Hello,
I am a T2 that uses 40u. of Levemir daily along with 1000mg/2x metformin and a <50g of daily carb diet to keep my BG daily average at or around 100. I was reading Dr. Richard Bernstein’s book ‘Diabetes Solutions, chapter 7, The Law of Insulin Dose Absorption’ and in that section he discusses the fact that insulin absorption varies by up to 39% depending on the injection site. He also stated that a portion of the injected insulin is destroyed by the body’s immune system before it even gets a chance to work. To counteract these variables, he recommends that for large doses of injected insulin, that they be administered in smaller doses in multiple sites. Has anyone had experience with this type of injection plan? It sounds viable to me, but I can’t locate any other research at this time to collaborate it. I’d appreciate any feedback on this.
Thank you,
Mike
I’m not sure if this is what you are talking about but I’ve been splitting both fast-acting and long-acting Insulins when needed for many years. It’s just in the earlier part of my day though since that is when I need more. My largest dose is 12 units at once so I split it into 2 shots. I believe the tip was: 7 units or less works Best for an injection. Although I will inject 8 units in one shot, if I need the extra unit of Lantus. No more. The 7 unit rule may have come from Bernstein(don’t quote me on that 
).
I give/get shots in lots of areas. I had http://care.diabetesjournals.org/content/29/4/926.full once. I had been using Humalog for about 6 years. I don’t wish to do that again. Rotate! Rotate! Rotate! Always.
Is Dr. Richard Bernstein an endocrinologist? I am extremely leery of books that recommends how to take insulin. That job should be left to you and your endocrinologist or specialist. Insulin works in different ways on different people, and under different circumstances. Sometimes it even depends whether your a woman or not. There are only so many places you can give a shot (on rotation). If your gonna go on that kind of regimen, then why not consider a pump? Btw, <50 carbs a day w 1000/2x Metformin in addition to levemir sounds like a lot to me, with too little food. Overall, is this working for you? Just concerned.
I take HUGE amounts of insulin so I have no real choice but to split them up into multiples. I try to keep them in sets of 20, so 20 here-20 over there, 20 there, etc. etc. To be honest, I haven’t really seen much in the way of feedback by my BS numbers. The only real benefit I see is I’m not shoving 100 units of insulin in one spot and having the bruising and lumping I was before, however, the pain from multiple injections is a negative. I have no idea how that would work with Levemir though. It couldn’t hurt to call your Dr’s office and leave a message asking. Any good doctor would have a nurse call back and give you a yeah, nay or make an appointment message. It can’t hurt to dial the number.
Are you very slender? If no, maybe you can discuss with your doctor about using a larger gauge needle. Needles that are too thin will make it difficult to push through larger dosages. I use 5MM 31G pen needles, and If I give myself any more than 15 units at a time, the button becomes difficult to push down. So using let’s say 29G maybe a little better for you. However, if you’re very thin you may get some bruising…