Dead pump has now been replaced ... but still interested in Lantus/Levemir advice

Hope the trial goes well, Kim!

I woke up super-low this morning — ugh — but then I’ve certainly had that happen on the pump, so I’m not blaming the Levemir yet.


I woke up to a 78 this morning, so I won’t complain, well not this time anyway, lol. Good luck with yours also. Just watch, we’ll both end up pumping again in a week, lol. Kim

Ah, NPH … those were the good ol’ days. I think I was in an extended honeymoon phase back then, and my control was actually pretty good. Sadly, this chart looks like many of my graphs when I’m on a pump! Grrr. >:-[

Guess we’re all going on Levemir at the same time - I started my test switch from Lantus to Levemir two days ago also.

One comment on the previous discussion - it isn’t the absolute number of units that varies the speed of action curve of Levemir - its the ratio of insulin to body weight. Here’s an interesting graph CLICK HERE.

Unlike anyone else here, I find I need more basal insulin at night than during the day. This is even true (in fact more true) when I exercise at night. I’m working on adjusting the ratio now - I was at 70%/30% (night/morning) with Lantus, but that didn’t give enough daytime coverage with Levemir so I’m going to try 62%/38% tomorrow.

Isn’t it fun always being your own personal guinea pig (or lab rat as the case may be)?

Thanks very much for that graph link, Jag. That’s very interesting and helpful. I’ll use the info in my next round of calculations.

Lab rat is right … I feel my nose starting to twitch. :-/

Thanks for the graph, Jag. According to this graph nobody should ever claim that Levemir is designed to cover 24 hours. It lasts 24 hours but it does not cover them equally. For the medical field this seems to be hard to understand. Only two shots of Levemir per day will give us perfect coverage.

This is an interesting challenge, trying to manipulate my Levemir dosing so that it mimics my pump basal as closely as possible. The two main trouble areas I’ve been dealing with are a tendency to go low in the 3 or 4 hours just before breakfast (opposite of dawn phenomenon?), followed by a mid-morning tendency to go high (whether I eat or not, so I don’t think it’s a case of under-bolusing). My evening dose of Levemir is lower (8 units), and last night I took it earlier (8pm instead of 11pm), which seemed to prevent the early morning low, but I haven’t yet figured out what to do about those mid-morning highs. I don’t want to increase my morning dose of Levemir (12 units), because it seems to work for the rest of the day. With the pump, I of course just program a higher basal rate for a few hours. What would you Levemirians do? Cover the trouble time with regular fast-acting insulin? Or do you have stable basal requirements throughout the day? (Lucky bums if you do! :slight_smile:

Could you give me a more exact example of your injection pattern for Levemir: time and dosage?

Sure! I’ve been working with a TDD of 20 units (Levemir only, doesn’t include Humalog), since that was my dosage of Lantus when I was last on it. I’m nervous about lows at night, so I’ve split the dose this way:

20:00 — 8 units

08:00 — 12 units

I don’t want to be a pain with these questions, Holger. If you enjoy working on these sorts of problems, I’m happy to provide you with whatever info you need, but also feel free to ignore me! :slight_smile: Either way, I really appreciate your knowledge and suggestions!

your mid-morning peak is at 10am? maybe take the morning shot an hour earlier at 7am in order to get it on board sooner before the mid-morning peak? If you are not awake at 7am, you could try shots at 08:00 and 21:00.

Of course you’d have to watch that you don’t start climbing from 7-8pm due to the dose wearing off before your nighttime shot.

are the low overnight and the mid-morning high due to MDI or did you adjust for them on pump also?

Thanks, Don … Yes, these are things I was adjusting for on the pump. My early morning basal rate would go down to .4 units/hr, compared to about .9/hr in the 8-11 am zone. These adjustments are hard to reproduce with shots … as are things like a two-hour rowing or soccer practice, for which I was doing temp basals. Sigh … I expect I’ll be back on my pump eventually, but for now it’s still so nice to be unplugged!

I can not explain your tendency to go low just before breakfast. Are you sure about that? Maybe you were lower for a longer period of time at night?

The mid morning highs are something to discuss with more detail:

1) the liver of most people will release Glucose after or before breakfast (dawn phenomen). This is a preparation for the coming activities and was mainly useful for times when there was no breakfast ready after we have stepped out of the stone cave (long ago ;-)

This is also true for me. I will cover this additional Glucose with my breakfast via the I:C ratio. Furthermore this means I will be punished for skipping the breakfast. So rigidity is the solution for me.

2) it seems that the gap in basal coverage is just around breakfast. This will add up to the dawn phenomen. So I would propose to inject the Levemir at 21:00. This shift will give you some more residual basal insulin at breakfast.

Thanks for the graph!

Darn cave people … why couldn’t they have had mammoth burger take-away or something?

I’m pretty sure about the time frame of the pre-breakfast lows, as I’ve tested in the night and/or worn a CGM … but this has only been a tendency for the past few weeks (I’ve had more typical D.P. in the past as well).

I’ll try increasing my breakfast bolus (right now, actually) and see how that goes, and I’ll try your suggestion of taking the evening dose at 21:00.

Hope all is well in Münster!

I’m about nine days into my switch from Lantus to Levemir, and find I am using more Levemir than I was Lantus.

Switching basals is never easy on control while trying to get tuned up, so I’m not surprised that my control has gone from an average BG of 118 to 145. Part of the reason is that I’m not treating excursions as aggressively so I can see what my basal is doing. I expect that to improve once the basal is adjusted.

But I am surprised by the ever increasing amount of Levemir I need to take. My basal dose has gone up more than 40% - Levemir compared to Lantus, and may need to go up more.

Has anyone else seen this?

It might help to model your basal insulin to give a complete 24 view of your pump basal rates - might be easier to match that with the Levemir profile. Also, you should consider your weight and units per Kg, since the graph I linked to showed a different peak and duration depending on units per Kg.

Yes, I found that units/Kg info very helpful. Thank you!

That’s interesting that you’re needing considerably more Levemir than Lantus. I seem to be using about the same. I think I’m also leaning toward going back to the pump fairly soon … but it’s been a really useful exercise to work with MDI again and to know that it’s available as a viable alternative when the pump is driving me nuts!

Twice per day (same as Lantus). I’m taking more in PM (currently about 60/40). My whole reason for trying this insulin is to see if I can deal with dawn phenomenon with unequal AM/PM doses of basal insulin so I don’t need to get a pump. Lantus was very flat for me in equal AM/PM doses - but apparently my dawn phenomenon has gotten more severe over the years and I had limited success with unequal Lantus doses so thought I’de give Levemir a try.

I’m amazed at how my basal keeps increasing - I’m up more than 80% now. Some of it may be the change in weather - I tend to require more basal in winter so go through an adjustment every spring and fall. But have never used nearly this much basal.