Levemir/Lantus Question

[belyro]

Is there a minimum amount of Levemir (or Lantus) that a person should take? I'm working to get my bloodsugar's more stable during the day (i.e. not such a steep drop between meals) by reducing my Levemir. I'm definitely seeing a difference, but it still needs adjustment. Right now I take a split dose - 6 units at night and 3 in the morning. It wasn't working really well to take it all at night when I first tried it, but I don't have much room now to keep going down in the morning.....I can take it down to 2 or 1 units, and that's it.

Suggestions? Do I run the risk of taking too little basal, or as long as I'm still having these sharp drops between meals am I OK to keep reducing?

Thanks!

[seacomp]

Usually people are started at 10 U and work their way up. The normal basal requirement is about 1 unit per hour or 24 units per day. Certainly evryone can vary from that but 9 units seems really low.
If you are going down after meals, I'd suspect the meal bolus (you do take a bolus per meal?) to be too big.
Skip a meal, and watch your Bg for a few hours If still goes down your basal level is still too high, but if the Bg goes up, the basal is low.
There is no a priori reason, BTW, why you couldn't have a dose as small as you can get it; half unit. It just wouldn't do very much.

[belyro]

Usually people are started at 10 U and work their way up. The normal basal requirement is about 1 unit per hour or 24 units per day. Certainly evryone can vary from that but 9 units seems really low.
If you are going down after meals, I'd suspect the meal bolus (you do take a bolus per meal?) to be too big.
Skip a meal, and watch your Bg for a few hours If still goes down your basal level is still too high, but if the Bg goes up, the basal is low.
There is no a priori reason, BTW, why you couldn't have a dose as small as you can get it; half unit. It just wouldn't do very much.

My bloodsugars actually go way up after meals and then come crashing....so I've concluded (with the help of some suggestions on here) that it was my basal that was the problem. After reducing it by 2 units and seeing a drastic improvement in stability, I'm now convinced that was/is the right approach. If it was too low all morning or all afternoon, I would think it was the bolus, but I used to have to hit 15-17mmol/L (270-310mg/dL) after breakfast if I didn't want to be low by lunch. On my reduced Levemir now, I had a day last week where I was 8mmol/L (~150 mg/dL) two hours after breakfast, and 6 (~110mg/dL) by lunch. That's some progress! So I really do feel like I'm on the right track by reducing the basal. I just want to make sure I don't reduce it too much.

[seacomp]

If you are having success with your method, who can argue? Not I! I hope you get it settled soon.

[BlueSky]

What happens if you inject your morning basal but skip breakfast and the corresponding bolus? That will tell you how well your basal is doing it's job. :wink:

[belyro]

What happens if you inject your morning basal but skip breakfast and the corresponding bolus? That will tell you how well your basal is doing it's job. :wink:

Interesting idea. I've never thought of it. Not sure I could do it without passing out on the way to work (I'm a breakfast NEEDer). I'm going to think about it though......thanks for the suggestion.

[BlueSky]

It doesn't work with NPH. But a "peakless" basal dosage can be tested in this way. Be aware of the DP effect when skipping breakfast, though. It could cause you BG to go up during the morning and come down again before lunch. For me, this has been a shortcoming of Lantus. Being "peakless" is a mixed blessing. :wink:

[belyro]

It doesn't work with NPH. But a "peakless" basal dosage can be tested in this way. Be aware of the DP effect when skipping breakfast, though. It could cause you BG to go up during the morning and come down again before lunch. For me, this has been a shortcoming of Lantus. Being "peakless" is a mixed blessing. :wink:

Maybe skipping lunch would be better for me then? Wow....I really don't think I could do that, though. My stomach sounded like a jumbo jet by 11:30am today. :)

[BlueSky]

Yeah ... I also hate missing breakfast, especially because it is my biggest meal. But I did the fasting thing today. I needed to have a fasting blood test done anyway. So I injected my Lantus at 6:00 and didn't eat/bolus. I have tested 7 times since then. The results are :

6:00 4.9
7:45 5.8
8:24 5.8
9:07 6.2
10:13 6.3
11:13 6.2
12:28 5.9

It shows the dawn phenomenon rise until the late morning, after which the BG starts coming down again. I inject 5 units of NPH before bed to deal with this effect. And it seems to be working quite well. :smile:

[belyro]

Yeah ... I also hate missing breakfast, especially because it is my biggest meal. But I did the fasting thing today. I needed to have a fasting blood test done anyway. So I injected my Lantus at 6:00 and didn't eat/bolus. I have tested 7 times since then. The results are :

6:00 4.9
7:45 5.8
8:24 5.8
9:07 6.2
10:13 6.3
11:13 6.2
12:28 5.9

It shows the dawn phenomenon rise until the late morning, after which the BG starts coming down again. I inject 5 units of NPH before bed to deal with this effect. And it seems to be working quite well. :smile:


Wow...that's really interesting to see. I should try that. I really should. I'll just have to warn people at work that if I pass out it's b/c I didn't eat breakfast. :)

[rzrbks]

One of the things I do regularly is go 14-18 hours without eating anything. That way I can check to make sure that my basal is correct.

I inject at 11:30pm every night and then during the day I check B/G levels.

Target range is 85/4.7 to 110/6.1...........

If I don't stay in that range, I'd do the test a second day to double check.

[belyro]

One of the things I do regularly is go 14-18 hours without eating anything. That way I can check to make sure that my basal is correct.

I inject at 11:30pm every night and then during the day I check B/G levels.

Target range is 85/4.7 to 110/6.1...........

If I don't stay in that range, I'd do the test a second day to double check.

I really don't think I can go that long without eating.

Are you pumping?

[BlueSky]

My bloodsugars actually go way up after meals and then come crashing....so I've concluded (with the help of some suggestions on here) that it was my basal that was the problem. .....

It could also be that the action of the bolus shot is not being matched by the influx of glucose into the bloodstream from the meal. In other words, the glucose supply is peaking before the insulin action. If, for some reason, absorption of the insulin is delayed, you can expect to see your BG go way up shortly after the meal. And it will come crashing down again later, when the bolus insulin eventually gets going.

Testing your basal dose will reveal whether this happening. If it is, you can then experiment with different bolus timing and/or changing the GI of your meals. Obviously, the more carb you eat, the more demanding this matching process is. The more insulin you inject, the more variability you can expect in its action. But you should be able to keep the post-prandial peaks below 9.0, even with a carb-heavy meal. :wink:

[belyro]

It could also be that the action of the bolus shot is not being matched by the influx of glucose into the bloodstream from the meal. In other words, the glucose supply is peaking before the insulin action. If, for some reason, absorption of the insulin is delayed, you can expect to see your BG go way up shortly after the meal. And it will come crashing down again later, when the bolus insulin eventually gets going.

I've wondered this before too. It does, however, seem that even if I take my insulin well in advance of my meal, while it may keep my bloodsugars lower after the meal, I will also still crash.

Interesting thinking, though. Thanks again for your insights! :)