Quick question on levemir

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gillrogers

gillrogers

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So into my 2nd week on levemir, started on 5 at breakfast and then 4 twelve hours later. Now on 7 at breakfast which seems perfect now and 3 at night. 3 is looking like it's too much at night. I'm having a supper of 10 grams of carbs on a reading of 9 to stave of the low alarm at 4.4 around 2am. I'm having my dinner at 6pm and this supper at 10pm. I think I need to drop my evening dose again. Is such a big difference between night time and day time units for Levemir usual? Seems strange to me after being on a once a day dose of Semglee.
 
gillrogers said:
So into my 2nd week on levemir, started on 5 at breakfast and then 4 twelve hours later. Now on 7 at breakfast which seems perfect now and 3 at night. 3 is looking like it's too much at night. I'm having a supper of 10 grams of carbs on a reading of 9 to stave of the low alarm at 4.4 around 2am. I'm having my dinner at 6pm and this supper at 10pm. I think I need to drop my evening dose again. Is such a big difference between night time and day time units for Levemir usual? Seems strange to me after being on a once a day dose of Semglee.
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There’s an oft quoted expression about insulin…'You need what you need' I take Levemir, 5 or 6 units in the morning, and 2.5 or 3 at bedtime, because my BGs seem to plummet under their own steam once my head hits the pillow.
 
Robin said:
There’s an oft quoted expression about insulin…'You need what you need' I take Levemir, 5 or 6 units in the morning, and 2.5 or 3 at bedtime, because my BGs seem to plummet under their own steam once my head hits the pillow.
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Thanks Robin, I'll drop it to two tomorrow night then.
 
Yes, it's common to have a big difference between the split doses. Since I've been using Libre 2 I can see the need to have that difference e.g. 13 in the morning and between 7 and 12 in the evening
 
I need much less at night but I need a lot through the day. Currently 24u in the morning and I find it best to take it an hour before I get up so that it is kicking in when I get out of bed to tackle Foot on the Floor syndrome and anywhere from 0-7 on an evening depending upon how active I have been. My morning dose has been pretty static since last summer, but my evening dose needs tweaking very regularly and sometimes I need to change the time that I take the evening dose. I used to take it at bedtime but just recently my levels have been starting to rise about 7pm (spotted via basal testing) so I brought my evening Levemir forward to tackle that, which seems to be working well. Adjusting the time you take it to suit your body's needs is nearly as important as the dose itself and it is what makes Levemir a much more flexible basal insulin.
I just love it for providing that flexibility.
 
Yes Im liking the flexibility. So I dropped my night unit by one which worked great last night but I think I may need to up the morning to 8 by the look of my readings this morning, to make the overall 10 units I now seem to be on - feeling like a balancing act?
 
It is an ongoing balancing act but the combination of Libre and Levemir gives you the a much better chance of achieving better balance than a longer acting insulin.
 
It certainly does. I'm feeling much better and more confident with the flexibility too.
 
I’ve been adjusting my basal recently. I now take around twice as much Levemir in the morning than I do at night. Getting those night time drops sorted was actually the trickiest bit. I never go to sleep on a BG less than 8, that sets me up for a nice wake up on 5.8 after a nice straight line overnight..
 
@rebrascora Hi Barbra, I see what you mea about the timings of the levermir. I'm having a quandary at the moment. My evening is rising noticeably once my day time Basel runs out and I've given my night time dose. Had my dinner half hour earlier and it's not gone up so quick. Finding I'm having to give me a bolus unit at bed time as I've not come back down. So thought of shifting my morning dose round so I can shift my night time Basal round to give my tea longer on the daytime higher dose. That won't work cos I'll have trouble with my breakfast. So think rather than changing the times of my basal doses to change my dinner time meal bolus ratio and up that to compensate.
 
It is not so much that your daytime is running out as it will generally last at least 16 hours so there is a good bit of overlap but it does tail off and it sounds like your basal needs are increasing at night which mine started doing in late December. I used to take my basal at bedtime 11ish and then 6.30am but I have brought it forward to 7pm ish now and that is helping to sort the problem but sometimes I need a unit at bedtime. That doesn't cause me any concern personally but I understand that some people worry about going to bed with active bolus on board, so increasing your evening meal ratio might sort it. I was having a similar problem in the morning with Foot on the Floor where I has to inject 1-2 extra units on top of my breakfast bolus.... but if I didn't have any breakfast I still needed to take those extra units so I didn't see it as a ratio change but just an "add on". Now that I inject my morning Levemir an hour before I get up, it seems to have mostly stopped that Foot on the Floor rise.
You just have to be prepared to experiment and jig things around a bit and find what works for you. Let me know how you get on with the new evening ratio strategy.
Personally rather than changing the ratio, I would just add a unit or two on to your bolus (rather like a correction but sort of in advance of needing it) because the rise in BG isn't tied to what you are eating, it is to cover your liver output, so shouldn't vary each evening according to how many carbs you eat, it's more of an "add on" like I do with my breakfast bolus. Just my thoughts on what works for me.... Good luck. Once you get it tweaked to work for you, Levemir is a great basal.
 
@rebrascora ah yes. I see what you mean with the evening ratio. That actually makes sense. I have up my evening basal to 3 tonight to see what happens. What you said about 16 hours makes sense too as it's about that point I'm giving me that unit of bolus at bed time. I'll only do it if I'm significantly high enough, just to get me back under 10.
 
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