Need advice on Levemir (and anything else I mention here ;))

Type 1 and LADA
1

Hi all!

I have read, and read, and read some more and now I think I have TOO MUCH info in my head. Basically what I need at this point is to make sure that I'm thinking about all of this straight...

Background info: I've been fighting with burnout for a little while now. I have a pump and a CGM and quite frankly I'm sick of the beeping and buzzing and attachment, and just being bionic in general. Well sick of D in general but nothing I can do about that. I'd like to be free for little while, i.e. take a vacation from ALL THE THINGS!

Main problems: My basal rates go all over the place and I have a relatively high insulin sensitivity. Therefore I need to plan accordingly for the long acting and then be able to give 1/2 unit doses of fast acting. Also, I've forgotten whether or not I took my dose MANY times before the pump came along so I really need the Novopen Echo so that I can check and be sure that I'm not doubling my dose accidentally.

Secondary problems: Although I was on Lantus before the pump I'm a bit nervous about going back on it after all the research I've done. I see that Lantus is NOT supposed to peak, but be a relatively steady release. Before the pump I shot Lantus twice a day but ultimately had trouble staying on target and often ended up low overnight. Also, Lantus does not work with the Echo pen so I can't track whether or not I took the dose.

Levemir would be the other option for me and I can take the disposable pen apart and apparently it will fit into the Echo pen and work just fine. However, Levemir usually has a peak somewhere around 6-8 hours depending on the person and is meant to be taken twice a day anyway.

Levemir planning: So here's my basal rates-
12am - 7am: .4 units/hr
7am - 2pm: .5 units/hr
2pm - 5pm: .175 units/hr
5pm - 9pm: .4 units/hr
9pm - 12am: .25 units/hr

My thoughts are that if I take one dose around lunch, maybe 11am, that should cover my raised basal in the afternoon after the lull and then if I take a second dose around bedtime, say 9 or 10pm, it should cover me overnight, but I feel like that will leave a gap in the mornings.

Has anyone tried 3 doses of Levemir? Maybe a very small one in the morning in addition would get me through. I'm just afraid that the timeframe will set me up for a bad low in the afternoon where my basal drops to almost nothing.

I just don't want to try and relieve my burnout just to make things worse and push myself over the edge.

I have an Endo appt next week and although she's great and doesn't override my objections like some do, I almost feel like she defers to my judgement too much. I've only been to see this one once before (I moved to a new city last year), but I want to be as prepared as possible in case I have to make a judgement call regarding my prescriptions.

Any thoughts?

2

Hello woolds, during the day you will probably be able to compensate for your basal rate changes with the meal boluses and meal carbs. From your basal profile it seems you don't have pronounced dawn phenomenon, so your night shot of Levemir shoud keep you steady until you wake up.
Many people find two Levemir shots a day works without dramatic peaks, perhaps that goes for you too. It sounds like you need that vacation!

3

Is it that apparent? lol. I used to have a dawn phenomenon but for whatever reason it's not really a thing anymore. I think you're right and I should just try it and see how it goes. I'm already vacationing from my Dex so that will have to end for a little while as I get things situated but I can't know until I do it.

Thanks for the response :)

4

MDI just is never going to give you the same profile as a pump. And even if it did, that might not be what you want. I would just start out simple. Why not just take two injections 12 hours apart that are exactly 1/2 of your previous total basal dose. Maybe take your injections at 9am and 9pm. And then make small adjustments based on your observations. If you wake high or low make small adjustments to you evening dose (5-10%). If you are high or low before dinner make small adjustments to your morning dose. And that isn't even messing with the timing. It is just too hard to figure out the variables of dosing and timing for three injections.