Levemir

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Bat5

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Type 1
Hi
I’m trialing Levemir on split doses and finding at night while asleep my BG rises on 8 units rather than being stable through until the morning. The other issue is that the 2nd split does of 8 in morning would be too much so I’ve reduced this to 4 units which I’m still finding is too much because I have an active job.
Another issue is that i don’t feel by upping the evening dose will help because this will last over 12 hours into the next day which will effect my levels when at work.
At the moment I’ve tried most things to get on with Levemir and find using it very testing so I’ll most likely go back to semglee unless there are any suggestion.
Thanks
 
Levemir (detemir) has a pronounced early peak rather than Semglee's (glargine) slower peak. So you should be able to up the evening dose to bring down overnight levels, without a dramatic effect on the next day. But it's also shorter lasting so if you take it at bed time, you'd have to watch levels between dinner & bed the next day.

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But if you find Semglee works better for you...
 
Bat5 said:
Hi
I’m trialing Levemir on split doses and finding at night while asleep my BG rises on 8 units rather than being stable through until the morning. The other issue is that the 2nd split does of 8 in morning would be too much so I’ve reduced this to 4 units which I’m still finding is too much because I have an active job.
Another issue is that i don’t feel by upping the evening dose will help because this will last over 12 hours into the next day which will effect my levels when at work.
At the moment I’ve tried most things to get on with Levemir and find using it very testing so I’ll most likely go back to semglee unless there are any suggestion.
Thanks
Click to expand...
Hi I’m on Levemir. 14 in morning and 16 at night. I find these levels are still not correct for me either, I am still rising about 3mmols and the nurses keep telling me to up by 1 more unit. I am now taking it 12 hours apart now instead of when I go to bed as it takes a few hours to kick in.
 
I’m on a single evening dose of Levemir which works for me so I can’t really advise you. for me it definitely keeps me stable from 10pm until at least 7pm the following day (I’ve not done a basal test for the evening, but I find that I don’t need extra bolus then so I assume all is ok). I believe Levemir duration is dependent upon dosage and my dose at 0.3 U /kg theoretically lasts at least 16 hours, but obviously everyone is different.

@rebrascora is a bit of an expert on Levemir split doses (hope you don’t mind me tagging you here) so she may be able to help you further.
 
Hi. When do you take your Levemir? I find the beauty of it is that you can not only adjust the split but adjust the timing of it to get the peak of activity when you need it most. If you need more at night and less through the day then reduce the morning dose a bit more. I am very much the other way and need lots through the day, but almost none at night so my current split is 24 in the morning and 2 at night. Normally I take it as soon as I wake up and always before I get out of bed (usually about 7am), because I get a strong Foot on the Floor response which needs 2 units of Fiasp as well as that large dose of Levemir to contain it. My evening dose is normally injected between 10 and 11pm (not not an even 12 hour split and this usually works for me but the last few days my levels have been rising suddenly about 10 pm and I have needed a correction before bed, so I am going to bring my evening Levemir forward to 7-8pm to see if that helps. It did this a couple of years ago and bringing the evening dose fixed it, so hopefully it will again, but gradually it went back to normal bedtime injecting again, which I have to say, is more convenient to remember. For me, I love how flexible Levemir is and that I can knock a couple of units off my evening dose if I have been particularly active that day and I get real time results that night. My basal needs vary quite a lot as I have a very irregular lifestyle so Levemir really suits me.

I think you have to consider why you changed to Levemir and what the problem was with Semglee that prompted the change and then work out how you can use Levemir to improve that situation. Yes, Levemir lasts more than 12 hours but the overlap is minimal because it is tailing off and the new dose is slowly building up. That graph above suggests it just cuts off suddenly but I really don't think it works exactly like that and there is a gradual tail off as with Semglee/Lantus.

I think it takes time to figure out how to make Levemir work for you and get confident with adjusting it. I also think it helps to have a half unit pen. For me a unit here ot there during the day doesn't make much difference but half a unit over night when I am just using 2 or 3 units can make a significant difference. It looks like you might benefit with a half unit pen to make finer adjustment to your daytime dose. There is certainly scope for reducing your daytime dose further if you need to and there are plenty of times when I have no evening Levemir at all after a couple of consecutive days of prolonged exercise because even 1 unit will cause me to hypo, so don't feel that you always need the second dose of the split dose. You need what you need, when you need it and that can and will change as your life/routine/body changes. For me Levemir gives me the ability to adjust for that and sometimes I will need to make changes day after day or night after night and other times my doses will be stable for weeks/months.

If you were happy on Semglee and it worked well for you and there was no good reason for the change to Levemir, then I would ask to go back to it and be wanting to know why they messed you about with a different insulin. Diabetes is difficult enough without your insulin being changed on a whim and you are entitled to a named brand if you have good reason... ie that it works well for you. Personally, I would fight tooth and nail to keep Levemir because I love it, but it doesn't suit everyone, however you have to understand how it works and experiment to find the best way to make it work for you.
 
As well as knowing how an insulin works on you, you also have to know how your body works with it! That sounds daft and you might think Eh??? surely they are the same thing. Nope. Bodies change - insulin doesn't. Because even with 5 or 5 plus jabs a day (2 Levemir and meals/corrections Novorapid) it still wasn't 100% correct I thought I may as well try a pump!
 
rebrascora said:
Hi. When do you take your Levemir? I find the beauty of it is that you can not only adjust the split but adjust the timing of it to get the peak of activity when you need it most. If you need more at night and less through the day then reduce the morning dose a bit more. I am very much the other way and need lots through the day, but almost none at night so my current split is 24 in the morning and 2 at night. Normally I take it as soon as I wake up and always before I get out of bed (usually about 7am), because I get a strong Foot on the Floor response which needs 2 units of Fiasp as well as that large dose of Levemir to contain it. My evening dose is normally injected between 10 and 11pm (not not an even 12 hour split and this usually works for me but the last few days my levels have been rising suddenly about 10 pm and I have needed a correction before bed, so I am going to bring my evening Levemir forward to 7-8pm to see if that helps. It did this a couple of years ago and bringing the evening dose fixed it, so hopefully it will again, but gradually it went back to normal bedtime injecting again, which I have to say, is more convenient to remember. For me, I love how flexible Levemir is and that I can knock a couple of units off my evening dose if I have been particularly active that day and I get real time results that night. My basal needs vary quite a lot as I have a very irregular lifestyle so Levemir really suits me.

I think you have to consider why you changed to Levemir and what the problem was with Semglee that prompted the change and then work out how you can use Levemir to improve that situation. Yes, Levemir lasts more than 12 hours but the overlap is minimal because it is tailing off and the new dose is slowly building up. That graph above suggests it just cuts off suddenly but I really don't think it works exactly like that and there is a gradual tail off as with Semglee/Lantus.

I think it takes time to figure out how to make Levemir work for you and get confident with adjusting it. I also think it helps to have a half unit pen. For me a unit here ot there during the day doesn't make much difference but half a unit over night when I am just using 2 or 3 units can make a significant difference. It looks like you might benefit with a half unit pen to make finer adjustment to your daytime dose. There is certainly scope for reducing your daytime dose further if you need to and there are plenty of times when I have no evening Levemir at all after a couple of consecutive days of prolonged exercise because even 1 unit will cause me to hypo, so don't feel that you always need the second dose of the split dose. You need what you need, when you need it and that can and will change as your life/routine/body changes. For me Levemir gives me the ability to adjust for that and sometimes I will need to make changes day after day or night after night and other times my doses will be stable for weeks/months.

If you were happy on Semglee and it worked well for you and there was no good reason for the change to Levemir, then I would ask to go back to it and be wanting to know why they messed you about with a different insulin. Diabetes is difficult enough without your insulin being changed on a whim and you are entitled to a named brand if you have good reason... ie that it works well for you. Personally, I would fight tooth and nail to keep Levemir because I love it, but it doesn't suit everyone, however you have to understand how it works and experiment to find the best way to make it work for you.
Click to expand...
Hi
Thanks this is really useful advice and makes perfect sense. Personally I can’t knock semglee but I was having a issues burning out with daytime activities, night time was perfect. I mentioned it to my specialist and she recommended trialling Levemir and see if it works for me, so I have the option of sticking to semglee. The only area she was wrong was recommending split doses of the same amount like for like as I was on semglee which clearly didn’t work. I’m out the point with Levimir where I would consider only taking an evening dose.
Thanks for the help I might be back in touch if you don’t mind ?
Matt
 
Bat5 said:
Hi
Thanks this is really useful advice and makes perfect sense. Personally I can’t knock semglee but I was having a issues burning out with daytime activities, night time was perfect. I mentioned it to my specialist and she recommended trialling Levemir and see if it works for me, so I have the option of sticking to semglee. The only area she was wrong was recommending split doses of the same amount like for like as I was on semglee which clearly didn’t work. I’m out the point with Levimir where I would consider only taking an evening dose.
Thanks for the help I might be back in touch if you don’t mind ?
Matt
Click to expand...
No worries. I am here if you have any questions. Just give me a tag.
If you are going to just give a single dose of Levemir in the evening and you have been using 8 and finding you still rise overnight, I would try maybe just another unit initially and see how that goes. What I mean is.... don't add the 4 you were taking in the morning to your night time dose of 8 as that may well cause you to hypo quite badly during the night. I would just go up to 9 for a couple of nights and see how you get on at that, bth through the day and the night. Be prepared to use your bolus insulin for corrections if you go high during the day. A assume you have Libre to alarm you if levels go low or high.... and to see what is happening overnight.
 
Just thinking some more about your situation and wondering if you might need different daytime basal doses for work days and days off. Ie. Maybe none or just a couple of units for work days and maybe 4u for days off (just as an example... the actual doses you need might be different) depending upon how active or restful your days off are compared to work days. It would be something else to experiment with to fine tune it a bit more once you get doses and timing of them more or less right for work days.
 
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rebrascora said:
Just thinking some more about your situation and wondering if you might need different daytime basal doses for work days and days off. Ie. Maybe none or just a couple of units for work days and maybe 4u for days off (just as an example... the actual doses you need might be different) depending upon how active or restful your days off are compared to work days. It would be something else to experiment with to fine tune it a bit more once you get doses and timing of them more or less right for work days.
Click to expand...
That’s confirmed what I was thinking about the coming week. I’ve only took the three units in the morning the last few days which I reckon eventually could be down to zero Which would be game-changing for work. I also changed the time of the evening dose the last few nights to an even 12 hour split which seems to be settling into a more normal pattern.
thanks
 
I never got to try Levemir (I switched to a pump instead), but when I was looking into strategies that others were using, it seemed that anything and everything was ‘on the table’ in terms of dose splits and timings. No need for a semblance of evenness between the doses, or 12hrs between the timings…

Any combination of big/small and long/short all seemed to suit different people 🙂
 
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