I mentioned that I switched to Levemir recently. I finally settled on the correct dose - 7 in AM and 7 in PM; it took longer than I thought to figure the dose, probably because I didn't sit with changes long enough. I keep learning over and over that for some reason dose changes don't really show effects right away.
Anyway my numbers are good, fasting, and between and before meals so I'm pretty sure the dose is right. But I have had consistently too high numbers at bedtime, such as in 140s and up to 172. The lowest was 120. I was thinking maybe my morning 7 units wasn't lasting to bedtime and the night hadn't yet kicked in. (I generally take the night dose around 8, 12 hours after the morning, and I take my bedtime blood sugar around 11 when I go into the bedroom to read.). So last night I took the Levemir a bit early (7:30) and was 132 this morning! (I'm normally 72-110). When I took one more unit in the morning I was having lows around dinner time.
Any suggestions? Is it possible one dose a day of 14 would work better for me? I was taking Lantus 2x a day so I just automatically switched to 2x for Levemir.
Levemir does work well with one dose because it doesn’t stay active long enough & is most effective taken in two doses. Believe this was mentioned in your other discussion about Levemir.
Taking a single double dose will result in lows, as you experienced by taking just one additional unit today.
It takes about 2 hours for Levemir to kick in. Levemir doesn’t have to be taken 12 hours apart. I take one dose right before bed & another soon after waking. Not suggesting this will work for you.
If your morning numbers are consistently high (you can’t tell just from one or two fastings), then raise your evening Levemir dose by 1 unit, keep it there for three days or longer & adjust further if needed. You may need more Levemir at night than during the day.
I’m questioning if your bolus dose is correct, or if bolus timing needs tweaking. How are your 2-hour pp readings? Rapid acting tends to last around 4 hours. With many highs after dinner when bolus is gone, it sounds like some of your evening meal is hitting after the insulin. You know how protein & fat slow down digestion. I’ve got gastroparesis so a different situation, but I take dinner bolus in split doses to try to time with delayed digestive problems.
Thanks, Gerri. Yes, I thought the two doses was what is used with Levemir.
The highs I’ve been having are at bedtime; mornings are fine. I had tried varied doses and kept them each for 3 days and when I went up to 8 in the morning I had lows around dinner. So the 7 and 7 were feeling right on except for those highs at bedtime.
Your thoughts about my dinner bolus might be where I should look. My 2 hour pp’s are usually fine. But the highs come later, so I was thinking basal. But all my other “basal points” like fasting and before and in between meals are good so it being the bolus makes more sense. Sounds like I should play with a bit longer time before eating dinner and possibly splitting the dose. Thanks! I didn’t even think of bolus!
I think there is a typo in Gerri’s first comment. I think she meant Levemir does NOT work well with one dose.
I am telling you what works for me, but it may or may not work for you, because we are all so different.
Lantus is supposed to last about 28 hours, if I remember correctly. Levemir is supposed to work about 16, depending on your dosage. I take Levemir at 7 am and 9 pm which works really well for me. (I get up between 630 and 7). This timing works better for me because there is more of an overlap in the morning when I need more basal, and the basal I am short after dinner is covered by my dinner bolus. I know I am short, because if I skip dinner, my bg rises. I have an easier time fine tuning my Humalog than my Levemir, because I have half units markings on my syringes. My Levemir is a pen, so I can only get it in whole unit increments.
I take 7 in the morning and 4 at night, except (only mentioning because you are female) those 3 days a month when I need more insulin. On those days I have to jump up to 10 and 6. If I take my allergy pills I have different numbers. I have always taken less at night than during the day.
My problem with taking one unit extra, as Gerri suggests, is that if I take one extra unit of Levemir at night, then I end up either drinking a cup of juice or eating like 5 or 6 glucose tabs at 3 or 4 am. Just make sure you are prepared with something on the night stand, just in case. I use my dinner and dinner bolus to get my numbers around 80 or 90 before I go to bed.
yeah. when i was originally DX’d they were prescribing levimir like lantus. as a matter of fact, they straight up called it lantus, and i had to go back and tell my doctors several times the difference between the two. im still technically prescribed lantus, even though it is actually levemir pens, and i STILL have to remind my doctors that i am not on lantus.
Thanks, Baby Tee. It seems like a need a bit extra at bedtime, and I thought maybe I’d take my nighttime basal a bit early, but I had a high fasting the next morning (which is unusual for me). But I know the mantra: “One time number does not a pattern make”. I think I’ll put that back on my list along with Gerri’s dinner bolus variation.
Now that I look back at my book, the highs at bedtime are often what got me on that cycle of changing my basal every couple weeks (and then usually changing it back) so I think I need to find other alternatives to fixing the problem in that timeslot! (Hmmmm…am I working myself up to a justification for a pump?) LOL.
I use Levemir pens also, and whole units are fine at night, but not in the morning. Apparently I make a little insulin during the day, so I need just 1 1/2 units in the morning. I take that morning dose using a syringe; just means I have to be sure to prime the pen at night.
I could see where 1/2 units would come in handy. For me, not so much for my basal, as my bolus. At bedtime my I:C ratio is 1:20, so if I eat, say a dinner of 45 carbs, I generally overbolus. You guys have given me a lot of food for thought. Thanks!
I’m one of those who need to take Levemir 3 times a day. Twice daily wasn’t too bad, but I was getting gaps in coverage at certain times of day (sugars would usually creep up around mid to late evening).
I was previously taking 12 units AM and 10 units PM. I currently take 7 units first thing, 5.5 units mid afternoon and 6 units before bed. Control is much improved and total daily dose is down from 22 to 18.5. Happy days.
That was a thought for me as well, and it sounds like we have gaps in coverage around the same time of day. I’m going to see if I can try other approaches (such as working on the dinner bolus or changing the time of my basal) first, but that is on my list of options as well. Thanks for the input.
I also did 3 times a day when I was on Levemir. It only lasted 7 hours for me and I filled in the gaps with fast acting. I did basal testing so I know for sure how long it lasted. If I upped my dose, I could make it last longer but then I was having lows so it was easier to do the 3 times a day.
I also have an evening gap. I take 5 units of Levemir at night; 1 1/2 in the morning; and to fill in the afternoon-evening gap I can either take another 1 1/2 Levemir or take half my dinner in Apidra and half in Regular. I prefer the latter since it really helps out with my slow digestion.
Sounds like I am not alone in the evening gap thing. Since a few of you went to 3 doses, I’m assuming you tried moving the dose up a bit earlier to get them to overlap? I usually take my morning around 8AM and evening around 8PM. I’m wondering if I moved my evening up to say 6 if that would help with the gap? If you’ve tried it and it didn’t work, then I don’t want to reinvent the wheel.
Dinner can be problematic because our bodies are slowing down. I don’t think the slow action of basal works well to cover this kind of evening spike. It doesn’t appear to be a gap in coverage as much as it is slower digestion at night.
