Levermir

[Lindiloo]

hi can anyone give me some advice - I’m type 1 diabetic was diagnosed at beginning of lockdown - I’m asking about basal insulin

My insulin isn’t holding me In range - I have done basal testing and have upped morning levermir by 2 units - it’s still not in target - can you just keep upping 1 unit at a time until it go back in sync

I’m normally in range but finding this very challenging

Any advise

 

[Inka]

Hi @Lindiloo When do you take your Levemir and how much do you take? When did you do your basal test? Have you had a Covid vacc or booster recently?

Lots of questions above, but if you explain a little more it will help. Btw, your avatar is still saying that you’re Type 2. You can change that by clicking on your name top right of the page, choosing Account Details and scrolling down to tick the Type 1 box.

 

[Lindiloo]

Hi @Lindiloo When do you take your Levemir and how much do you take? When did you do your basal test? Have you had a Covid vacc or booster recently?

Lots of questions above, but if you explain a little more it will help. Btw, your avatar is still saying that you’re Type 2. You can change that by clicking on your name top right of the page, choosing Account Details and scrolling down to tick the Type 1 box.

Hi thanks for reply

I take levemir morning about 8 and before bed around 10.30 ish I take 20 evening and 14 morning - basal testing I have done from 1 o’clock until about 6 ish

Had booster about 3 weeks ago tomorrow and did find that sugar levels went through roof

My diabetic nurse is brilliant but I feel like a pain I the arse keep contacting her - what I really want to know is do you keep adjusting levermir- I have Libre so I understand patterns but this time I just can’t seem to sort it Levels at lunch time are holding about 8.5 to 9.7 and normal range is 4 to 7

 

[DaveB]

Hi. Do you have Bolus as well as the Basal? Try to balance the Levemir by fasting for a few hours and seeing whether your BS goes up or down and adjust the Levemir up and down a bit over a few days to suit Split it if your aren't already. After that, leave it to to using the Bolus to make adjustments

 

[Inka]

Hi thanks for reply

I take levemir morning about 8 and before bed around 10.30 ish I take 20 evening and 14 morning - basal testing I have done from 1 o’clock until about 6 ish

Had booster about 3 weeks ago tomorrow and did find that sugar levels went through roof

My diabetic nurse is brilliant but I feel like a pain I the arse keep contacting her - what I really want to know is do you keep adjusting levermir- I have Libre so I understand patterns but this time I just can’t seem to sort it Levels at lunch time are holding about 8.5 to 9.7 and normal range is 4 to 7

A basal test needs to be done section by section over a number of days so you get a picture of your blood sugar over the whole 24 hours. I’m not sure if you’ve done this?

And when are you going high?

 

[Fagor]

I am always adjusting my Levemir. Down to 7 units am & pm (for a few days) in Sep, now at 13 & 13, waiting to see effect as about 75% of BGs above 7.5 in last few weeks.

 

[rebrascora]

My daytime Levemir dose nearly doubled between Feb and May last year following my first Covid jab. I must confess that I was resistant to increasing it every few days and would try to balance it with corrections but eventually I would increase the Levemir doses a bit more.... mostly the daytime one as the night time seems to be reasonably stable give or take a unit or two if I have done a lot of exercise during the day, but the daytime one just kept needing a bit more and a bit more until one day I ended up having something like 5 hypos in the day (it was a particularly active day to be fair) but I had fully expected my levels to "drop off a cliff edge" at some point after such a big increase in basal. I dropped it back a couple of units from that day and that has more or less kept me balanced since then give or take normal adjustments. I am pretty sure this was actually the end of my honeymoon period and perhaps my immune system was triggered by the Covid vaccine to see off my remaining beta cells.
It was a very concerning time for me as a near 100% increase in basal over a few months seemed huge and I worried about where it would end and also if I would suddenly not need it all and hypo really badly, but you just have to roll with it and it was more frustrating to have to constantly inject corrections of quick acting to try to keep reasonably in range.

Always err on the side of caution and test lots if you continue to increase your basal dose and give the increase a few days before you decide if you need to increase again. That would be my advice. Once you have had a DAFNE or equivalent course, I think you will become more confident of adjusting your basal insulin doses and at recognizing when they need tweaking, but it sounds like you are already reasonable adept but perhaps like me last year, just concerned about where or how it will end. Hopefully my experience will give you a little confidence. I should say that the 5 hypos I had in one day were all relatively minor and dealt with without any assistance, just annoying and inconvenient.

 

[Lindiloo]

Hi. Do you have Bolus as well as the Basal? Try to balance the Levemir by fasting for a few hours and seeing whether your BS goes up or down and adjust the Levemir up and down a bit over a few days to suit Split it if your aren't already. After that, leave it to to using the Bolus to make adjustments

Aww thanks for reply dave - this is what I’m doing at moment - can I ask. Do you change your levermir - not daily but from time to time upping and lowering depending of levels. I’m beginning to understand it but have gone through honeymoon period and now have to adjust - I’m worried that levermir is going up - but I take it that doesn’t matter

 

[Lindiloo]

My daytime Levemir dose nearly doubled between Feb and May last year following my first Covid jab. I must confess that I was resistant to increasing it every few days and would try to balance it with corrections but eventually I would increase the Levemir doses a bit more.... mostly the daytime one as the night time seems to be reasonably stable give or take a unit or two if I have done a lot of exercise during the day, but the daytime one just kept needing a bit more and a bit more until one day I ended up having something like 5 hypos in the day (it was a particularly active day to be fair) but I had fully expected my levels to "drop off a cliff edge" at some point after such a big increase in basal. I dropped it back a couple of units from that day and that has more or less kept me balanced since then give or take normal adjustments. I am pretty sure this was actually the end of my honeymoon period and perhaps my immune system was triggered by the Covid vaccine to see off my remaining beta cells.
It was a very concerning time for me as a near 100% increase in basal over a few months seemed huge and I worried about where it would end and also if I would suddenly not need it all and hypo really badly, but you just have to roll with it and it was more frustrating to have to constantly inject corrections of quick acting to try to keep reasonably in range.

Always err on the side of caution and test lots if you continue to increase your basal dose and give the increase a few days before you decide if you need to increase again. That would be my advice. Once you have had a DAFNE or equivalent course, I think you will become more confident of adjusting your basal insulin doses and at recognizing when they need tweaking, but it sounds like you are already reasonable adept but perhaps like me last year, just concerned about where or how it will end. Hopefully my experience will give you a little confidence. I should say that the 5 hypos I had in one day were all relatively minor and dealt with without any assistance, just annoying and inconvenient.

Thankyou. I’m beginning to understand it more and more

 

[rebrascora]

I know you addressed your question to Dave, but my own experience is that sometimes I need to adjust my Levemir doses on an almost day by day or dose by dose basis or several times a week and other times it can be relatively stable for months. Sometimes up, sometimes down. When it is repeatedly upwards that suggests to me that I have probably lost some more beta cells.... like last Spring, assuming that I can't identify any other reason, like injury or illness or medication like steroids etc. to cause an increase in need.

Libre helps enormously with spotting an issue with your basal insulin especially if you are like me and don't have set meals and regularly skip them. I do think there is an intuitive element to basal insulin adjustment and diabetes management in general, so do listen to your gut instinct as well as using good sense and logic. You should always keep one eye very firmly on keeping yourself safe though and when in doubt, err on the side of caution.

 

[Lindiloo]

I know you addressed your question to Dave, but my own experience is that sometimes I need to adjust my Levemir doses on an almost day by day or dose by dose basis or several times a week and other times it can be relatively stable for months. Sometimes up, sometimes down. When it is repeatedly upwards that suggests to me that I have probably lost some more beta cells.... like last Spring, assuming that I can't identify any other reason, like injury or illness or medication like steroids etc. to cause an increase in need.

Libre helps enormously with spotting an issue with your basal insulin especially if you are like me and don't have set meals and regularly skip them. I do think there is an intuitive element to basal insulin adjustment and diabetes management in general, so do listen to your gut instinct as well as using good sense and logic. You should always keep one eye very firmly on keeping yourself safe though and when in doubt, err on the side of caution.

Hi thanks for reply. I’m learning day by day and must admit my diabetic nurse is amazing - but I sometimes forget to ask when I go to hospital the questions I need to ask.

I understand the workings of both insulin’s but now I understand that it will go up and down (basal) - thanks for advice I appreciate your help - hoping to try and get back In sync.

 

[rebrascora]

Some basal insulin's don't allow for such adjustment because they are very long acting, but it is one of the main reasons that I love my Levemir as it is so adjustable and means you can fit it to your body's needs much better than the likes of Tresiba or Toujeo. It is worth noting that the doses of Levemir don't necessarily have to be taken exactly 12 hours apart as is often suggested. I used to take my morning dose at 7am and my evening one at 11pm-midnight and that worked really well for me with a very uneven split having most in the morning and sometimes just 1 or 2 units on an evening and sometimes none at all in the evening if I had been really active for a few days. That worked great for a couple of years but just recently my levels have started to rise early evening so I have brought my evening basal forward to about 7pm which is helping to prevent that rise as there is now more overlap with the morning dose. This may change again at some point and I will go back to needing more of an overlap in the morning, so I will take the evening dose late again.

My advice would be, don't be frightened to experiment a bit to see what works for you.... but always with one eye on safety. You may end up teaching your nurse a thing or two because all they know is the theory which with Levemir suggests that the 2 doses should be taken 12 hours apart and with bolus insulin you shouldn't prebolus more than 30 mins in advance of a meal. My body needed 1hr 15mins prebolus at breakfast time with NovoRapid and currently 45mins with Fiasp to prevent my levels spiking.... My consultant was horrified when I told him this but he couldn't argue with my results and Libre graphs. If everyone sticks to what they are told we don't find what works for us as individuals, so to me being encouraged to experiment and test lots, will help you to see how your body responds and find what works best for you.
Diabetes is a bit of a strange condition because you need to become the expert in your own diabetes management and the medical staff should be there to support you with that rather than tell you what to do...... once you gain a suitable level of knowledge that is! Of course you need their advice and guidance in the first place until you get things figured out for yourself, but you live with it day by day and meal by meal and activity by activity whereas they just see a small snapshot every now and then.

 

[Lindiloo]

Some basal insulin's don't allow for such adjustment because they are very long acting, but it is one of the main reasons that I love my Levemir as it is so adjustable and means you can fit it to your body's needs much better than the likes of Tresiba or Toujeo. It is worth noting that the doses of Levemir don't necessarily have to be taken exactly 12 hours apart as is often suggested. I used to take my morning dose at 7am and my evening one at 11pm-midnight and that worked really well for me with a very uneven split having most in the morning and sometimes just 1 or 2 units on an evening and sometimes none at all in the evening if I had been really active for a few days. That worked great for a couple of years but just recently my levels have started to rise early evening so I have brought my evening basal forward to about 7pm which is helping to prevent that rise as there is now more overlap with the morning dose. This may change again at some point and I will go back to needing more of an overlap in the morning, so I will take the evening dose late again.

My advice would be, don't be frightened to experiment a bit to see what works for you.... but always with one eye on safety. You may end up teaching your nurse a thing or two because all they know is the theory which with Levemir suggests that the 2 doses should be taken 12 hours apart and with bolus insulin you shouldn't prebolus more than 30 mins in advance of a meal. My body needed 1hr 15mins prebolus at breakfast time with NovoRapid and currently 45mins with Fiasp to prevent my levels spiking.... My consultant was horrified when I told him this but he couldn't argue with my results and Libre graphs. If everyone sticks to what they are told we don't find what works for us as individuals, so to me being encouraged to experiment and test lots, will help you to see how your body responds and find what works best for you.
Diabetes is a bit of a strange condition because you need to become the expert in your own diabetes management and the medical staff should be there to support you with that rather than tell you what to do...... once you gain a suitable level of knowledge that is! Of course you need their advice and guidance in the first place until you get things figured out for yourself, but you live with it day by day and meal by meal and activity by activity whereas they just see a small snapshot every now and then.

Thanks again for advice I’m really struggling- at 6 this evening I was 11.7 so I had 40’gms of carbs and injected 10 units of rapid and just now I’m 12.6. I just can’t control it It’s seems since I’ve had covid booster. I don’t really know what to do anymore - I’m so confused with it all

 

[rebrascora]

If it's any consolation my levels have been up to a massive 17 tonight and only coming down now because I have whacked in a whole load of Fiasp. Currently 10.9 and coming down fast at last but been high most of the evening.

Don't let it get to you! Tomorrow will be a better day, but if it's not, then maybe the day after. In the short time I have been diagnosed (nearly 3 years) I have found that my "control" seems to ebb and flow. I go through spells of great control when everything works perfectly and my levels are all in range and it just all seems to be relatively easy and then I hit a spell when it all goes horribly wrong and the more I get exasperated and frustrated, the less it cooperates. What I do is remind myself during those times that it will settle down and I will have another good spell soon and in the mean time I just tread water and do the best I can and wait for it to pass.... and so far it always has.... and I see no reason to believe that will change. Just hang in there and sooner or later it will all make sense again or you will figure out what to do to help it make sense again. Usually for me it is a basal dose change, but at the moment the cause is eating higher carb foods. Once I go back to my low carb diet it will all be much easier to manage. I just got tempted by some Chinese meal leftovers tonight.

How long did you wait between injecting and eating. I have a general rule of not eating if my levels are above 8, so in your situation I would inject the rapid insulin and then wait for my levels to come down before I ate my meal, even if it meant 30mins or an hour. Of course that is much easier with a Freestyle Libre sensor than finger pricking but I have done it with finger pricks testing every 5 mins after the first 10. If I eat when my levels are above 8 it's almost like I didn't inject any insulin. It becomes much less effective. Other people have found this and it seems to be particularly true of Fiasp.

 

[Lindiloo]

If it's any consolation my levels have been up to a massive 17 tonight and only coming down now because I have whacked in a whole load of Fiasp. Currently 10.9 and coming down fast at last but been high most of the evening.

Don't let it get to you! Tomorrow will be a better day, but if it's not, then maybe the day after. In the short time I have been diagnosed (nearly 3 years) I have found that my "control" seems to ebb and flow. I go through spells of great control when everything works perfectly and my levels are all in range and it just all seems to be relatively easy and then I hit a spell when it all goes horribly wrong and the more I get exasperated and frustrated, the less it cooperates. What I do is remind myself during those times that it will settle down and I will have another good spell soon and in the mean time I just tread water and do the best I can and wait for it to pass.... and so far it always has.... and I see no reason to believe that will change. Just hang in there and sooner or later it will all make sense again or you will figure out what to do to help it make sense again. Usually for me it is a basal dose change, but at the moment the cause is eating higher carb foods. Once I go back to my low carb diet it will all be much easier to manage. I just got tempted by some Chinese meal leftovers tonight.

How long did you wait between injecting and eating. I have a general rule of not eating if my levels are above 8, so in your situation I would inject the rapid insulin and then wait for my levels to come down before I ate my meal, even if it meant 30mins or an hour. Of course that is much easier with a Freestyle Libre sensor than finger pricking but I have done it with finger pricks testing every 5 mins after the first 10. If I eat when my levels are above 8 it's almost like I didn't inject any insulin. It becomes much less effective. Other people have found this and it seems to be particularly true of Fiasp.

That makes sense about waiting if high before you eat. I’ve been told 15 mins I do have Libre so easy to check. I’ve never had this before for so long - I’m coming down now I’m 7.8 I’ve injected 21 levermir and I’m going to adjust morning level - I think I need to up morning levermir to try and get it back into sync at lunch time - it’s so hard when it goes wrong

I think I’ve hit a brick wall and just finding everything overwhelming - but I will pull my big pants up and carry on

Think I get scared - it frightens me when I’m. It in control

 

[rebrascora]

Totally understand and it is normal to get waves of feeling overwhelmed and out of control.... I'm a control freak too!

Good to hear you have Libre as that does make it a little easier.
I think it was @Pumper_Sue who divulged the tip about not eating when levels are above 8 and it really is a good bit of advice to follow whenever possible. The other night I was low 9s and jabbed 3 units, 2 of them for a bowl of cream of chicken soup plus a 1 unit correction and 1.5 hours later I was still waiting to eat and it had gone up to 9.7 instead of down, so I jabbed some more insulin and waited another half hour and then ate and that did it. This evening rise in basal needs I am experiencing recently had obviously just swallowed up my bolus insulin for the soup, so I had to start again!

 

[Lindiloo]

Totally understand and it is normal to get waves of feeling overwhelmed and out of control.... I'm a control freak too!

Good to hear you have Libre as that does make it a little easier.
I think it was @Pumper_Sue who divulged the tip about not eating when levels are above 8 and it really is a good bit of advice to follow whenever possible. The other night I was low 9s and jabbed 3 units, 2 of them for a bowl of cream of chicken soup plus a 1 unit correction and 1.5 hours later I was still waiting to eat and it had gone up to 9.7 instead of down, so I jabbed some more insulin and waited another half hour and then ate and that did it. This evening rise in basal needs I am experiencing recently had obviously just swallowed up my bolus insulin for the soup, so I had to start again!

Well I’ve had a revelation tonight - I thought sugar levels were due to covid booster but didn’t think it was exercise. I normally walk dog twice a day - she been unwell for 3 weeks and i haven’t walked her until tonight and hey presto levels are 5.6 now. Will wait and see tomorrow but hoping that what it was