Levemir split , how it works- units' quantity wise

I just need to ask how levemir works if splitted , I am not asking duration wise as I do understand that we split it to make it covers the 24 hours but I am asking about the units number>>ie suppose that I need 30 units at 8 pm to get my morning BG in OK number>>>then I have problem later in the day, so I decided to split the unit either 15 each or 20 night and 10 morning> My question is why the 20 units injected at night time should cover my BG with the same effiency that 30 units (that I used to injecte before split) did.

That's not a question wth a simple formula because individual needs vary.

How are your readings during the day? If you need a specific dose to keep fasting BG good, then that's still the same dose you need overnight. No, taking less in the evening will not cover it. If your daytime BG isn't where it should be, then you require another dose during the day to handle that. It's a matter of experimentation to know what works.

As you add a second daytime dose, start conservatively. Keep the dose the same for 3-4 days before making changes to get a broader picture. Add or subtract units in small increments to arrive at what you require.

Large doses, like 30 units, tend to work better if injected into different sites because large doses don't act as predictably.

Ok, now if I am taking 30 units night time (2 shots at different spots) and that makes good fasting reading...Do I have to inject same 30 units in the morning (or less according to day readings) to get flat readings between meals or should I split the 30 that I take night time to two doses 15 in the night and 15 in the morning ?

How are your daytime readings? Do you also use rapid acting insulin for meals?

You don't necessarily need another 30 unit dose during the day. You may or you may not. As I mentioned, it will take experimentation, trial & error, to know what you need.

Again, you obviously need 30 units for good fasting. Splitting that into 15 & 15 won't give the same results.

Ok thanks, yes I do take novo rapid with meals and snacks and I am on kind of low to medium carb diet. Currently I am 30 jnits levemir night and 10 morning and i guess i will have to increase day dose a little and see...thanks a lot Gerri

no, don't inject 30 units MORE...break up or split the 30 units you're already using. I was taking 10 units, total, i split that up to 6am and 4 pm...I'm now taking about 14 - 15 levemir but I'm a type 1. I do more in am, less overnight. PLEASE DON'T ADD 30 MORE UNITS..PLEASE TALK TO YOUR ENDO OR HEALTHCARE PROVIDER!

Basal insulin is for the glucose that is coming from the liver. At first basal insulin is not active. This is done by adding additional atoms to the molecule itself. For levemir the added atoms will cause that the insulin will bind to the albumin of the blood first. This way it can not attach to the insulin receptor of the cells. Over time the binding to the additional atoms will dissolve. Then the insulin molecule will get active for the first time. It the cirulates and binds to several insulin receptors and later it will be destroyed in the kidneys. Now this whole approach does not make sense if all molecules would get active at once. So the likelyhood that the binding to the albumin will disappear should be spread evenly over 24 hours. Now most of us know that this is just a theoretical number. In practice the activity is more unevenly distributed. If you inject 30 units it is very likely that 60% of the activity is in the first 12 hours. The rest of 40% acts for the following 12 hours. If you inject one shot before going to bed this makes it likely that you will experience more lows at night. It makes it also likely that you will have less basal insulin than needed in the second half of the 24 hours.

The solution is to split the dosage. Splitting means dividing the one shot into two shots. In an ideal world you would split the dosage evenly. But the release of the liver follows a pattern and this makes it more complicated:

Phase 1: For most people the liver will decrease its release rate from 2 to 3am because your body needs less energy in this phase. This makes us very sensitive to insulin and many lows at night happen around this time. The proneness to lows is caused by the basal insulin that has no glucose release to work against.

Phase 2: Hormonal changes at dawn will cause that the liver starts to increase its release rate again. The result of this is an in increase in blood glucose called Dawn Phenomenon (DP). This DP is to prepare our body for the next day (we had millions of years without breakfast so this was the best strategy). To effectively handle the DP we need basal insulin to be present to handle that.

Obviously Phase 1 and Phase 2 are causing two conflicting trends in blood glucose. You need to find the dosage that will prevent going too low in phase 1. Still it should be able to handle the rise in phase 2. It is a very delicate balancing act. I personally inject 7 units of Lantus at 8am and 5 units at 10pm. One unit more for the night and I will go low, one unit less and I will go too high. For Levemir I had comparable dosages.

If you wake up with perfect 88 mg/dl you can not be sure that everything worked as planned. You might have overslept a low in phase 1. If you wake up with 180 mg/dl you might have had perfect numbers until 5:30am when the DP kicked in. It needs additional testing at night to verify that you have found the correct dosage.

In the full picture it is even more complicated: if enough basal insulin is present the liver will release less glucose in phase 2. This is because insulin has some capability to block the liver release (it act as a signaling hormone). The amount to release in phase 2 also depends on the blood glucose at dawn. With 80 mg/dl around dawn it will release more than with 110 mg/dl. Thus I prefer to eat some slowly digested carbs like Wasa bread for the night. This seems to increase my BG just enough so that the spike from phase 2 is moderate to non existant. You see the balancing act here: basal insulin dosage, food intake, muscles that will restore their glucose storage late at night, the exhaustion of your body from the previous day and so forth...

For you 18 units in the morning and 12 units at night might be perfect. You will have to find that out...

this is very good and useful info. like you, i too need more during the day - a few less units at night, i was adding more at night or taking an equal split dose and couldn't understand why I was waking up high like 180's+, after checking and getting a CGM I was having bad rebound highs in the middle of the night from a 2 - 4AM drop, even a small drop can produce a liver dump, one doesn't even have to be really low. if I add even one more unit, this will happen. If I take one unit away in my AM dose I will trend high towards evening. This is why I'm going on a pump...I still can't get my MDI basal right. It takes a lot of practice and nothing will be perfect. I also do my AM dose at around 8AM and my PM dose around 9 or 9:30pm, so a few hours more then 12 apart but like to overlap a bit in the morning to tie in with morning bolus. Also, lantus is stronger then levemir, people who use levemir use a bit more compared to what they'd be using on lantus.

Sarah, I tried and split the 30 to 15 and 15 or even 20 and 10 and still my numbers is bad waking up, only when I am 32 then my numbers starts to improve a lot , I added gradually 12 in the morning and so far I am doing OK through the day>>>.what I meant in this post that there is a lot diabetics think that split long acting insulin is splitting what they already take at night timeto two doses to be taken in teh morning and night and there are others think that splitting means take the same amount that they already take at night in teh morning ...ie if they take 30 at night , they will take another 30 morning and work it from there

I do thank you a lot Holger for your continuous useful information, but is it make any sense to split the 30 to two doses if I am already have around 100 waking up using the 30 units at 10 pm...I mean if I split the 30 units, do my wake up numbers will go high...anyway I will try and see.>>>again thanks a lot for your advice...one more thing that I heard that apple cider vinegar affect morning numbers , I did try that for 3 weeks now and I have about 20 point improvement in morning numbers but I can not exactly know if the ACV is the reason or no

I am a 40 year old female. I've been type 1 since 1984.

I take 4 units of Levemir at 9pm and 7 units of Levemir at 7 am. It works for me because that way it covers the night and it overlaps in the morning when my bg is rising. The larger amounts of insulin tend to take longer to start working and they tend to last longer than the smaller doses, and they tend to be more predictable. I think if you split the dose it is possible you may need less.

Ok I am currently 32 at 9 pm night (2 shots) and 12 morning at 8 >>>should I go ahead directly and split the 32 and see what will happen or that will be a lot of reduction at once

interesting that we're basically doing the same thing, less at night, more in am with a overlap in am dose. i think i'm going to drop another unit off my pm dose, something funky is happening overnight; i have the hardest time around 1AM - 4AM. i don't understand how i need 14 - 15 units of levemir, started out with only 2 units while honeymooning, when i'm 5'4" and weigh 106 lbs? maybe i'm taking too much? can't wait to start the pump..ugh!

if it's working then stick with it, i guess? are you a type 1 or 2?

Well i am type two with zero production of insulin and totally dependable on insulin....i think i am type 1 but drs say i am t 2

I think I understand now. You had been taking 32 units at night in a single dose and you split that into two injections at night. And you found that if you did two injections of 10 units each, it was the same effectiveness as a single injection of 30 units.

Bernstein argues that any injection over 7 units in size starts to be less potent and won't act as consistently. His argument is that injection size is proportional to volume (think a sphere of insulin), while absorption is proportional to surface area. Volume goes up as the cube of the radius, while area only goes up as the square, thus absorption drops with bigger doses.

He recommends that his patients split their injections into 7 unit or less doses. You don't have to be so strict, but you may notice a marked difference as you appear to have found.

Thanks Brian, Yes I read that part in Dr. Bernstein book but he said that he advise any one who takes much insulin to split it to smaller doses not to exceed 7 units each as per the law of insulin absorption...