Levemir issues

Hi,

I've been a DAFNE graduate for the last 3.5 years. I've found it really helpful and it definitely helped my HbA1cs initially. However, I now have a 2 year old and, since having him, I've found that my control has worsened a lot - I think simply because life is much more hectic than it used to be and I spend less time looking after myself.

I've been trying to get things back on track again and my DAFNE educator suggested that I switch from Lantus to Levemir for my BI. I've been using it for about 5 months now and I still can't get the hang of it. It's difficult to explain but I feel that my results on it are much less predictable than on the Lantus and I seem to be getting many more extreme highs than I feel that I used to on the Lantus with less justification. It feels like I get a more extreme reaction with highs and lows and obviously what I'm striving for is a more constant level. Just as I think that I've got the right BI levels and it seems to be working, I need to alter them again for seemingly no reason. There seems to be no consistancy.

In particular I'm having a real problem with my BG results first thing in the morning. I'm waking each morning with readings of 15 and above and increasing my evening BI doesn't seem to be having an effect.

I also find it hard having 2 injections of BI a day as I find it less easy to judge doses.

I'm wondering if there is anything related to Levemir that might be causing this and any reason why things on Lantus seemed to be more predictable? I know that Levemir is generally seen as a "better" insulin but could there be any reason why I'm better suited to the Lantus. My DAFNE educator is keen for me to keep trying with it but my results seem to be getting worse and worse and it's really disheartening. I also find it hard to apply the DAFNE principles as the results seem to be totally unpredictable.

I'm currently taking 9 units of Levemir at night and 3 in the morning.

Any help or advice would be really appreciated. It's really getting me down.

Many thanks,

Melissa

There must of been a reason for you to go on Levemir, like the Lantus not lasting the full 24 hours....

The change over from these 2 insulins can be hard as the dose is now split and are weighed out differently, like they are now, more in the morning, less at night...

Its basically like starting from the beginnig, the BI dose needs to be established before anything else fits into place......

For me when I changed I started at the overnight readings, no food or QA, just BI, if its holds steady you have the right dose, if not adjust until its right..........then you can move onto the morning dose....miss breakfast and see what your blood does......if it goes up, fire on a unit, then you could maybe miss lunch the next day, or carb free, and see what happpens, just keep adjusting till it holds...........

While this BI investigation is going on your bound to have dodgy readings, you just have to try and compensate with th QA until your confident the doses are right........

You mentioned waking up high every morning even with putting up your PM BI dose, probably dawn phenomonon, I have suffered from this since starting DAFNE, theres not much that can be done apart from pump therapy.......speak to your team about dawn phenomonon, they might have better advice....

good luck

Hi,

Many thanks for your response - much appreciated.

I understand that it's hard adjusting to a new insulin but it's been months now and it seems to be getting worse rather than better. Surely it should have settled down by now?

Also, I thought that I had managed to stabilise my levels - for a few weeks my readings were good at a dose of 7 at night and 2 in the morning. Then it all changed again. Why would I constantly need to keep changing my BI doses when everything else is consistant? Surely they should be more regular? Otherwise it starts having to be as flexible as the QA. I know that you can alter the dose if necessary but surely it shouldn't have to be all the time? Otherwise you're just juggling all the time and your levels are constantly all over the place.

I think the reason that Levemir was suggested was because my control wasn't good. But the reason for that was that I had been taking less care of myself. My control is better now but I think that's purely because I'm spending a lot more time on it rather than because of the change of insulin. I can't help thinking that my control might be even better if I reverted to Lantus and spent all this time on it still.

Do you know what advantages Levemir has over Lantus? As I mentioned I find the 2 doses really hard to manage as well.

Thanks again,

Melissa

If you think it was purely just your commitment then you should maybe ask to go back, or tell them your going back to Lantus......

Lantus and Levemir are the same pretty much in that they have almost no peaking time and hold your blood sugars steady........the difference is that Lantus doesnt always last for the 24 hours you need it to last in everyone..........hence the split.......its not un heard of to actually split lantus too...

I wouldnt give up so easily though......its all about testing and writing things down, then you can see whats going on and can give reasons for the results......

As I said previously, start with your overnight test, 3AM, make sure you dont eat or take quick acting and see what happens, do an hourly one if you need to, then you will know if its right or wrong....

What ratios are you on throughout the day on QA....?

1:1 for all 3 meals at the moment...

How long would you say that it would take to aclimatise to an insulin in your experience? I thought that, after 5 months or so, I'd given it a pretty good shot! I've been testing regularly, writing everything down and reviewing it all for all that time as well which is why it's a bit disheartening. The problem is that fairly often I can't find any reason for things happening or things seem to change from day to day which makes finding patterns and applying DAFNE really difficult. Things seem to be a lot more unpredictable on the Levemir and it makes it hard to analyse.

So is there any patterns in your results.......sometimes there can be days like that, but it ususally gets better.

Antother thing could be the ratios, you say you wake up high, I bet you need more than the standard 1:1 at breakfast time....have you considered that.....

Is there any chance of you posting 3 day sworth of results, do you know how to do that....?

I would rather wake up with a decent result rather than use a higher ration or corrective dose at breakfast. My logic being that if I'm running too high overnight then that's making my BG readings dangerously high for 8 hours a day which presumably is having a bad effect both on my HbA1c as well as my general health.

I've not tried posting results yet but I'm sure that I can work out how to. I'll give it a go.

There don't seem to be any specific patterns other than the highs in the mornings. I've brought them down by upping my evening BI but then they come back again. I could really do with working out why this changes to such a degree. It's rather like what happened in the later stages of my pregnancy (when my body was presumably becoming more resistant to the insulin and my results were harder and harder to predict) but I'm definitely not pregnant.

You will probabvly find that if you on target before bed, you will stay like that till the early hours, 3,4,5 in the morning, the hormones kick in and the liver starts dumping glucose to help start the day, so if it is dawn phenomonon it wont be all night....

If you keep upping your night BI, there will be a point where you go low over night, 3am test needed, thats when you know its too much......

You say you have brought your morning reading s down, what are they at now.....?

They were down to a reasonable level a few weeks ago (under 10) and now they're back up again to 15/16.

I've put the last 4 days into a diary. I think I've attached it. Can you let me know?

I can see it, well done.........

My observations:

You are not giving your Levemir doses 12 hours apart, this is important as it only last that long, give or take....

It would be hard to say when the best time is, you need routine. I get up at 6.30am during the week, so I take my AM dose then and then at about 5 when dinner is served, 11 hours but close......

Make sure you get the timings right to within an hour, that means you wont run out at night which sends you high, and you wont overlap in the afternoon sending you low.

Another thing is corrections, my course didnt mention this and I had to find out for myself.

The higher you blood sugar is the more insulin you need (insulin resistance). Everyones different, but the rule I am followong is as follows;

<10mmol/l - correction = 1 unit drops 2.5 mmol/l
10-15mmol/l - correction = 1 unit drops 2 mmol/l
15+mmol/l - correction = 1 unit drops 1.5 mmol/l

I think you should adopt similar rules for correctionm, see what happens, you might get positive results there. And definetly try and get your BI dose 12 hours apart, it makes a difference.

See what the results are like with those two ideas, I think you might see some change.....

If there isnt then you can look at the doses again.......