very long winded post. Gold star to anyone who managed to follow my train of thought!
