Adding ANOTHER unit of levemir to nightime dose?

kay, so ive had some high numbers in the morning before breakfast and added an extra unit so that im now taking 3 units of levemir in the evening and 1 in the morning. i am still high in the morning after a week of the increase. i normally do not require so much ridiculous hand-holding for my decision making in other areas of life but am i doing the right thing? my dose in the morning is just one unit of levemir, which seems to me a very lopsided dosing. i imagine its a "whatever works for your body" time thing, but id be taking 4 units of levemir at night and 1 in the morning. my i:c ratio for breakfast is 1:25 and for the rest of the day its 1:30 with novorapid.

thank you in advance!

To me this is a bit odd. Usually our basal needs are lower at night. So I would have expected you are using 3 in the morning and 1 or 2 for the night. The problem with Levemir is that the more you inject the longer it will act. Very likely even 3 units will fade out around 5 am or earlier. This fading out combined with the dawn phenomen will very likely cause a sharp rise in the morning. Have you tried different combinations like 2:3, 2:2 or 3:2?

With these low dosages even 1/2 unit can make a huge difference. I know that because I use 6:4 which also a sign of high insulin sensitivity. For this the half unit pens like NovoPen Echo are of good use. But before buying this pen you also have the option to try Lantus first. With these low dosages the Lantus might last longer than the Levemir. Thus you can potentially cover a longer period of time with a lower dosage. This is also a new finding for me because I switched to two shots of Lantus just recently (6:4 despite the fact that lantus covers 24 hours). It is not perfect but with low dosages it works better than Levemir for me. Over the years and with regular sports my insulin sensitivity increased. Thus I had to find a solution and adjusted like we all constantly do.

holger, thanks for your reply. im injecting my three units of levemir at about 11pm before i go to bed and my AM 1 unit at about 9am, so i dont know if it would be used up that fast. possibly, because im using so little?
im also doing a low carb dinner which i usually dont inject for (less than 15 grams of carb)but that shouldnt affect am numbers, right?

53% of protein is converted to carbs so, even with a low carb dinner, you get some carby fuel through that mechanism that, in turn, will nudge your BG up I think, particularly in the absence of insulin. It may be that counting the G of protein and bolusing a small "whiff" of insulin might also serve to cover that? I am often inclined to look at protein and fat as "free" but get better results when I add in the 5-10G of carbs the hunks of cheese, meat, tofu or whatever will add up to. I like to think I know what I'm doing but I am *totally* lazy about carb counting and sometimes get pretty far off.

You have had "some high numbers" in the morning, but what you need to do is establish your basal doses to your average. If you wake up sometimes at 80 and other times at 150, you can't change your basal dose to address the 150 without risking a hypo. So I like to track the average of my morning numbers and use that as a guide. And if my morning numbers rise, I increase my evening Levemir. My evening dose is three times my morning dose. It is recommended that you change your basal dosing by 5-10%, but you will just have to do the best you can.

But before you do that, you might try rolling back the time of your dosing a bit. Levemir peaks at 6-8 hours (although everyone is different) and if you take your evening dose at 11pm, you may find that it peaks too late. You might try taking your evening dose in the 6-9pm window and see if that helps before increasing your dose.

ps. I have some morning highs that are just due to bad sleep or "whatever." I just correct them and get on with my day. Such is life.

thanks very much for the info. brian, i had to change the time of the levemir cuz it wasnt doing it at the old time of about 9pm, made it later and it was working better at the new later time. no chance of me waking up hypo these days. think there may be an inordinate amount of denial going on here and am going to add some more carbs to dinner and shoot up for it, as im about 1:30 and cant just give myself a whiff of insulin, as you say, acidrock. if only!! yeah, lots of denial and ill-just-eat-less-carbs style bargaining happening, seeing as nothing im trying so far is working. i guess only insulin works for the beetus...can i just say how much i hate this?


Dose everyone split their doses ? Does it even bg out better ?

drsoosie said she drinks almond milk in the evening and it seems to smooth things out. It’s not in my routine but it seems to work nicely for me on those occasions I’ve tried it.

buyin it tomorrow then, thanks!
josephine, i split my dose after i first started the levemir (switched from lantus) because it wasnt covering me 24 hours.
yeah, vodka, that makes me wake up low. i should just get pissed every night, haha!

Maybe you're not taking Levemir soon enough in the evening for it's peak to be effective to bring down the "dawn effect".

- Check your bg in the middle of the night. I bet it will on target. If it is, then I suggest try taking your Levemir earlier to time the peak for 2 hours before you get up.
- Do you have lows mid-morning? I suspect you have to take such a lesser dose in the morning because you are still getting the effect from your night dose.

- Test your bg when you go to bed and when you get up. How much of a difference is there?