Levemir

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KJP1

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Type 3c
Hi,

I will be starting Levemir soon. One injection in the morning and the other in the evening.

From experience, what is the best way to take this?
i.e is it best to inject, leave it 10/15 minutes and eat something or eat and then inject.

I would appreciate your advice 🙂
 
Levemir is a long acting insulin. It is unrelated to food as its purpose is to "mop up" the glucose dripped from your liver throughout the day and night
The best way to take it is at the most convenient times about 12 hours apart. Don't worry about when you eat (unless meal times are a convenient time).
 
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Hope the insulin start goes well @KJP1

I’ll tag-in some of our other Type 3c’s who can compare their experiences of starting on insulin. I think most are on both rapid acting (mealtime) insulin, as well as a long-acting / basal / background insulin like Levemir, but I’m not sure if some started on basal-only?

@eggyg @Proud to be erratic @soupdragon @martindt1606
 
Hello @KJP1,

I'm on Tresiba as my basal. But when I was on Levermir (Feb 20- c. Feb 21) I took it am & pm. I had no CGM and no-one had explained the rather subtle relationship between Levermir (basal) and my quicker acting NovoRapid (bolus). During the previous 12 months I'd been told how much basal to take and this had been adjusted by my DSN (without explanation) from time to time. After Xmas '20 I was carb counting and adjusting my NovoRapid to what seemed appropriate. But I was continually going hypo and it was only the arrival of Libre 2 in Feb 20 that I got some meaningful visibility of my daily BG and the start of my awareness of just how out of control my BG was.

So my Levermir experience is, I think, not particularly helpful to you.

Also, I was on Multiple Daily Injections (MDI) of both Levermir (the longer acting basal) twice daily and NovoRapid (the quicker acting bolus) with each meal. I deduce from your earlier post this week that you will still be taking oral meds and no NovoRapid bolus. I have no real understanding of how that medical treatment (Levermir + tablets) is supposed to work. Has there been any indication that you will also be discontinuing tablets and starting on a quick acting insulin?

3 questions if I may:
What has changed in recent months to bring about the introduction of Levermir?
AND, from my non medically qualified perspective, is this change being orchestrated by a specialist hospital based team or your GP?
What is supposed to be gained by putting you on a basal insulin with tablets? Have you been given a rationale for this treatment plan? [OK, that's almost a 4th question].

I note that you have over many years adjusted your diet to help you manage your pancreatitis - which is a perfectly sensible thing in conjunction with treatment by just tablets. But it seems to me that someone has determined that your pancreas is increasingly not coping and now is putting you on what seems to be a mixed treatment that appears to my (non-medical perspective) dubious. If your panc'y is noticeably failing then real help needs to come from MDI or a pump.
 
After my Total Pancreatectomy I was the first patient my local hospital diabetic clinic had seen with no pancreas. We spent a number of years working together to try and identify an insulin regime that would be substainable over time. We started with Novorapid and single pre bed Lanctus, the DSN quickly identified that the 24 hour profile wasn't working so we switched to 2 injections 12 hours apart (7:30 - primary reason for this time was to inject before setting off to work and wasn't linked to any food requirement). This was OK for about 6 months and we then switched to Levermir twice a day. Again once we had fine tuned the required ratios this was good for around 9 months when again control started to go. A discretionary budget was then found to allow me to get a pump and control the basal requirement with Novorapid. To summarise things change over time, you need to be patient during the first few months whilst setting your ratios, you need to be aware and reactive when your blood sugars trend away from normal and try to set new ratios, you need to be open to changing the type of insulin if this is necessary. Keep discussions open re Pump/CGM, but to benefit from closed loop you need the background experience.
 
KJP1 said:
Hi,

I will be starting Levemir soon. One injection in the morning and the other in the evening.

From experience, what is the best way to take this?
i.e is it best to inject, leave it 10/15 minutes and eat something or eat and then inject.

I would appreciate your advice 🙂
Click to expand...
I'm not a doctor, but Levemir (insulin detemir) is a long-acting insulin used to control blood sugar levels in people with diabetes. Here are some general considerations when taking Levemir:

  1. Timing: Levemir is typically taken once or twice daily. If you're taking it twice daily, it's often recommended to take the injections approximately 12 hours apart.
  2. Consistency: It's essential to be consistent with the timing of your injections each day to maintain steady insulin levels.
  3. Before or After Meals: Unlike rapid-acting insulins, which are typically taken just before or after meals, Levemir is not directly tied to meal timing. This means you don't necessarily need to eat right after injecting Levemir. However, you should follow your healthcare provider's specific recommendations regarding meal timing and insulin injections.
  4. Injection Sites: Rotate your injection sites to prevent lipodystrophy (lumps or pits in the skin). Common injection sites for Levemir include the thighs, upper arms, and abdomen. Avoid injecting into the same spot repeatedly.
  5. Storage: Store unused Levemir pens or vials in the refrigerator. Once you start using a pen or vial, you can keep it at room temperature for up to 42 days. Do not freeze Levemir, and do not use it if it has been frozen.
  6. Monitoring: Regularly monitor your blood sugar levels as directed by your healthcare provider. This will help ensure that your insulin dose is appropriate and that your blood sugar levels are well-controlled.
  7. Other Medications and Lifestyle Factors: Inform your healthcare provider of all medications you're taking, as some can interact with insulin. Also, factors like exercise, stress, illness, and alcohol can affect blood sugar levels, so it's essential to be aware and make adjustments as needed.
  8. Hypoglycemia: Be aware of the signs of low blood sugar (hypoglycemia), which can include sweating, shakiness, confusion, blurred vision, and dizziness. Always carry a source of fast-acting sugar with you, like glucose tablets or fruit juice, to treat hypoglycemia if it occurs.
It's crucial to follow your healthcare provider's specific instructions regarding Levemir dosing, timing, and monitoring. They will provide guidance tailored to your individual needs and circumstances. If you have any concerns or questions about your treatment, don't hesitate to reach out to your healthcare team.
 
Do you use Levemir @gary-in-kent ? Are you the carer or partner of someone who does? It would be more helpful if you posted your own experiences rather than copying and pasting things from the internet 🙂
 
I must say, I’m having a few hollow laughs reading the advice. 'Consult your health care advisor' More like, 'tell your health care advisor at your annual review, what you’ve been doing, and they’ll nod and smile and say 'carry on doing what you’re doing'
 
gary-in-kent said:
I'm not a doctor, but Levemir (insulin detemir) is a long-acting insulin used to control blood sugar levels in people with diabetes. Here are some general considerations when taking Levemir:

  1. Timing: Levemir is typically taken once or twice daily. If you're taking it twice daily, it's often recommended to take the injections approximately 12 hours apart.
  2. Consistency: It's essential to be consistent with the timing of your injections each day to maintain steady insulin levels.
Click to expand...
Although consistency is the ideal, in practice I have found Levemir to be very forgiving of more erratic timings, so I no longer worry if I am several hours out as it seems to make little or no difference.
 
Robin said:
I must say, I’m having a few hollow laughs reading the advice. 'Consult your health care advisor' More like, 'tell your health care advisor at your annual review, what you’ve been doing, and they’ll nod and smile and say 'carry on doing what you’re doing'
Click to expand...
Ha ha yes. Though my consultant has come up with the occasional helpful suggestion. I tend to, to be honest, see them as a source of medical tests and funding
 
I do wonder where this is copied from. It does not sound like the sort of thing I would expect from the NHS (or NICE) as I do not think they have the healthcare providers with time to respond so often and learn so much about every single one of their patients.
Imagine asking our healthcare provider every time we work a few hours longer (or shorter), find ourselves doing a bit more exercise (do we have to plan when we are late for the bus as that run to catch it may be counted as extra exercise). How many of us monitor exactly as our HCP told us? I know I test more but others test less.
Am I the only person who spent a little longer out with friends one evening so delayed my basal?
My DSN is wonderful but she would not be happy if I called her every time my day was not quite as planned. And I would not expect her to dictate when I took my insulin with the exact dose. For me, I need the freedom to live my life and have the tools to adjust my diabetes management accordingly.
 
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