I am currently taking Levemir basal around dinner time. I seem to still be waking up with high FBG, sometimes over 200. Also, I always spike way high in the afternoons and postprandial. I have read here that most "24 hour" insulins are not, in fact, 24 hours. I am still trying to dial in my dose for the basal. I am currently up to 50 U, increasing by 2U every day.
I am seriously thinking about splitting my dose into 2 daily, 1/2 my total in the morn and the other 1/2 12 hours later. I know Levemir (detemir) can be split into twice daily injections. Just want to make sure this isn't a bad idea. I think that, because the rate isn't in reality a full 24 hour dose, (looking more like 20), that if I split the doses, I theoretically will have full day coverage. As one is in mid cycle, I take the other to extend the coverage as the first drops off. Ad nauseum. Is this sound thinking on my part?
There's no reason you can't split your dose. My Doc suggested such when he prescribed it but he left the choice to me.
It sounds to me like your in the same situation I was a few months ago. I started with Levemir and kept increasing but never did get a reasonable level of control. My Doc finally put me on MDI's (multiple daily injections) with Levemir for basal insulin and Novalog before meals. This has worked well for me, I have lowered my A1C from the low teens to an even six. I added in a good dose of exercise along the way to help things along.
So keep plugging away until you reach your goals, the worst thing we can do as diabetics is to be stagnant with our treatment.
I started on Lantus and had to split that dose, unfortunately my insurance preferred Levemir...I tried it for a month and me personally I did NOT like it, I just never could seem to get as good of control on it as I could Lantus. But yes it does seem like most people split their dose whether taking Lantus or Levemir.
I take Levemir in two doses & it's the best way to take it. I also took Lantus in split doses.
What works for me is one dose right before bed & another after breakfast, so not 12 hours apart. I use slightly more at night because of our friend dawn phenomenon.
The problem is that Levemir is active for 24 hours BUT its activity is not evenly distributed. It will start to degrade at typical dosages around 12 hours after the injection. This has been tested with healthy people in a steady state experiment. Healthy people get insulin and glucose is used to stabilize the blood glucose at a specific target. They will inject a dosage of Levemir and then they measure the blood glucose every 10 minutes. If the blood glucose starts to drop they will administer glucose to keep the blood glucose steady. The more glucose it needs to be stable the more active the insulin was. If this is done for 24 hours they will know how the insulin unfolds its reaction. It is a typical test that has been done for all insulins for safety reasons. The result is visible in the graph below. The line with the small dots is a small dosage. The line with the longer dots is a higher dosage. For comparison the solid line shows the nasty NPH insulin. It clearly shows that Levemir (here called with the older name IDetemir) does react more evenly than NPH. At the same time it shows that for good and even coverage you will need two shots every 12 hours. The reaction curves of two shots will nicely combine to a very even line. Only the two shots pattern can lead to comparable I:C ratios over the day. Otherwise you will have problems with uneven coverage, quite dramatic differences in I:C rations over the day and the effect of being more sensitive to carbs at specific times.
Once your dose gets to about 50 units, you need to split your injections anyway. Larger injection volumes absorb poorly. This results not only in longer absorption, but increasing amounts of insulin are wasted as they never make it into the blood stream properly. Even if you don't split morning and night, you should probably split the 50 units into two separate injections.
A little update. I have been doing split doses for a few days now. I am having more even CBGs overall, but am still having large spikes postprandial. AM fasting is staying 123 to 136 and mostly throughout the day I am staying in the low to mid 100's (FINALLY), but I keep spiking after eating. Trying to self-teach on carb counting and whatnot. I have my next doc appt on Tuesday. Probably need to bring up bolus injections since I'm just not staying in the Good Zone after eating. I think I also need to ask her for a CDE and maybe a dietitian.
