[blackbird]

Hi everyone,

If you can help, please do, my docs office is closed today and this is driving me nuts. If I can figure this out, I'll be good but I am having issues.

ok, the story:

I WAS taking Levemir at night, (L19) had perfect morning blood sugars (I am canadian, so mine were 5-6). I take Humalog with meals. however, I run, and now work on my feet all day doing physical activity and was having issues balancing my humalog to get a good A1C. (afternoon and after dinner was the problem). For me Levemir seemed to dull down after about 18 hours.

So my doctor has now split my Levemir dose: half with breakfast (L9), half with dinner (L10). Its now easier to take. BUT. I ned a drastically larger amount of humalog (used to average H5 per meal, now about H12) for each meal (fine)-but having LBS's now, probably as a result of my morning blood sugars I cant get under 11. (not good). I am not dropping low at night either to cause this.

ok, now I am not mathmatically included, lol!
What should I increase to get a better morning sugar and less repercussions during the day???

ANy advice/help would be wonderful please. The local health nurse hotline wants me to wait to call the doc tommorrow, however, I would like advice from other 'users'.

[Subby]

Hey blackbird, welcome. I can't comment on Levemir specifically, having not taken it (hope to soon) but I was on Lantus and other long acting for many years.

If the Lev was really running short at say 18 hours (and perhaps even earlier) then your dose to keep you contant in the morning but then conking out sometime in the afternoon, if spread out over the 24 hours with a split, is likely to give inadequate 24 hour basal coverage. How much? At a complete guess on the hours that are missed and the hours leading up, it could be up to a third. So when splitting, it makes sense to me that you may need to increase overall dose, even quite substantially.

If you had good Bg in the morning with 19 units, (and you'd adjusted in the evening - it wasn't being used to come down from a high) then it makes sense your night dose is going to need to be something more like 19 units than 10. I'd be putting the balance back to the night. I'm going to talk numbers but they are entirely hypothetical: I'm not prescribing a dose.

Assuming your entire needs through the day are substantially more, something like 26 units, I would put the emphasis back on the night because you know that I higher dose then, maybe 15 units. Then 11 units for the split.

Again, I'm not suggesting you just try this on my word. If you were to do something like this, be sure to move up slowly and take a lot of tests.

If things get really hard, search on the forum and internet for "basal testing" it's a method to troubleshoot these issues logically.

Good luck.

[blackbird]

thanks! what you says makes sense. I was wondering which (am or pm) I should adjust, It makes sense to start with pm.

[xMenace]

Subby's right on, I think. You've basically removed 1/2 your lev dose from covering your "dawn phenomenon" which is our biggest need (google it and search for it on here).

Another option is to wake at 5am and shoot a few units of Humalog, but only if that fits your lifestyle.

[sarahspins]

Like others have suggested, I'd think it's wiser to leave the evening dose as it was before (19u), and start off with a very low dose (maybe 2-4u) in the morning and add to too that GRADUALLY (1u at a time) until your afternoon/evening #'s start behaving themselves better. There's really no need to change the night dose if your fastings were and are good, unless you start going too low overnight (because of the residual left from the added morning dose).

Make sense? I'm not surprised at all that your fastings are higher after cutting the evening dose in half.. clearly your history as you described it suggests a basal deficit (you need more insulin in the morning to help cover the rest of the day), not simply a distribution problem (which splitting your dose in half obviously didn't fix).

[mazea]

I agree with pp. It sounds like to me that your night Levemir once a day was keeping your morning blood sugars under control. Now your not taking as much at night your blood sugars are higher in the morning. Probably because of morning phenomenon.

I take Levemir twice a day, and I have found that an unequal dose suits me best. My blood sugars have less hypos at lunchtime and less high blood sugars at dinner on 1/2 unit of Levemir in the morning and 1 1/2 units of Levemir at night. So taking an unequal dose can sometimes be very successful. If I have one dose of Levemir my blood sugar starts rising to 11mmol at night because it doesn't last 24 hours.

Morning phenomenon is a bugger. I find that I spike about 9 mmol without eating in the morning. I have found one option to be having a larger dose of insulin at breakfast and then following it up with a morning tea 2 hours later( splitting the breakfast meal) to be successful.

[BUFORDHWY]

A real good read on Levemir (and Lantus).

"comparison of pharmacokinetics and dynamics of the long-acting insulin analogs glargine and detemir at steady state in type 1 diabetes mellitus: a double-blind, randomized, cross-over study" Luzio et. al.,

online at Diabetes Care

best

[jenb]

I agree with the suggestion that you may need to increase your evening dose. And that you should do some basal testing. (hey - what's wrong here - we all agree?????).

Jen