High dose of background insulin?

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ChrisT2

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Type 2
Hi, I’ve been started off with 10 units of Levemir in the morning. But as with the previous oral meds I took for years, it doesn’t seem to do much. My ‘insulin’ appears to be heavy diet restriction abd lots of exercise. I want to avoid having to inject rapid insulin before every meal. I get the impression 10 units of Levemir is not a lot. Anyone taking a lot more than that without the short-acting insulin too? Nurse says this isn’t an option but I think it would work for me as I don’t tend to eat carbs and certainly no sugar, so not prone to major spikes. Thanks
 
You need what you need, it really is as simple as that.
The fats and protein you eat instead of carbs would need insulin as well. Personally I think it's very silly just trying to use a basal insulin for all your needs. What if you have a vomiting bug?................. One hell of a hypo would insure with all that insulin swimming around.
 
@ChrisT2 what is your reason for wanting to avoid bolus injections?
Is it the inconvenience of the extra injections? If so, I find the inconvenience of limiting what and when I can eat, exercise, be stressed, be unwell, etc. is much greater.
Some people, especially those with type 2, are prescribed a mixed insulin dose which provides the bolus component as well as basal. Maybe this is what you are after. But it does come with the limitations of flexibility.
 
I would go for adding the Bolus; you don't have to use it with every meal if the carbs are low. Be prepared to split the Levemir into two daily injections in the future as it only lasts 8 to 10 hours.
 
I agree with @DaveB in respect of accepting a bolus insulin and use it as and when you need to. It is useful even if you just use 1 or 2 units here and there with meals. If you get ill (and lets face it, with Covid so prevalent, the chance is not as minimal as it might be) that bolus insulin could be really helpful.
Where I disagree with Dave is that Levemir lasts longer than 8-10 hours however it is best split into 2 doses, morning and evening and it doesn't have to be an even split.... far from it.... many of us find that one dose needs to be significantly bigger than the other. I am currently 26 in the morning and just 6 at night and if I have had a very active day, it is usually the night time one which needs reducing.

Can I ask if they are sure you are Type 2? If you are following a very low carb diet as it sounds you are, also needing insulin to manage your Type 2 is unusual. Your introductory post back in Feb 2016 says you were skinny and losing weight..... that would suggest a possible slow onset Type 1 ie LADA (Latent Autoimmune Diabetes in Adults) Were you ever tested for that?
 
rebrascora said:
I agree with @DaveB in respect of accepting a bolus insulin and use it as and when you need to. It is useful even if you just use 1 or 2 units here and there with meals. If you get ill (and lets face it, with Covid so prevalent, the chance is not as minimal as it might be) that bolus insulin could be really helpful.
Where I disagree with Dave is that Levemir lasts longer than 8-10 hours however it is best split into 2 doses, morning and evening and it doesn't have to be an even split.... far from it.... many of us find that one dose needs to be significantly bigger than the other. I am currently 26 in the morning and just 6 at night and if I have had a very active day, it is usually the night time one which needs reducing.

Can I ask if they are sure you are Type 2? If you are following a very low carb diet as it sounds you are, also needing insulin to manage your Type 2 is unusual. Your introductory post back in Feb 2016 says you were skinny and losing weight..... that would suggest a possible slow onset Type 1 ie LADA (Latent Autoimmune Diabetes in Adults) Were you ever tested for that?
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Hi. You may want to look at this Levemir 3D time profile. A lot depends on the dose. The definition is a bit poor.Levemir profile.jpg
 
@DaveB I am well aware of/familiar with that graph which is why I made my comment. It has a peak of activity and tails off but to say it only lasts 8-10 hours is a strange interpretation of that graph to me and I think misleading.
 
Levemir lasts the length of time it lasts, dependent on the ratio of it to the body weight of the patient. BUT!!! that and the graph is for a Type 1 diabetic. And it's pretty darn correct for 99% of T1 folk.

I am not 100% certain that it works precisely the same for a T2 - none of us is able to estimate how much insulin resistance anyone might happen to have apart from anything else.
 
I take 38 units of tresiba basal insulin a day. I think the large amount needed is probably due to me being a biger girl, and I have PCOS which often includes insulin resistance.

However I have found myself not needing a bolus insulin yet, though it may come in time.
 
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