Levemir question

[Adehem]

I have just gone onto Levemir Balos insulin. I was taking 9 units of Lantus just at night. Now I am on Levemir and started at 4 units twice a day night & morning. I then went on 5 units and now on 6 units. I do not seem to be getting any benefit from it. I have been doing some 3:00 o`clock BG tests. I just want those to be above 5 and they are. I thought that I would be using less QA but I am not. Do you think it would be better to increase my levemir dose.

 

[Inka]

Remember that your Levemir split doesn’t have to be equal @Adehem In fact, usually it’s not. So, for example, you might need 6 units in the morning but only 4 in the evening. What are your blood sugar test results like, and have you done a basal test?

 

[DaveB]

For info my Levemir split is very unequal i.e. 15 in the morning and 8 at night. My Libre has shown this is the right split for me. Unless your split is exactly 12 hours between the shots then you need to take account of that.

 

[Fagor]

We're all different, it may take a while to get correct balance.
I was advised to try & keep my am and pm units about the same, but might depend on activity, eating patterns etc.
And I have to keep changing my Levemir. It was 8 units am & pm in Jan, currently 13 am & pm as trying to get more BGs below 10.

 

[Robin]

We're all different, it may take a while to get correct balance.
I was advised to try & keep my am and pm units about the same, but might depend on activity, eating patterns etc.
And I have to keep changing my Levemir. It was 8 units am & pm in Jan, currently 13 am & pm as trying to get more BGs below 10.

I sometimes wonder whether HCPs giving advice have ever tried it for themselves, or listened to their patients a bit more closely. 😉
I swapped to Levemir because I thought it would suit me better. At the time, I'd only got a GP surgery nurse seeing me, and she freely admitted she didn’t have a clue about splitting doses, so I was left to my own devices. (or more accurately, my Libre device!). I started with an even split, and tweaked it, tweaked it again, tweaked it back and forth, til I found the 'best fit' which for me is 3 units at 10.30pm, 5 units at 8am. And by best fit' I mean, what fits in with my routine as well as the insulin profile. No point in deciding on times to do it if they’re going to turn out inconvenient, or I’m going to forget. Just before bed and just before I get up work best, and I can keep the Levemir pen permanently by my bed.

 

[trophywench]

14u when I got up each morning and a further 4u approx 9.30 pm. Started off taking the 4u at bedtime but though I had gone high by 11pm ish when we went to bed, I then went hypo about 2am, so just kept bringing it forward until it was OK.

Oooh yes, a lot of testing - but I'm worth it!

 

[DaveB]

I sometimes wonder whether HCPs giving advice have ever tried it for themselves, or listened to their patients a bit more closely. 😉
I swapped to Levemir because I thought it would suit me better. At the time, I'd only got a GP surgery nurse seeing me, and she freely admitted she didn’t have a clue about splitting doses, so I was left to my own devices. (or more accurately, my Libre device!). I started with an even split, and tweaked it, tweaked it again, tweaked it back and forth, til I found the 'best fit' which for me is 3 units at 10.30pm, 5 units at 8am. And by best fit' I mean, what fits in with my routine as well as the insulin profile. No point in deciding on times to do it if they’re going to turn out inconvenient, or I’m going to forget. Just before bed and just before I get up work best, and I can keep the Levemir pen permanently by my bed.

My DN who was otherwise very capable told me not to split my Levemir and showed me a Novo Nordisk promotional chart with Levemir being flat over a full 24 hours to prove the point. Sad when DNs have to rely on rubbish marketing material. I hope NN have now withdrawn that material.

 

[rebrascora]

I am on larger doses at the moment (since Covid Vaccine) but like almost everyone else my Levemir split is very uneven. Currently 22units in the morning and anywhere from 0-6 at night depending upon how much exercise I have fitted into the previous few days. I need much more basal insulin in the morning and you can see my levels start to drop in the afternoon/evening on my Libre. I need very little at night by comparison and I tend to take the doses similar to @Robin, ie when I wake up at 7am and bedtime 11pm-1am. There is a convenience element to this routine but also that the evening dose has built up to maximum activity to cope with Dawn Phenomenon/Foot on the Floor in the morning but doesn't have too much "oomph" to it in the early hours when I need very little. My Levemir dose needs constant tweaking due to me having a varied routine and activity levels and there will be several adjustments required every week, but that is the beauty of Levemir that it allows for such dose adjustment to fine tune it to your body's needs.


Having Libre makes such a huge difference in being able to see where your basal insulin needs adjustment and experimenting to see what works best for you. I also think that education courses like DAFNE help give you the understanding and confidence to make these changes, to get a best fit from your basal insulin.

 

[Adehem]

Remember that your Levemir split doesn’t have to be equal @Adehem In fact, usually it’s not. So, for example, you might need 6 units in the morning but only 4 in the evening. What are your blood sugar test results like, and have you done a basal test?

My BG jumps about a bit. I am trying to stay in DAFNE targets but I am active. Gardening in the morning and walks in the afternoon. I do reduce my QA during the day due to that - always carry jelly babies. After reading this help I am going to increase my daytime Bi just 1 unit at a time.

 

[Paulbreen]

I’m 22 at 22:00 and nothing the rest of the day, really helps my DP issues

 

[Adehem]

The 6 at bedtime are good because I am only about 0.3 different BG from the night before. I need to get my Evening meal QA down. I am skinny and want to put on weight so don`t want to reduce my carbs. So I am going to put up my Levemir dose up to 7 in the morning. If I go too low at lunch I can eat more carbs at breakfast or reduce my QA. Hopefully I can then reduce my evening meal QA. That is the plan!!

 

[Inka]

Why do you need to get your evening meal QA down @Adehem ? We need the insulin we need. If you’re wanting to eat more carbs (which is perfectly fine and normal) then you’d need more QA for that meal.

I’d also say that the targets are just that - targets. It’s impossible to achieve perfection. You said your BG jumps about a bit - what do you mean? It’s normal for BG to go up and down within the normal range, and when you have diabetes that range can be slightly larger.

 

[Adehem]

Why do you need to get your evening meal QA down @Adehem ? We need the insulin we need. If you’re wanting to eat more carbs (which is perfectly fine and normal) then you’d need more QA for that meal.

I’d also say that the targets are just that - targets. It’s impossible to achieve perfection. You said your BG jumps about a bit - what do you mean? It’s normal for BG to go up and down within the normal range, and when you have diabetes that range can be slightly larger.

Well if you inject a large amount of QA it may not be as effective as a small dose. I inject upto 13 units but do not like to go higher than that. I am a skinny guy so my belly area is not so large. I put Bi into my butt. I am active, after breakfast I work in the garden. After Lunch we do a circular walk average 6 miles. Then after evening meal we chill out. So I am burning up BG during the day but at evening meal I am not so I am having to have more QA. I am trying to take a bit more Bi in the morning to see if I can get my evening BG down a bit so I do not have to have too much QA. I am not sure if that will work I have injected 7 units of Levemir this morning just added 1 unit.

 

[Inka]

You can always split the bolus (QA) if you need to. So what’s your ratio for your evening meal? Is some of your evening QA a correction dose (you said ‘at evening meal’ so I wasn’t sure if you meant you’re high when about to eat it)?

Your basal insulin is to keep your blood sugar in range in the absence of food not to deal with food. Have you done a basal test? That would help show you if the Levemir dose was right. We all need what we need as regards insulin, but perhaps you need more basal rather than your 13 units for evening meal. I’m female and no doubt smaller than you, but I take 3 or 4 units for evening meal usually. Your 13 units might well be right, but it is worth checking your basal as getting that correct helps enormously.

If you can put a day’s results here, then others could look and make suggestions.

 

[rebrascora]

Hi

It is difficult to understand your situation without knowing the numbers. What are your pre evening meal readings like and how many carbs do you normally have in the evening?

An alternative might be to have less carbs on an evening and more at lunchtime or go for your walk in the evening after your meal instead of the afternoon. Or you could have less carbs in general but increase your fat intake if you need to maintain or increase weight. Eating more fat will provide you with slow release energy and it is generally rather enjoyable.

 

[Adehem]

You can always split the bolus (QA) if you need to. So what’s your ratio for your evening meal? Is some of your evening QA a correction dose (you said ‘at evening meal’ so I wasn’t sure if you meant you’re high when about to eat it)?

Your basal insulin is to keep your blood sugar in range in the absence of food not to deal with food. Have you done a basal test? That would help show you if the Levemir dose was right. We all need what we need as regards insulin, but perhaps you need more basal rather than your 13 units for evening meal. I’m female and no doubt smaller than you, but I take 3 or 4 units for evening meal usually. Your 13 units might well be right, but it is worth checking your basal as getting that correct helps enormously.

If you can put a day’s results here, then others could look and make suggestions.

My breakfast & Lunch ratio is 1-1 but my evening meal is 2-1. It is because I am active during the day but sat on my butt at night. Splitting my QA is a bit dodgy because I have not got that many sites an my little belly. By basal test do you mean the 3:00 test early hours because I have done that a few times.

 

[Inka]

A basal test can include a 3am test but it’s more than that - it’s testing your basal for each segment of the day and night to check it’s holding your blood sugar relatively steady. You don’t need to starve yourself for 24hrs to do it. You split the day/night into segments and test one segment at a time over a period of a few days. This will show you how your basal is doing and if it needs adjusting. If your basal isn’t right, then that can make it much harder to get control because you’re ‘building your boluses’ on an unsteady foundation (ie incorrect basal).

After sorting your basal, you can then move on to checking each meal-time ratio.

 

[rebrascora]

Splitting my QA is a bit dodgy because I have not got that many sites an my little belly.

You can also inject into thighs and buttocks and arms not just your stomach and you should be rotating around your stomach.... and other body locations if you use them. I put my morning basal into my buttocks, night time into my thighs and keep my stomach for bolus insulin. The chances of the needle going into the same spot twice is probably about the same as winning the lottery, no matter how tiny your waist, as the needles are so fine and if you rotate, around your belly button even less so, so splitting the dose shouldn't be a problem unless you have lots of lumpy sites which you need to avoid.

A key phrase that was missing from @Inka's post above is to test your basal insulin is holding you steady for each segment of the day in the absence of food, so skip breakfast one morning and then skip lunch the next day and miss your evening meal the final day, so that you can see what your levels are doing without confusing things with food and bolus insulin.

 

[Jonathan_15Jan1969]

Sorry to hijack thread slightly, I am a bit similar as I have changed to Levemir from Lantus. In my case due to what appears an increased insulin sensitivity in the early hours that has suddenly come to my attention. As Lantus appears unable to be split, my diabetes consultant suggested a split dose of Levemir which appears a common thing and seemed the best thing in this case.

I am also trying to get right doses for each split but am wondering if your body needs a time to adjust to the dose and needs to be done for a few days before making another adjustment. I noticed that my evening dose (doing 6am and 6pm) is no longer hypo level in the morning but was above 8 mmol/L so was going to increase evening dose, but would that be too soon to adjust. Think I was told when on Lantus to wait to adjust to new insulin quantity before changing again but if you are high and it's the same the next day you don't want to be high too long even though it's safer than the other way.

Thanks

 

[Inka]

@Jonathan_15Jan1969 I tend to try a dose change for 3 days before changing again if I get a higher than desired result. That way you can check if it’s consistently wrong or if something else has caused your high. If I get a low, I change my dose immediately to avoid the risk of hypos.

So, your 8 isn’t shockingly high, and personally I’d leave that dose as it was and gather a few more results first.