Levemir doses.

[Annette Arundell]

Hi I've been on here a few times last few days, I'm now back on Levemir and take 10 units 8.30am and 7 units at 9.00pm but they both run out before next one kicks in. this am took a 1 unit correction before getting up due to DP or Levemir running out, sugars starting to rise 6.7, 7.11am, then 5 units with 40gram carb breakfast ( allowing extra) at 8.40am sugars 5.6, well 10.48 sugars 16.1!!!!, so 2 correction of NovoRapid given. So my Levemir is not lasting to next dose, I cant increase night one as always have hypo around 3 or 4 am if I do , so I'm stuck between a rock and a hard place I was thinking of splitting 3 ways, or taking larger dose am and taking my small dose before bed rather than 8.30pm so it might last until morning, anyone got views on this, as I really don't know what to do as all my insulin needs have suddenly changed. And I don't seem to get much sense from DN who i spoke to.

 

[PattiEvans]

I think it's unusual for Levemir not to last 12 hours minimum, but that's not to say there aren't people for whom it doesn't. According to this graph the lower the dose per kg of body weight you take the shorter the duration of action. You don't seem to be on particularly low doses. Have you done any basal testing during the day? It could be that the levemir dose is right but your ratios may have changed.

It's very annoying that a lot of Diabetes teams seem to have gone into hibernation due to Covid and there's little help of a professional nature at the moment. I'm a great proponent of pumps, which could wipe out your overnight difficulties, but I do understand that not everyone is keen on having one.

 

[Annette Arundell]

Hi I weigh 62 kgs., I used to take 10 units of Levemir at night and only 4 units in morning, and it dident seem to run out, now everything's changed, I take more in morning now due to early morning hypos. I worked in care field for 42 years, and had Covid in December, I have now retired as felt not up to it since, I'm wondering if Covid messed up my system? I seemed to stay in quite high numbers most of the day since going back on Levemir, which I had to due to not getting on with Tresiba so maybe it does need increasing a lot? As you say not much help out there at moment, I seem to be taking lots more NovoRapid, and my sugar rises in morning on waking, as I test with Libre through night, I never had this problem before, Thanks for replying, I don't really understand graph, but I do see people writing that Levemir doesn't last long on smaller doses.

 

[DaveB]

I would have thought those Levemir doses were actually quite low? I take 13 units in the morning and 14 at night. My BMI is 22 with low fat mass tested at the gym so don't believe I have much insulin resistance? My weight is 61Kg.

 

[Robin]

I would have thought those Levemir doses were actually quite low? I take 13 units in the morning and 14 at night. My BMI is 22 with low fat mass tested at the gym so don't believe I have much insulin resistance? My weight is 61Kg.

You need what you need, and some people have a little bit of endogenous insulin production left which can help out with background, but doesn’t have the oomph to ramp up for food intake. I’m around the same weight and BMI and take 3units of Levemir at night and 5 in a morning.
I think others have found that Covid has messed up their blood sugars for a lot longer than expected, so that might be it.

 

[trophywench]

Graph - divide your dose of Levemir by your weight - so 14u divide by 64 = 0.21875. Find nearest dose on left hand axis - 0.2. Follow horizontal line across graph. Hence, that dose tails off considerably after about 8 or 9 hours.

As you only take 10u of that in a morning I'd be surprised if it had any effect whatsoever after 4 or 5 hours.

Dosage is clearly inadequate for your body's current needs.

Please - do yourself a favour and do a Basal test asap!

 

[rebrascora]

Hi

My guess would be that your morning Levemir dose may need increasing a little and injecting earlier. Is there any reason why you wait until 8.30 rather than inject it as soon as you wake up at 7am? that way, the Levemir has a chance of working on the DP along with the NR unit you inject or perhaps do away with the need for the NR depending upon your waking reading.

Your rise to 16 at 10.48am is likely due to your breakfast rather than a deficit of Levemir which would certainly be active by then and absolutely not running out if you only injected a 8.30am. It has a minimum activity period of around 16-17 hours although there is minimal activity at the tail end when you get to 14+ hours.
Do you pre bolus your breakfast and have you experimented with the timing of that? My levels were regularly spiking up into the mid teens after breakfast until I started experimenting with the timing of that breakfast bolus insulin.

How long do you currently give it to work before you eat breakfast? The standard advice of 10-15mins is not enough for many of us and I slowly experimented on increasing it by 5 mins each day until I found what worked for me. I believe you have a Libre so you should see when the NR starts to kick in and I now use that to tell me when to start eating and I just scan every few mins until I see my levels start to drop. I can have 30g carbs doing this and not even see a blip on my Libre graph let alone a spike.

My morning routine now is that I usually wake at 7am inject my Levemir and my quick acting insulin (Fiasp at the moment) and that dose will include any correction depending upon my waking reading + my bolus for breakfast + 1.5-2 units for DP (Foot on the Floor in my case). Then I potter on with my morning routine... coffee, ablutions etc and have my breakfast ready to eat. I keep scanning my Libre until I see the direction of travel change and levels start to drop and then I eat breakfast. With Fiasp it is about 45 mins for me and NR an hour or more. I hope that helps but my gut feeling is that this problem is not your Levemir.

It may well be that the Covid has altered your insulin needs. I have found that just the Covid vaccine has wreaked havoc with mine over several weeks/months even. You just have to adapt your insulin regime to best cope with the changes.

 

[EllsBells]

I wondered if covid had killed off a load of your remaining beta cells too.

 

[Annette Arundell]

Hi

My guess would be that your morning Levemir dose may need increasing a little and injecting earlier. Is there any reason why you wait until 8.30 rather than inject it as soon as you wake up at 7am? that way, the Levemir has a chance of working on the DP along with the NR unit you inject or perhaps do away with the need for the NR depending upon your waking reading.

Your rise to 16 at 10.48am is likely due to your breakfast rather than a deficit of Levemir which would certainly be active by then and absolutely not running out if you only injected a 8.30am. It has a minimum activity period of around 16-17 hours although there is minimal activity at the tail end when you get to 14+ hours.
Do you pre bolus your breakfast and have you experimented with the timing of that? My levels were regularly spiking up into the mid teens after breakfast until I started experimenting with the timing of that breakfast bolus insulin.

How long do you currently give it to work before you eat breakfast? The standard advice of 10-15mins is not enough for many of us and I slowly experimented on increasing it by 5 mins each day until I found what worked for me. I believe you have a Libre so you should see when the NR starts to kick in and I now use that to tell me when to start eating and I just scan every few mins until I see my levels start to drop. I can have 30g carbs doing this and not even see a blip on my Libre graph let alone a spike.

My morning routine now is that I usually wake at 7am inject my Levemir and my quick acting insulin (Fiasp at the moment) and that dose will include any correction depending upon my waking reading + my bolus for breakfast + 1.5-2 units for DP (Foot on the Floor in my case). Then I potter on with my morning routine... coffee, ablutions etc and have my breakfast ready to eat. I keep scanning my Libre until I see the direction of travel change and levels start to drop and then I eat breakfast. With Fiasp it is about 45 mins for me and NR an hour or more. I hope that helps but my gut feeling is that this problem is not your Levemir.

It may well be that the Covid has altered your insulin needs. I have found that just the Covid vaccine has wreaked havoc with mine over several weeks/months even. You just have to adapt your insulin regime to best cope with the changes.

Hi again doesn't levemir take about 4 hrs before it starts to work? Thats why I thought night one ran out before morning one kicks in, I wait 15 mins after what you said before about pre bolus, I drop a bit then go up and keep rising, I seem to stay in high numbers most of the day, even with corrections, so I feel like no insulin working, so don't know what to alter any more its really getting me down now, as I've had problems for few months now, thanks for reply.

 

[helli]

Have you done a basal test recently to confirm your Levemir doses are correct without he use of any bolus (or food) to maintain them?
It is common for our basal doses to change - honeymoon period comes to an end, we get a long term illness, we move around less, we put on weight, we are affected by weather, ...

Once you are confident that your basal doses is correct, then you can test your bolus dose. This may vary at different times of the day when, for example, we may be more insulin resistant first thing in the morning.

 

[Annette Arundell]

Hi

My guess would be that your morning Levemir dose may need increasing a little and injecting earlier. Is there any reason why you wait until 8.30 rather than inject it as soon as you wake up at 7am? that way, the Levemir has a chance of working on the DP along with the NR unit you inject or perhaps do away with the need for the NR depending upon your waking reading.

Your rise to 16 at 10.48am is likely due to your breakfast rather than a deficit of Levemir which would certainly be active by then and absolutely not running out if you only injected a 8.30am. It has a minimum activity period of around 16-17 hours although there is minimal activity at the tail end when you get to 14+ hours.
Do you pre bolus your breakfast and have you experimented with the timing of that? My levels were regularly spiking up into the mid teens after breakfast until I started experimenting with the timing of that breakfast bolus insulin.

How long do you currently give it to work before you eat breakfast? The standard advice of 10-15mins is not enough for many of us and I slowly experimented on increasing it by 5 mins each day until I found what worked for me. I believe you have a Libre so you should see when the NR starts to kick in and I now use that to tell me when to start eating and I just scan every few mins until I see my levels start to drop. I can have 30g carbs doing this and not even see a blip on my Libre graph let alone a spike.

My morning routine now is that I usually wake at 7am inject my Levemir and my quick acting insulin (Fiasp at the moment) and that dose will include any correction depending upon my waking reading + my bolus for breakfast + 1.5-2 units for DP (Foot on the Floor in my case). Then I potter on with my morning routine... coffee, ablutions etc and have my breakfast ready to eat. I keep scanning my Libre until I see the direction of travel change and levels start to drop and then I eat breakfast. With Fiasp it is about 45 mins for me and NR an hour or more. I hope that helps but my gut feeling is that this problem is not your Levemir.

It may well be that the Covid has altered your insulin needs. I have found that just the Covid vaccine has wreaked havoc with mine over several weeks/months even. You just have to adapt your insulin regime to best cope with the changes.

Hi again doesn't levemir take about 4 hrs before it starts to work? Thats why I thought night one ran out before morning one kicks in, I wait 15 mins after what you said before about pre bolus, I drop a bit then go up and keep rising, I seem to stay in high numbers most of the day, even with corrections, so I feel like no insulin working, so don't know what to alter any more its really getting me down now, as I've had problems for few months now, thanks for reply

Graph - divide your dose of Levemir by your weight - so 14u divide by 64 = 0.21875. Find nearest dose on left hand axis - 0.2. Follow horizontal line across graph. Hence, that dose tails off considerably after about 8 or 9 hours.

As you only take 10u of that in a morning I'd be surprised if it had any effect whatsoever after 4 or 5 hours.

Dosage is clearly inadequate for your body's current needs.

Please - do yourself a favour and do a Basal test asap!

I can't do basal test as I'm rising all the time, wiith novorapid and any food, so without novorapid id be higher than ever I also get ketones if I dont eat, so I seem pretty screwed at the moment, thanks for reply but I do think I should increasing Levemir in morning will be needed, but can't increase night one as would have hypo, but would like to move it later before bed

 

[rebrascora]

Hi again doesn't levemir take about 4 hrs before it starts to work?

No Levemir starts to work within an hour.

That unit of NR you inject when you first wake up may be confusing the issue with your timing of your breakfast bolus. Is there any reason why you can't inject your breakfast bolus and that extra unit for DP all at the same time? Then get your breakfast ready so you can eat as soon as the insulin starts to kick in and watch for it starting to drop.
No point in having an extra injection if you don't need to.

 

[rebrascora]

15 mins would be nowhere near enough for me. Experiment with increasing that by 5 mins each morning and see if you can find the "sweet spot" where the insulin and glucose meet each other at the same time. For me with NovoRapid it is over an hour at breakfast time but just 20-30 mins during the rest of the day.... it might just be 30 mins for you or 45mins or more but only you can figure out that timing by experimenting. Ideally try this on a day off when you have more time on a morning to monitor things closely and keep yourself safe.

Levemir 3x a day would not be a good idea now that you have explained the situation more clearly. It is your understanding of how the Levemir works which is awry.

 

[rebrascora]

The Levemir builds up quite quickly and actually peaks in activity at about 4 hours so if you injected it at 7am, by 11am it would be having it's maximum impact, which is what you want.

If your BG levels are rising without using NR corrections whilst doing a basal test then that tells you that your basal insulin dose needs increasing. It is likely the morning one that needs increasing. It sounds like the night time one is fine or may need decreasing if you increase the morning dose, because some of the morning one will still be working during the early part of the night because it lasts about 17 hours. It is not a 12 hour insulin and I wonder if this is where you are misunderstanding because you have been told to take it 12 hours apart. There is quite a lot of overlap between one and the next but it does start working almost immediately and will be up to maximum effect 4 hours after injecting it and then slowly and gradually tail off.

 

[SB2015]

Good to see you back @Annette Arundell

From what you have said it does look like a basal rate test would be helpful. If you do this you split the day into three or four parts, and don’t eat during the period you test. That way the bolus insulin is not involved. You may well still see a rise with the Dawn Phenomonon but try to avoid the temptation to correct for that. This process is to check the working of your basal insulin. This will take a few days to cover the whole 24 hours but it is worth it. As only when that is right can you sort out your bolus ratios.

I suspect that even if the basal is a bit out you will also need to look at both the timing of your bolus injections. I think you already do this 15 minutes before your meal, but for you this may not be enough. Between us we have a wide of range of times. You mention that you start to drop and then rise continuously. You could try reducing your carbs so that you are dealing with smaller doses, and then smaller spikes. I know I have to adjust my ratios if I eat a larger meal.

We are dealing with so many variables, and we need to check things out regularly as our bodies change, and our needs for insulin change with the weather. When I first joined this forum I thought that these were fixed for each of us, but then I listened to people on here and found out how to check, and change, ....and then review.

 

[PattiEvans]

You are on 0.16u per kilo of bodyweight. It is a very very low dose. Given what's happening in the daytime I should imagine that you could safely increase the morning Levemir. However, I completely agree with everyone who has said you need to do a basal test. Have you ever been told how to do it? Cos you don't do it all in one go as @SB2015 says. Have a look at this page about 2/3 of the way down you'll find the method.

I imagine a care job would require a great deal of physical energy expenditure and that also could have resulted in you needing less basal than you do now when you aren't doing the job. Who knows what Covid does to people? Even the vaccination sent my BGs soaring after the first jab and then dropping like a stone after the 2nd. Ahhhh the joy of Diabetes!

 

[Annette Arundell]

You are on 0.16u per kilo of bodyweight. It is a very very low dose. Given what's happening in the daytime I should imagine that you could safely increase the morning Levemir. However, I completely agree with everyone who has said you need to do a basal test. Have you ever been told how to do it? Cos you don't do it all in one go as @SB2015 says. Have a look at this page about 2/3 of the way down you'll find the method.

I imagine a care job would require a great deal of physical energy expenditure and that also could have resulted in you needing less basal than you do now when you aren't doing the job. Who knows what Covid does to people? Even the vaccination sent my BGs soaring after the first jab and then dropping like a stone after the 2nd. Ahhhh the joy of Diabetes!

Thank you