New to levemir, need some advice!

hi everyone! just switched from lantus to levemir, felt like i really needed a change because sometimes even a little change can make me feel like i am capable of many life changes. i was taking 21 units of lantus each night before bed and my doctor told me to do the same exact dose with levemir. so the first night i took 20 units and woke up very low at 5 am with a reading of 50. from doing some research on here i noticed a common strategy of splitting doses. should i consider doing this? maybe 10 at bed time and 10 in the am? i really really really want to avoid afternoon highs. any advice?

I would do 8 at night and the rest in the morning.

I personally found that I was allergic and super sensitive to any of the human insulins and have changed to pork insulin.

Since you are new to levemir it might take you time to work out a pattern, but generally you should need less of this at night - however high you are because your blood sugar levels naturally drop during the night already, however high you are before bed. You might do well to set your alarm for 3 am (when it is at its lowest) and check your sugars - say for a week and see what it is doing at 8 units a night.

Levemir is meant to be taken as a split dose for t1s, taking it as a single daily dose will crash you BG as it did in your case and then run out before the end of the day. Levemir is not a flat profile, it is usually best suited for doses every 12 hours. Some T2s who only need a small basal boost can get away with one shot per day, but that is a horrible idea for a T1 or fully insulin dependent T2. I am really surprised that your doctor would recommend something like that, as it shows a complete lack of understanding about the insulin he is prescribing and is very dangerous to your health, any doctor should know better, I would be looking for a more knowledgeable doctor.

Hey Andrea,
I started levemir I think about 6 weeks ago, I was also told to start with 1 dose. But also continue to have episodes of lows around 5AM- I take my bedtime shot about 11: 00 PM to 11:30 - But 4 weeks ago decided to split the dose as I’ve read a few posts about it and was finding that my after dinner numbers were higher than I liked. Chad’s advice is interesting he suggests a 12 hr split, I just might try that myself. Ive been doing my daytime shot about 2 PM and have been getting pretty good coverage. Currently I’m taking 6U at bedtime and 16 U afternoon. I also had a 50 the other morning, I just keep tweeking the insulin doses hoping I’ll hit the target. But perhaps I should also be looking at changing the split timing. I will be definatly interested in how things go for you over the next few weeks. Please keep me filled in on your doses.

Chad, do you feel the 12 hr split is the best with Levemir? It makes sence, I tried it for a few days when I first starting spliting the doses, but found that coverage after supper was not great. So that is when I bumped my dose to later afternoon.
Im really still not sure about any of this. Second guess myself all the time. But maybe I didn’t give it enough of a chance.

Good heavens! I can’t believe your doctor forgot to tell you that Levimir is always taken in a split dose! That’s because unlike Lantus, Levimir doesn’t last 24 hours. More like 16. Normally half before bed and half in the morning, but the timings can be refined to sort out any highs/lows you might have.

I have the opposite problem to you in that I go high overnight on Levimir. I am trying to fix that by taking a bigger dose before bed and a smaller one in the morning. I tried that for the first time last night and it seemed to work. Although still not giving me the perfect morning numbers I had on Lantus.

Another point is that the dosage might not be the same. I was on 18 units of Lantus and getting perfect 80-95 morning fastings. 9x2 units of Levimir saw me waking up at 120-130 and even 150 one horrific morning.

How are your afternoon highs on Levimir?

Definitely split dose the Levemir - it just doesn’t last long enough to do a single dose. I went from split dose Lantus to split dose Levemir about a half year ago. It took a while, but I am now getting much better basal coverage with Levemir than I did with Lantus.

I tried uneven dose, morning and night, but was surprised to see that equal dose worked better for me. I tried lots of tests to come to this conclusion - I think this is key to getting basal to work. Try to minimize daily variation by making food and exercise from one day to the next pretty similar - that seems the best way to see how well the basal is working. Fasting or no carb meals and increased testing is also key to improving basal match.

I found that taking my AM shot when I woke but delaying my PM shot until 10pm gave me the best overnight coverage, and eliminated what I had thought was a dawn phenomenon. So once you get the AM/PM split figured out, do some experimenting with different timing to fine tune your results.

It takes a while, but you’ll get there if you keep at it.

Likely 12 hours, but I think that some people have had success with other time variations. I also tried Levemir but couldn’t get it to work very well, so I gave up and went back to Lantus. The point I was making is that it is not a once a day shot for a T1. The issue with Levemir is that at small doses it does not act nearly as ideally as it is advertised and a lot of people find it has a nasty peak to it.