I currently take Levemir ar bedtime for my basal insulin injection. I know it is supposed to last 24 hours nut I am finding my BS is consistently running high before dinner and I have to correct with a bolus even though I bolused for my lunchtime meal? Do I need to look at increasing my units ( I currently take 20) or should I coonseider taking it in the morning instead of the evening? I know it is recommended for evening but I was wondering if anyone takes it in the mornings and does that work better? Type 1 for 41 years. I do not use or want a pump.
Hi @drkatt Kathleen, many people find that 24 hour insulin doesn’t work for 24 hours. I never took Levemir, but it has the same profile as Lantus.
Ask your doctor if maybe splitting your shot into 2 “half” shots every 12 hours might be a better option. The problem with just taking more is you may have too much basal insulin overnight and probably all the way up to lunch. Too much basal and you’ll drop between meals.
I can’t say what would work best for you. I’ve always gotten the ok from my endo before changing doses. I’m on a pump now, but for years I used Levemir. I took one injection in the a.m and another at bedtime. I needed more at night, but I think it’s a onCE a day insulin. My endo thought it would help to divide it up though.
I’ve been using a pump for my last 19 years with T1D, so no experience with your Med, but I think that doesn’t matter a lot, since the basic process is not specific to the dosing method. I would recommend you test your basal insulin during the midday to evening time period. That will give you the answer to, “do I need to change my dose.” If the basal insulin is doing its job OK, then you would need to re-evaluate your carb counting, carb ratio and ISF, and modify your lunchtime bonus dose if needed. I don’t know about you, but it seems things change in my body, my situation, etc., and I need to retest and reevaluate every year or two. Good luck!
Hi Kathleen @drkatt, I can understand frustrations with long-acting / background insulin; I have used a variety of them, probably like you, for 47 years before switching to a pump. I’m on my 4th pump now and really love it - but won’t try to push you onto one.
Although Levemir “active 24 hour life” is not supposed to have peeks & valleys, it may work differently in you. I remember needing to play around with my Lantus dose while MDI was my chosen method and actually found that by reducing my background insulin and readjusting my meal bolus ratios smoothed out my BG swings.
Good luck with your attempts. I hope that after 41 years that you feel very comfortable making corrective adjustments with insulin dosing; of course any major change should be discussed with your doctor.
Thank you for your input. I split my dosage and it seems to be working better
I can tell you without a doubt that Levemir is NOT a true 24 hour insulin. It has a small peak around 8-10 hours, and starts wearing off around 18-20 hours. We use this insulin at my hospital, and I am constantly trying to get the doctors to order it as twice a day (split dosing), and they never do, which results in at least one very high reading that requires correction with a rapid insulin (we use Novolog pens). Our medication instructions for Levemir even suggest split dosing for Type 1’s!!
I’m glad you’re seeing better control with the split dosing.
Thanks for the info! Do you happen to know if Lantus lasts any longer? I have the option to switch if I want.
Yes, Lantus, and the generic glargine, tend to last an average of 26 hours. That’s why it’s more commonly used in treating T1D versus T2D. It’s effective time is 22-28 hours, and I’ve not heard of anyone having the kinds of problems you described above.
This doesn’t mean that you need to change your insulin, if the Levemir is working for you.
Hi @drkatt Kathleen, many people have to split Lantus into 2 half-shots as well. It will take a month or so before a pattern emerges. If you like MDI you could always try it and see if it’s better, same, or worse. That’s what matters. Good luck.
Hi All, I’ve had Type 1 for almost 40 years and had been taking Levemir twice daily (split dose before breakfast & dinner, plus Humalog 3x daily before meals). Pre breakfast & dinner I always combined the Levemir with Humalog in same syringe (off label use to reduce injections). It worked pretty well so long as I allowed extra time for the Humalog to kick in, taking combo injection 15-30 minutes before meals. The split Levemir improved sugar levels, but I still had dawn phenomenon.
One week ago I switched from Levemir to Tresiba. Tresiba is once daily. Currently taking Pre breakfast; Tresiba + Humalog approx 15-30 mins before breakfast. Humalog alone 5-10 minutes pre-lunch. Humalog alone 5-10 minutes pre-dinner. All done with endo okay. The Tresiba has made a world of difference, am running much more steady/in-range day and night.
Btw my endo helped me to get a formulary exception for Tresiba coverage from pbm OptumRX. It was worth the effort !!
Note Lantus CANNOT be combined with bolus insulin in same syringe, never. Something to do with acidity levels in insulin formulas.
Hi @Jophilly I hope you are well. The reason you shouldn’t mix modern long acting insulin is because you will interfere with the way the long acting formulation works and it will become “less” long acting. Lantus is the most affected by mixing and if you mix it, the lantus will all absorb, all at once. Levemir and Tresiba will absolutely be affected by mixing. The effect is to disrupt the absorption to an extent, whether or not it is working is a personal observation.
Not that it’s wrong. It’s awesome that it works for you but if someone really needed that long acting and they decided to mix to save a shot they could get into serious trouble. This is one reason we always say that what works for me may not be a good idea for anyone else.
Cheers and continued good health.
Thanks, you are absolutely correct that what works for one person won’t necessarily work for another. However my endo, a very experienced & well respected one, told me Treseba is approved to mix. Not sure why they haven’t adjusted the label. Anyway no one shouid make any change without checking with their endo!!!