Splitting Levemir

[EmmaL76]

Morning all. After the recent shortage of my Semglee basal, I was switched to levemir. As I had a bit of stock of my old one I only started on this yesterday. After reading the instructions on dosing i was still a little unsure, so I played it safe. With Semglee I’d been on 11 units for a good few months but had recently needed to up it to 18 over the corse of a few weeks. However I decided to go for 12 units of levemir split over 2 doses, 12 hours apart… 7am - 7pm. The day time was great, better than usual, but at midnight last night I woke up in a sweat, alarms going off for hypo (which hasn’t happened to me in a while ) I treated the hypo after finger prick but I stayed low most of the night. Were my timings wrong? Should I split the dose differently ? Any advice/ experience welcomed

 

[Robin]

It’s a very individual thing, but I find I have to use a smaller dose at night, to stop me crashing. But that’s because my blood glucose seems to sink naturally at night, then pick up again round about 4am. Yours may be different, but worth an experiment.

 

[SB2015]

Hi Emma

I think Levemir is showing you the benefits of a split dose. Your daytime dose worked well and it sounds like you need less in the night, which you can now do without impacting the successful dose of daytime.
I also found that I needed less at night, but we are all different and with each change we make it can take time to find what works for you.

Another thought about this, as it was the first day, did you have any of your previous basal insulin still doing its stuff? Keep a watch on levels and make adjustments as necessary. Another advantage with Levemir is that changes you make show straight away.

Let us know how you get on.

 

[Inka]

When I take a pump break and go back to injections, I need around 50% less basal in the evening compared to my morning dose @EmmaL76 If you didn’t have any lingering Semglee and were ok during the day, personally I’d leave the morning dose alone and cut the evening dose by half. That might be too big a cut but it’s safer to build up to the correct dose. It can take a few days to get it right but it’s far better to be cautious, especially at night.

 

[helli]

Another thought about this, as it was the first day, did you have any of your previous basal insulin still doing its stuff?

This is a good point.
Before I started pumping, I was using Lantus (another glargine insulin like Semglee). My DSN advised that there is some residual Lantus left for up to 4 days.

 

[rebrascora]

Sorry to hear you had a hypo on your first night.

My day night split is very uneven with usually a fairly stable 22 in the morning but anywhere from 0-7units at night. I also don't do a 12 hour split, (usually 7am and 11pm ie. walking up and going to bed, which probably leads to more of an uneven split, although I was told to do an even split of 7 and 7 from my 14 units when I first started splitting it just before my DAFNE course.

I agree that you may have had some Semglee overlap with your first day dose of Levemir helping it out and possibly the night too. You may need to increase the daytime dose a bit more yet even though it seemed perfect for that first day and especially if you decrease the night time dose as there is some overlap, so the lower night time dose does impact the following day results slightly. It takes time to get it balanced right and it can seem like a bit of a "dark art" at first but the more you learn to tweak it, the better you understand it.

 

[EmmaL76]

It’s a very individual thing, but I find I have to use a smaller dose at night, to stop me crashing. But that’s because my blood glucose seems to sink naturally at night, then pick up again round about 4am. Yours may be different, but worth an experiment.

Think I could be similar. Thank you

 

[EmmaL76]

When I take a pump break and go back to injections, I need around 50% less basal in the evening compared to my morning dose @EmmaL76 If you didn’t have any lingering Semglee and were ok during the day, personally I’d leave the morning dose alone and cut the evening dose by half. That might be too big a cut but it’s safer to build up to the correct dose. It can take a few days to get it right but it’s far better to be cautious, especially at night.

Yes that’s my thoughts. I will give that a go I think and see what happens. Thanks inka

 

[EmmaL76]

Hi Emma

I think Levemir is showing you the benefits of a split dose. Your daytime dose worked well and it sounds like you need less in the night, which you can now do without impacting the successful dose of daytime.
I also found that I needed less at night, but we are all different and with each change we make it can take time to find what works for you.

Another thought about this, as it was the first day, did you have any of your previous basal insulin still doing its stuff? Keep a watch on levels and make adjustments as necessary. Another advantage with Levemir is that changes you make show straight away.

Let us know how you get on.

Thankyou so much, that’s so helpful. I think once I’ve worked it out it may work better for me that the previous insulin. Think I may have more flexibility. Maybe there was also some still in my systems.

 

[EmmaL76]

Sorry to hear you had a hypo on your first night.

My day night split is very uneven with usually a fairly stable 22 in the morning but anywhere from 0-7units at night. I also don't do a 12 hour split, (usually 7am and 11pm ie. walking up and going to bed, which probably leads to more of an uneven split, although I was told to do an even split of 7 and 7 from my 14 units when I first started splitting it just before my DAFNE course.

I agree that you may have had some Semglee overlap with your first day dose of Levemir helping it out and possibly the night too. You may need to increase the daytime dose a bit more yet even though it seemed perfect for that first day and especially if you decrease the night time dose as there is some overlap, so the lower night time dose does impact the following day results slightly. It takes time to get it balanced right and it can seem like a bit of a "dark art" at first but the more you learn to tweak it, the better you understand it.

Brilliant thanks @rebrascora. This is all useful info. Get more info from you guys than the tablecloth sized instructions in the box lol

 

[trophywench]

22u of Lantus for me. 14u of Levemir at c 7.30am on rising, plus another 4u at c 11pm bedtime, but then hypo at 2.30 to 3 am so gradually brought that forward to 9.30pm ish.

It's quite a dark mystical art, dosing of Levemir, cos it depends on the ratio per kg of body weight as to how long it happens to actually stay active for each person! (and not an easy graph to follow!)

 

[SB2015]

It's quite a dark mystical art, dosing of Levemir, cos it depends on the ratio per kg of body weight as to how long it happens to actually stay active for each person! (and not an easy graph to follow!)

I reckon each of us deserves our very own GCSE in ’managing our diabetes’

 

[trophywench]

GCSE?????? How very dare you - flippin Masters Degree if you ask me!!!!!

Any number of the teachers at my senior school had their Ph.Ds - and certainly Caps and Gowns were in evidence on certain formal occasions but the wearing of them was always optional even then, so we were informed as pupils. Only ONE teacher ever introduced himself to us all as Dr though - and expected to be addressed as such throughout - the others were ALL addressed as Mr & Miss/Mrs. This Dr G taught French so he taught me. I later met the lady who was his wife back then, with her second husband - lovely woman and ditto chap who a friend had met recently quite by chance and invited round to theirs for drinks, so knowing I was taught by him, deliberately asked myself and (1st) husband round the same evening. The ex Mrs G who'd known Mr G since they were teenagers etc said he was always pretentious and eventually decided she would be better off without him and still thought she was, much. Hence I'm not suggesting we use the 'Handle' by any means!