Moving to Levemir twice daily

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Ken21

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Type 1.5 LADA
Hi, 14 years diabetic, Lada. Was on Metformin SR , now also on Levemir for past month. I'm thin, low carb on main meals but snack inbetween, good amount of exercise.
Initially 6.5u of Levemir early evening took me lowish overnight but didn't fully control ( brief) daytime highs ( up to 15).

Transitioned to 9u at breakfast, only marginal gains during day, didn't send me lowish overnight.

Transitioned back to 8u early evening, still not controlling brief daytime highs but now definitely sending me low (3.9) overnight. Use Libre 2.

Doc says 2x Levemir bfast, eve .... at 7u, but sketchy reasoning.
1. Have I exhausted 1 jab option?
2. I think 2 lots of 7u might send me low overnight and I might be better trying 7 and 4. Any thoughts welcome. Thanks!
 
There’s absolutely no reason why the two doses have to be the same, you do whatever works for you. So if that means you need 10u in the morning and only 2 at night then that’s what you do. That’s the whole point of splitting a Levemir dose into two, so you can find what keeps you most stable and it’s a lot more flexible than only taking one dose every 24 hours.
 
Hi and welcome

I am a huge fan of Levemir because it provides so much flexibility, but understanding how your body works and the profile of the Levemir's action is key to getting the right dosage and timing and contrary to popular belief it doesn't have to be an even split and they don't have to be 12 hours apart.

I think you are right to be extremely wary of taking 7units in the morning and 7 at night if you are currently on just 8 units total as that is almost doubling your dose and will almost certainly give you some nocturnal hypos. Even 7 and 4 is a significant increase and you would need to keep a close eye on things overnight for a day or two. Obviously having Libre 2 is a huge bonus with this.

When were you taking the 9 (or 8) units on a morning?
I find the sooner I can get my Levemir into me on a morning the better. I often set an alarm for an hour before I intend to get up and inject it and go back to sleep. This is because our liver starts to pump out glucose in the morning to give us energy to start our day..... Sometimes this will start in the early hours of the morning, particularly at this time of year (Dawn Phenomenon or DP) or if you are lucky like me, it will wait until I set foot out of bed which we refer to as Foot On The Floor or FOTF. I keep my insulin pens and hypos treatments within reach of the bed to make it as quick and easy as possible to get that Levemir into me, so that I don't have to get up and I get straight back off to sleep no problem. So I will inject at 6am to get up at 7 because it takes the Levemir about an hour to get going.
To give you some perspective, my current doses are 20units in the morning and 4 units last night at bedtime (usually 11pm). The night time dose for me is pretty variable depending upon what I have been doing during the day (ie how active I have been) and will vary from 0 to 7 units.
Sometimes I start to see my levels rising on an evening (Libre is an amazing tool!) and I need to take my night time dose earlier to deal with that for a few days or weeks even. Again this is due to a glucose release from the liver.

Another thing to be aware of is that basal needs change due to a number of factors and doses will need tweaking from time to time. My daytime dose has just decreased from 24 to 20 units due to the change of season/warmer weather.

If I was you I might stick with the same total number of units of Levemir as you are taking now but have a small number at night and the majority in the morning, or maybe stick with just one dose for a week and try my strategy of injecting before you get up first, if it isn't too much of an inconvenience and see how you get on with that. The other thing that I used to do was inject 1-2 units of bolus insulin before I got out of bed to deal with DP/FOTF. I do not inject bolus insulin and go back to sleep though as that is potentially risky, so just before I get out of bed.

Anyway, that is what I would do in your situation but I think your gut feeling about the Drs advice on 7+7 units is correct and I would be very wary of that. Always err on the side of caution and go lower to start with.
 
rebrascora said:
Hi and welcome

I am a huge fan of Levemir because it provides so much flexibility, but understanding how your body works and the profile of the Levemir's action is key to getting the right dosage and timing and contrary to popular belief it doesn't have to be an even split and they don't have to be 12 hours apart.

I think you are right to be extremely wary of taking 7units in the morning and 7 at night if you are currently on just 8 units total as that is almost doubling your dose and will almost certainly give you some nocturnal hypos. Even 7 and 4 is a significant increase and you would need to keep a close eye on things overnight for a day or two. Obviously having Libre 2 is a huge bonus with this.

When were you taking the 9 (or 8) units on a morning?
I find the sooner I can get my Levemir into me on a morning the better. I often set an alarm for an hour before I intend to get up and inject it and go back to sleep. This is because our liver starts to pump out glucose in the morning to give us energy to start our day..... Sometimes this will start in the early hours of the morning, particularly at this time of year (Dawn Phenomenon or DP) or if you are lucky like me, it will wait until I set foot out of bed which we refer to as Foot On The Floor or FOTF. I keep my insulin pens and hypos treatments within reach of the bed to make it as quick and easy as possible to get that Levemir into me, so that I don't have to get up and I get straight back off to sleep no problem. So I will inject at 6am to get up at 7 because it takes the Levemir about an hour to get going.
To give you some perspective, my current doses are 20units in the morning and 4 units last night at bedtime (usually 11pm). The night time dose for me is pretty variable depending upon what I have been doing during the day (ie how active I have been) and will vary from 0 to 7 units.
Sometimes I start to see my levels rising on an evening (Libre is an amazing tool!) and I need to take my night time dose earlier to deal with that for a few days or weeks even. Again this is due to a glucose release from the liver.

Another thing to be aware of is that basal needs change due to a number of factors and doses will need tweaking from time to time. My daytime dose has just decreased from 24 to 20 units due to the change of season/warmer weather.

If I was you I might stick with the same total number of units of Levemir as you are taking now but have a small number at night and the majority in the morning, or maybe stick with just one dose for a week and try my strategy of injecting before you get up first, if it isn't too much of an inconvenience and see how you get on with that. The other thing that I used to do was inject 1-2 units of bolus insulin before I got out of bed to deal with DP/FOTF. I do not inject bolus insulin and go back to sleep though as that is potentially risky, so just before I get out of bed.

Anyway, that is what I would do in your situation but I think your gut feeling about the Drs advice on 7+7 units is correct and I would be very wary of that. Always err on the side of caution and go lower to start with.
Click to expand...
I’ve just reduced my Basel from 14 to 11 which after reading this I will presume it’s also down to the weather - as over the last few weeks I’ve noticed I’m regularly lower than usual/where I’d like to be.
 
Welcome to the forum @Ken21

Depending on your ‘per kilo’ dose level, Levemir most likely seems to last somewhere between 12 and 18 hours (larger doses tend to last over a longer period). So splitting Lev is quite common, and often helps to spread the action of the insulin, plus allowing a sort of 2 phase flexibility where people, for example, need more insulin active during the day but less active overnight.

There are no hard and fast rules, and perhaps explains your Dr’s “try this and see how it goes” experimental approach. Often a short period of experiment and adjustment is the fastest way to find the right doses (for now). And then re-experiment and adjust when insulin needs look like they have changed.
 
Thanks for everyone’s advice. Forgot to say pre insulin I was aHba1c 70, now on
1xday Levemir settled at 62.

So, tried 9u at bfast but highs during day, overnight ok.
Tried up to 8u recently at around 7pm but giving me brief highs (up to 15) during day and near hypos at 3:30a.m.

Don’t understand why manufacturer suggest single dose best time with evening meal …..since this gives peak action overnight?

I might try an even bigger single dose very early breakfast or…….
2 doses, say 5u bfast and 3u mid evening.

Any further comments welcome.
Big thanks to all!
 
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