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New here. What is the maximum amount of Levemir and Novolog that you take?

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#1
Christine18

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I have been put on injectables for about a year but my A1C is getting worse. At first I was put on low amounts of Levemir and Novolog but nothing worked and am now at 40 units of Levimir in the morning and 50 units at night. I also am taking 25 units of Novolog at dinner and sometimes 10 to 15 at lunch. My A1c is still over 8 and I test at 170 to 200 in the morning. My GP say that I should jut slowly increase my meds. My endo says not to do this. I am in the process of getting a treadmill so I can do at least 30 minute a day. How high can I go with these meds. I am so confused and am so upset that I have been at this for a year and my A1c has increased and I believe I have gained about 7 pounds over the year from the insulin. Any thoughts would be greatly appreciated. Should I go on a pump and if I do so would that record the amount of insulin I need. My endo has me afraid to increase my insulin but I feel sick from my raised blood sugars. Thank you for any thoughts you may have. I am so grateful to join this forum

#2
Christine18

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Can't seem to edit above post of mine but wanted to say hello to everyone and I am so glad to have found this site:)

#3
Penny

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Hi Christine, this is a good place for you to get help. I take 140 units of Lantus, split morning and night, and anywhere from 10 to 30 units of Novolog per meal. I still have some days I cannot keep my numbers low enough. I did not start at those amounts though. I was told to keep increasing the units by 3 a day until I had a decent fasting number or 2 hour post meal number. I don't understand why your endo would tell you not to increase, unless he wants to see what you can do with diet and exercise first. The exercise should help. I hope you get things figured out soon. :)
[SIGPIC][/SIGPIC] Love doesn't make the world go around, but it makes the ride worthwhile.

#4
Christine18

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Thanks you so much for the response. I started out with very low amounts of both drugs and increased to where I am today but endo doesn't like approacing 50 units at night as he thinks I could go hypo in the early morning hours but I am never even close to normal. He has never given me an upper amount and just doesn't like taking alot of these meds. Has talked about putting me on other meds but my GP says there is no reason I can't go up in small doses at a time and says there is no top amount. It is all vey upsetting becasue most of the time I dont even see the Endo but his staff and they dont like my hitting 90 units of levimir. I can understand that I need to exercise more as I am insulin resistant but I still think I need to reduce my blood sugars now with medications as I feel very groggy and sick in the mornings when I wake up. This has been going on for over a year now now without any form of control.So maybe I will try to keep slowly increase at night. The Endo has me deathly afraid to do so. I feel like I have a crystal ball when I pick an amount. They have given me no formulas to use ( carbs for units of insilin) and I feel like I have been in the dark for over a year. Maybe I need a new Endo but he has a good reputation. Is Lantus the same as Levemir? I am going to try to slowly bump up. Thank you

#5
ShottleBop

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What is you eat, typically?
Functionally, a Type 2 (missed the label by th-a-a-a-a-t much)
Dx prediabetic 02/08 (FBG 127 and 123), A1c 6.5
So far, controlled without meds.

#6
Penny

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I am fairly sure insulin is not a medicine. It is something that is in everyone's body. We Diabetics, either do not have enough or do not use it well. I figured out a "sort of" formula for myself by doing a all night testing. Mostly by testing all night, every hour or at least every two hours. I kind of know when I go low and when I start going up again in the morning. This does not mean it works all the time, as soon as I think I have it figured out, I will have a night when it is entirely different. But, it gives you an idea what to expect and will help you with your worries about going low a night. Personally, I wake when I am going low...I feel real hot and shaky, you may not. I also do not have a formula for carbs to units of Novolog, some carbs cause me to go higher than others. I have mostly figured it out by testing after most of the foods that I eat. It is a lot of work, but can be done.
[SIGPIC][/SIGPIC] Love doesn't make the world go around, but it makes the ride worthwhile.

#7
Christine18

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There is a new test where they can insert a device into your stomach and it takes your insulin readings for three or four days. I think I will try this in the future.
Dont have a typical eating pattern except that I eat lighty for breakfast and light/moderate for lunch and dinner is heavest meal. I am out for dinner many nights but try to watch what I eat and/or give myself enough novolog. I don't eat alot during the day but do eat heavier at dinner. PC Dr says I am insulin resistent. I am increasing exercise and watching what I eat at dinner but have no idea how much insulin people take. Dr has never told me upper limits. I do worry though that you can put on weight from taking too much insulin. The Endo put me on such small doses originally that it has taken me a year to get to the doses I am at and my diabetes isnt controlled. I was doing better on oral meds. Waking up with a 170 to 205 every morning makes me feel awful.

#8
ErniB

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Hi there, I use anywhere between 8-12u Novorapid at breakky, lunch and dinner; and 60u of Levemir before bed (I split this into about 4 sites though as a large dose of 60u can ache for while).

My bsl's are pretty good, but depending on if I am hormonal, stressed out, sick or hot (weather), my doses can change greatly. Same if I was to eat something a bit different. For example, I can eat Eagle Boys pizza without a huge surge to my sugars (up to around 10mmols or 180), but I made a beautiful healthy homemade gourmet pizza the other day and my sugars shot right up to over 15 mmols (270)...

But, it's all trial and error really! You win some, you lose some.

A slow increase to your shots should eventually work your levels out. I've had D now for only 3 months, but it took about 2-3 weeks to finally get my sugars normal... And then we even lowered my amounts of Novorapid to keep me 'normal' (it took greater amounts, approx 16u or more at each meal, to get me down to the normal range as I started out with massively high readings of 30mmols [over 500], and spent some time in hospital). But it's all good now :)

Good luck!!

Erin - Brisbane, Australia
- that which does not destroy, strengthens - Fried Nietzsche
T1 - MDI of NovoRapid & Levemir - - - - Dx 14/10/10: 33mmols & DKA - - - - A1c 11/10: 9.7; 02/11: 5.8; 04/11: 5.5
Every day in every way, I am getting better and better...

#9
shyam

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I figured out a "sort of" formula for myself by doing a all night testing. Mostly by testing all night, every hour or at least every two hours.


Will the numbers be similar when the body is asleep ? I doubt it.
DX Type II Nov 2007 (219 fasting)
Diet/Exercise since Aug 2010
1stAug10 : BG 178 Fasting / A1C : 8.00, Oct'10 6.9 / Jan'11 6.4
Apr'11 6.0 / June'11 5.9 / Oct'11 5.8 / Jan'12 5.6 / Apr'12 5.3
Now between 70-125 all the time
;)

#10
Subby

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I have been put on injectables for about a year but my A1C is getting worse. At first I was put on low amounts of Levemir and Novolog but nothing worked and am now at 40 units of Levimir in the morning and 50 units at night. I also am taking 25 units of Novolog at dinner and sometimes 10 to 15 at lunch. My A1c is still over 8 and I test at 170 to 200 in the morning. My GP say that I should jut slowly increase my meds. My endo says not to do this. I am in the process of getting a treadmill so I can do at least 30 minute a day. How high can I go with these meds. I am so confused and am so upset that I have been at this for a year and my A1c has increased and I believe I have gained about 7 pounds over the year from the insulin. Any thoughts would be greatly appreciated. Should I go on a pump and if I do so would that record the amount of insulin I need. My endo has me afraid to increase my insulin but I feel sick from my raised blood sugars. Thank you for any thoughts you may have. I am so grateful to join this forum


You are T2? How long for? Filling us in on diet would also help.

As for the pump it is not automatic as far as responding to requirements. That technology is probably at least 5 years away if not 10. It will record what you tell it to put in, just as you can write down on a piece of paper what you inject.
20 years T1. NPH and Novorapid.
Some essentials for my blood sugar control: dosing via i:c ratio and cf • basal testing when needed • daily 40 minutes moderate exercise (or close) • carbs somewhere below 120g currently • only eating carbs and carb/fat combos that do not cause a problem spike, with or without insulin.

#11
jenb

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I don't want to seem cavalier about this, but with insulin, you need what you need. What is a typical bedtime BG reading for you? If you're starting at 170 and waking up in the morning at 170, your Levemir dose may be perfect. You may just need some additional basal during the day to move the baseline down to a more "normal" range. If you're starting at 100 before bed and waking up at 170, your night time Levemir dose may be inadequate.

Get one or both of these books: Think Like a Pancreas by Gary Scheiner or Using Insulin by John Walsh. Follow the instructions for basal testing and get your Levemir straightened out first. Then follow the calculations for appropriate bolus doses.

Limiting (or eliminating) your starchy carb intake in favor of other non-starchy veggies may help. Forego pasta and rice and replace them with things like spaghetti squash and cauliflower "rice". Lighten up on grains, breads and starchy snacks. This will help minimize your bolus needs and may also alleviate some of your insulin resistance. I know when my BG is running high it really does take more insulin to regulate it.

Good luck with this. I know how frustrating it can be!

Jen

#12
Penny

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Will the numbers be similar when the body is asleep ? I doubt it.


It works for me...not exact, but close enough that I can figure what I am doing at night. I doze, sleep a couple hours some of the time. It helps me decide how much insulin I need at night. :)
[SIGPIC][/SIGPIC] Love doesn't make the world go around, but it makes the ride worthwhile.

#13
oldwest

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Christine
I am a newbie here and far from experienced in all this, but have made a couple changes recently that have helped me a lot. One is I've gone on a low carb, high fat/protein food regimen. This helped a lot, but I still struggled with my readings. I am taking 4 metformin at night, 5 mg glipizide er twice a day, and 69 units of levemir. My typical bedtime readings would vary from 140 to 200+ and morning readings 120 to 150+. Sometime they would be a little lower but mostly in that range. After going on the low carb diet my evening readings are below 140 and my morning readings were much better, but I still struggled to get them below 120. My dr wanted them below 100.

I heard & read about caffeine affecting insulin resistance, so I stopped my coffee and caffeinated sodas last week and my numbers have dropped dramatically. My morning readings are 100 or below and this morning it was in the 80's. If you consume very much caffeine you might try cutting it out. I got the withdrawal headaches for a couple days but after that no problems. I know this might not help everyone, but it sure helped my numbers.

#14
aggie168

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Hi Christine18, there is no upper limit. You do have some work ahead of you to adjust your dosage of Levemir as well as you need to start learning how to count carbs to give yourself the right dosage of Novolog during meals. It is a many month long process. When I switch to a pump from oral medications, it takes me many months to get most of the setting right and my A1C goes from 8 to under 6 now.

A quick summary:
1. It should be safe for you to slowly increase your dosage of Levemir by 2u every few days until you see your average BG and morning BG at a normal level. That would be 80 to 120 for most people. Some people also split it into a morning and evening shot.
2. After learning how to count carbs, and determine a baseline insulin to carb ration for your body, you then inject the right amount of Novolog together with each meal to counter the effect of glucose surge from the meal.
3. Finally, consult your doctor often as your medical team should work with you on the #1 and #2 above.

Hang in there. :)

===============================================
DX 02/2002, Minimed 530G(751) w/CGMS on Novolog
Aspirin 81mg + Lipitor 10mg + Losartan 50mg
10/2013 A1c=5.9 Chol=126 Trig=69 HDL=52 LDL=60
05/2013 A1c=5.7 Chol=137 Trig=79 HDL=47 LDL=74

#15
Christine18

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Thanks everyone for the replies. Endo finally says I can work on the novolog and give myself larger quanties and more frequently so I am going to start with that. I also will take the suggestions you have made for reading because I have no idea how much to inject, just know it has to be more than he suggested before and to inject more if I have more carbs than usual. I have cut down on carbs but can not or will not give up eating them. I am very good about limited amounts at breakfast and lunch. Dinner is another matter. I am Italian so giving up pasta just isn't going to happen. I do eat much smaller amounts and try to pick meals that don't involve breading( which is hard enough to do... no chicken parm, veal parm, eggplant parm). I have switched to eating whole grain pasta and brown rice more frequently,however we do dine out alot and we like Chinese, Mexican, Italian, Middle Eastern foods all of which can be a challenge to eat. I think I will try to increase exercise and am happy I finally got go ahead to increase novolog. I have just been so frustrated that I didn't have go ahead to take the insuin I needed and my reading have been terrible since I started injecting a year ago!!!. I have also eliminated most sweets with an occasional slip up. For now endo doesnt want me to increase my Levemir so I am staying at 90 units that I split with a morning and evening shot. He confirms that increasing insulin can put on weight.Hope my increased exercise will help with my obvious insulin resistance. I only drink 2 cups of decaf coffee a day. I also have quite a few roasted chicken/or fish meals with alot of veggies. Just have to have Italian at least 2 times a week. I am hoping increasing my novolog is going to be the answer for me. Endo has had me so frightened that I would go under at night if I increased my insulin but now thinks this wont be a problem. Thanks again for all your help. My internist was right all along. Should have listened to him instead of endo!

#16
aiah23

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Thanks everyone for the replies. Endo finally says I can work on the novolog and give myself larger quanties and more frequently so I am going to start with that. I also will take the suggestions you have made for reading because I have no idea how much to inject, just know it has to be more than he suggested before and to inject more if I have more carbs than usual. I have cut down on carbs but can not or will not give up eating them. I am very good about limited amounts at breakfast and lunch. Dinner is another matter. I am Italian so giving up pasta just isn't going to happen. I do eat much smaller amounts and try to pick meals that don't involve breading( which is hard enough to do... no chicken parm, veal parm, eggplant parm). I have switched to eating whole grain pasta and brown rice more frequently,however we do dine out alot and we like Chinese, Mexican, Italian, Middle Eastern foods all of which can be a challenge to eat. I think I will try to increase exercise and am happy I finally got go ahead to increase novolog. I have just been so frustrated that I didn't have go ahead to take the insuin I needed and my reading have been terrible since I started injecting a year ago!!!. I have also eliminated most sweets with an occasional slip up. For now endo doesnt want me to increase my Levemir so I am staying at 90 units that I split with a morning and evening shot. He confirms that increasing insulin can put on weight.Hope my increased exercise will help with my obvious insulin resistance. I only drink 2 cups of decaf coffee a day. I also have quite a few roasted chicken/or fish meals with alot of veggies. Just have to have Italian at least 2 times a week. I am hoping increasing my novolog is going to be the answer for me. Endo has had me so frightened that I would go under at night if I increased my insulin but now thinks this wont be a problem. Thanks again for all your help. My internist was right all along. Should have listened to him instead of endo!


Your endo definitely doesn't seem right for you. Definitely get the books Jen recommended to you, they will help A TON when it comes to dosing and adjusting your doses, it also teaches you how to basal test. The foods you like to eat out will cause a delayed spike so you're going to have to split your novolog doses out over a few hours to better match your needs, sounds like you need to test more frequently to figure out what will work for you. another option you may want to look into concerning the insulin resistance issue, is taking metformin on top of your insulin. This may work well for you and you may want to bring it up to your internist as it could help reduce your insulin doses.

Fawn
Novolog and Levemir, MDI
Sleep deprived first time mommy working full time! :eek:
A1C: 6.7 as of 04/28/12

#17
Christine18

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Thanks Fawn,

I agree that endo doesnt seem right for me. I have had him for awhile. He seems bored with clinical practice and me but he has very good credentials. I do take 2 metformins before bed each night. I didnt know about delayed spikes or split novolog so I will have to read about that. Never taught about basal testing..so annoying and I am well educated so I can't understand why they haven't taught me this. I started testing 6 to 8 times a day recently to get some handle on my reactions and increased insulin needs. Plan on spending more time with my internist.

#18
Tomas090

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I'm not sure how exactly to put this without sounding like I hope someone has more problems, but: I am "happy" to see it is not just me who has problems adjusting to insulin!

I was controlled via Glyburide and Byetta for 8 years, rarely went over 130 and if I did Byetta brought it down quick, too quick sometimes

I move to Florida and Medicaid does not cover Byetta so hello insulin

I started with 64u of Lantis at 9pm each night for 2 weeks and established my baseline at 200-230, no good. Added Nova Log 10u before each meal and got things "leveled" out to a usual reading of 140-150 so naturally I believe I should increase Lantis by 10-20 units and Novalog to 15 or so depending on meals

My biggest issue: Amerigroup, Florida Medicaid will only cover so much of any insulin per month so if I increase the Nova log I run out, lilkewise the Lanris!

My diet, today is typical

8 am 2 oz fish and tomatoes
11am Celery/carrots

1pm 4 oz fish and tomatoes

8pm 4 oz fish and tomatoes WITH lettuce, whoa boy!

I am 6'5" and weigh 320 and if anyone thinks I can stay on this diet to keep my BG in range is nuts, am running on empty

I will sort it out, just reassured to see that tuning Insulin is an issue most face, and I believe I could fine tune/adjust it very well, IF I had the amounts needed :-(

#19
aggie168

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I started with 64u of Lantis at 9pm each night for 2 weeks and established my baseline at 200-230, no good. Added Nova Log 10u before each meal and got things "leveled" out to a usual reading of 140-150 so naturally I believe I should increase Lantis by 10-20 units and Novalog to 15 or so depending on meals. My biggest issue: Amerigroup, Florida Medicaid will only cover so much of any insulin per month so if I increase the Nova log I run out, lilkewise the Lanris!


Hello Tomas, use fast acting Novolog to cover basel is a very "dangerous" game. You can get yourself into hypo situation very easily. My suggestion is to work with your health care team and increase your basel (Lantus) until you get your fasting BG down to the 80-120 range instead of 200-230. If cost become an issue, you can contact the manufacturer. Many of the have assistance program. :)

===============================================
DX 02/2002, Minimed 530G(751) w/CGMS on Novolog
Aspirin 81mg + Lipitor 10mg + Losartan 50mg
10/2013 A1c=5.9 Chol=126 Trig=69 HDL=52 LDL=60
05/2013 A1c=5.7 Chol=137 Trig=79 HDL=47 LDL=74

#20
jenb

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Hi Tomas. I wonder if you could add some Metformin to your therapy. It might help with what looks like a lot of insulin resistance, and might help you reduce the amount of insulin you're using.

As for that limited menu - yikes! I'd be going nuts too. Can you change it up from time to time? How about some eggs for breakfast with a small bowl of berries, or a whey protein shake with almond milk. Turkey breast with some mayo in lettuce wraps, or maybe a grilled hamburger with cheese and salsa for lunch. A pork chop and salad for dinner. Is cooking just not appealing to you?

Jen




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