Replies to This Discussion

Permalink Reply by Brigitte on June 18, 2010 at 2:25am

I use Levemir 12 units, and for my meal or correct I use Apidra 4 or 5 units before meal ( I count my carbs). One year ago I was under Lantus (8 units) and every day I used to have a big low in the night, and a big low in the afternoon. I injected Levemir in my thighs and Apidra on my stomach/abdomen. I never used a pump. Now I can control my blood sugar levels because I control what I eat (carbs counting) and how many units of insulin I need. Courage! I don't understand why you stop pump? People who use pumps seem happy to use them and have good control. These days I'm going low after meal because I'm sure I only need 10 or 11 units of Levemir, but with these numbers I have high blood sugar when I wake up. When did you inject your Lantus? I choose 7 in the morning when I wake up.

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Permalink Reply by Brigitte on June 18, 2010 at 2:58am

Yes, I understand you. I'm older than you but I'm a thin woman and yes people can show a pump! You have the chance to live in California, good weather, a dream for European. Now it's time to have lunch in France!
I chose do do my Levemir in the morning because I am afraid to forget to inject it at night, and I go out too many time at 9 or 10 at night. And I don't sleep too much. If you need help We are all here for you!

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Permalink Reply by Elizabeth on June 18, 2010 at 9:00am

Hate to be a spoilsport and a "Mom", but did you know that not getting enough sleep can affect your insulin sensitivity (makes you mildly insulin resistant)? If you aren't getting a full 8 or 9 hours, that could very well explain your highs... I'm just sayin'... Even ONE NIGHT of insufficient sleep is enough to have that effect. Think about it, next time you want to stay up late.

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Permalink Reply by Osob on June 18, 2010 at 2:44am

I am on Levemir 11 units and for meals/correction I am on Novorapid same as Brigitte I carb count that helps me figure out how much insulin to take for that meal.
I use my thighs a lot,its a brilliant place for me hardly feel any pain and do move around a lot.Hardly use my stomach as it hurts and get marks after.
Goodluck and get in touch if you need any help.xxx

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Permalink Reply by biggleton on June 18, 2010 at 4:14am

Hi,

Im thinking that perhaps on your pump you/ your healthcare professional didn't allow for the extra insulin sensitivity that a pump causes. If that's the case, then having gone back to your usual doses you'd have fewer lows. I use the outside of my thigh, the top of my bum, and my stomach, but if you have a decent amount of fat on your arms you can use them too. I'm on 14 units Levemir at night, and my Novorapid varies depending on how much carbohydrate is in the foods i eat, but I have an I:C ratio of 1:10, and i'm extremely hungry most of the time. I'm about to go on a pump, hoping that it will allow me to snack more easily and bolus at restaurants etc without having to use an open needle in front of friends.

Hope this helps

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Permalink Reply by Anna Kingsbury on June 18, 2010 at 5:02am

I recently went back on shots for the summer so I could spend time exercising in the pool. I use the Lantus, and Novolog just like you are using. I have found my blood sugar jumps around...... high, then low. I have been having trouble keeping it consistant. Were you on a MiniMed pump? You might want to try the OmniPod. No tubing, so fast and simple to apply. Not all that tubing, priming, and it inserts itself......Good luck!

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Permalink Reply by Leo2 on June 18, 2010 at 6:25am

Megan,
Biggleton is right. You use less insulin via pump, so you need to look at your basal amount at 4 time periods through the day and determine if you need more.
After that is set so that you know your round the clock BG is in your target zone, then recalculate your I:carb ratio to set enough for each meal. I:C ratio may differ between meals. You're doing GREAT to be asking these questions.

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Permalink Reply by Cathy on June 18, 2010 at 6:33am

I am on shots and use humalog and it really works for me and i dont think i could find a better insulin for me . do whatever works for you is my method and belief . mine is a sliding scale so I really cant say . I dont think I will ever use a pump because it is so hard to get insurance when you are a diabetic and if you cant afford it you go with out and pray to god you dont end up in the hospital .I dont think I have ever had health insurance cause we could not afford it . Even through my husbands work is very costly and when you have to decide wheather you want to eat that week or pay your health insurance then you know it costs too much .

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Permalink Reply by drrps3 on June 18, 2010 at 6:54am

Hi Megan: I've been diabetic about 13 years now, and I have always been on shots. I take Levemir twice a day at bed (11 units) and morning (6 units). The split dose works from me. I take Humalog on sliding scale before meals. I tend to watch what I eat so I do not have to take big shots of Humalog. Of course, the higher the carbs, the more Humalog. I inject in my stomach, thighs, butt and upper arms. Shots, for the most part, work for me. With diabetes, I find you have to constantly adapt and make it work the best you can, because we are thrown a lot of curves each day. I know the pump is a wonderful technology and works for a lot of people, but a pump would never be for me. The insulin pens are a good choice for me so I am glad for that option. Good luck! Peter

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Permalink Reply by Holger Schmeken on June 18, 2010 at 7:12am

I am on shots with Novolog and Levemir. I am not a big fan of Lantus because there is quite a likelyhood that one shot will not cover 24 hours. I also dislike that this one shot regime is just too static for an active lifestyle. Many Lantus users have an incredibly high dosage to cover the whole day and this often leads to lows - especially at night. With a two shot regime on Levemir you can react to heavy physical activity by decreasing the night dosage for example. This also gives you the right mindset to always think about the right basal dosage - very important for times of being ill. This is truely an advantage because I am convinced that a good basal coverage is the fundament for good control. Without good basal coverage you will need many corrections with the danger of overcorrections for example. Please do not believe the claims that Levemir is a one shot insulin like Lantus. This is just a claim that is valid because the higher the dosage the longer the coverage. With two shots of Levemir you will be on the safe side and will reach 24 hour coverage for sure. With my endo I can try different basal insulins to find out my individual reaction to it. This is something I recommend to you too. Just be experimental and seek a medical team that will support your search for improvements.

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Permalink Reply by FHS on June 18, 2010 at 8:16am

I'm on 10-12 units of Lantus and 5-7 units of Novolog before meals. I've never tried Levemir and my new endo hasn't said anything about it since he's been trying to get me to go on the pump.

I was, indeed, having a terrible time on higher doses of Lantus to cover 24 hours. 2 smaller doses of Lantus screwed with my exercise plan though. I would always go low during my evening gym sessions regardless of my Lantus dose. I have since lowered my one evening Lantus dose and I make sure I get into the gym in the afternoon before dinner and before my evening Novolog dose.


So far, so good. I can adjust my dinner time Novolog according to my BG and I usually can get coverage all the way up until my evening Lantus. I'm waiting for my Dexcom to check my overnight BG but I've had more consistent early AM spot checks, less nightime hypos and a more stable fasting since going back to 1 Lantus shot and regular early evening work-outs.

I realize this doesn't follow your advice and I wouldn't recommend my program either. But I'm very active and work-out regularly and, barring a switch to Levemir instead of the pump, it's what I've found works best for me.

Hopefully, I can apply what I've learned when I go over to the pump.

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Permalink Reply by Holger Schmeken on June 18, 2010 at 2:17pm

On MDI you will always need additional carbs to cover heavy physical activity. The basal rate should be picked in a way that covers normal activity. To have a dosage that needs the additional activity like you have choosen is to restrictive. It will structure your day in a way that takes away any flexibility. There will always be days where the activity is not possible. On these days you risk higher numbers. Why not setting the basal right and then you figure out how much to eat as a preparation. For example I will eat glucose tabs and drink juice for my 1 hour workout if necessary. After a while you will know exactly how much carbs you will need and how fast they need to be. This is also helpful on the pump because the reduction of the basal rate must for most users happen one hour before the activity. Otherwise the insulin on board will drag you down as the basal insulin on MDI does.

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