I had my endo appointment yesterday. It went well, but my endo "hates" my use of NPH. And I agreed to try Levemir, but I'm a bit concerned about split dosing. Right now, I use NPH and split my dose into two highly staggered and uneven doses. I take 14 units at 6 am and 40 units at 10 pm. I think that gives me about three times the basal rate overnight as during the day.

My endo suggested that I just use the same timing and dosing for Levemir, but I'm concerned that won't work. Levemir has a slower onset and markedly longer duration of action. I think that if I stick with my current timings and dosings, I'm going to get a totally opposite action and have a much higher rate during the day.

I'm kinda inclined to just evenly split my dosing at 12 hours apart and make adjustments with basal testing from there. What do you all think?

Does anyone else split their Levemir unevenly or stagger the times?

Tags: Levemir, basal, hypo, split, split dosing

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Hi,

I changed from Protaphane to Levimir about two years ago. I always needed less basel during the day than at night. However, I in general need less units of Levimir than what I needed using Protaphane and especially my sugars in the morning improved a lot. It was definitly a good idea to switch. Right now I am using about 18 units at night which I take around midnight and 10 units in the morning which I take around 8:30. I definitly would reduce the amount of units in the beginning and then see if it works out.
Cheers

BSC, did you start the Levemir yet? I am having some problems with my Levemir. I started having some problems after starting a new box. I called the Levemir people yesterday and they said they could get a new box to my pharmacy in 3-5 business days. After I told them I couldn't wait that long, they checked with my pharmacy and they had a new box to give me from a different lot. That still isn't working. On Sunday, I started using Apidra every 2 hours and that works great except I need to get some sleep so I am thinking of using NPH at least overnight until I can get Levemir that didn't come thru the same distributor in case there is a problem with them.

I am curious if you started the Levemir how you adjusted your doses so I can do it in reverse.

My endo gave me two pens. I started a little more than a week ago. I found Tim's advice compelling and dropped my dose 33%. I had been taking 54 units/day and started with a simple regime 20 units twice a day, 12 hours apart at 6am and 6pm.

And surprisingly my blood sugars responded well. In fact, after 2 days I concluded that I needed to reduce my dose, so I moved down 10% and then another 10% down to 16 units, twice a day. But now my fastings are drifting up so I have moved back up to 17 units/day. I am still adjusting.

I'm not sure what to tell you about the Levemir. It seems strange that it would just stop working. You can develop a reaction to certain insulin's (antibodies) that will over time render them ineffective, but it generally doesn't just happen overnight.  I would not immediately suggest that you take my experience as an indication that you should use more NPH.  It is probably better to be conservative and think that they have a similar strength.  In fact, it might be prudent to try NPH during the day to gauge your response before trying it overnight.

I am still working out the kinks on my Levemir, but it has demonstrated that it can tame my Darn Phenomenon without causing daytime hypos. So I'm probably going to switch.

BSC, glad to hear it is going well. I still have to adjust from time to time. Good luck. :)

Thanks. I think that we all have to make certain adjustments as well as learning to just accept that we will all have those up and down days.

You can develop a reaction to certain insulin's (antibodies) that will over time render them ineffective, but it generally doesn't just happen overnight

Never heard of this, one certainly can become insulin resistant, but it's not the said insulin..if one develops antibodies from insulin...it would be some type of allergic antibodies, I would think?

I'm still adjusting my levemir...been doing this for a year..ha! Thankfully, I'm going on a pump in 2 days and NO MORE basal..yahoo! Sounds like you're doing great though..congrats.

Some people develop an immune reaction to insulins. Animal insulin's often created this effect, but it can occur with modern analog insulins. There is a test, anti insulin antibodies that can be used to test for a large immune reaction. The antibodies actually go out and deactivate the insulin, essentially resulting in your needing more insulin (hence insulin resistance).

Thanks BSC. I called the Levemir people again and the guy I talked to today isn't going to make me wait 3-5 days to get it. He said he would overnight it to my pharmacy so I will have it tomorrow. I can manage one more sleepless night. If the new stuff works, then I will know it is a distributor/pharmacy problem. If it doesn't, then I guess the problem is with me. He did say they haven't had any other reports of problems. But I also have to wonder how many people are just pulling their hair out trying to figure out what is wrong.

I am glad that the Levemir is working for you. I really like it other than this last problem.

Have you heard any opinion of using Levemir and Byetta? I was using Byetta once before my evening meal (that's when I was the hungrest(SP) ) Now that I take Levemir once each PM I am wondering if I could still take the Byetta. Really don't want to call the Drs office. The nurses act like I should already know these things.

I used Byetta for a year and then also went on Victoza. Neither provided me with any long-term benefit. However I think that for many, both Byetta and Victoza can do a great job of improving your blood sugar response at meals. When Byetta first came out, there was little information on how well a combined Byetta and (basal) insulin regime worked. Since then, a number of studies have found that it works quite well with Lantus. And I believe the FDA has now approved its use with Lantus. However, neither Victoza nor Levemir have been studied to demonstrate that it is safe and effective and the FDA has not approved a Levemir/Byetta or any Victoza/insulin regime.

That is not to say that they are not safe and effective and won't be approved in the near future, only that the studies have not been done. Your doctor however has the knowledge and authority to prescribe this regime to you (Levemir/Byetta) (this is called an off-label use). You can talk to him about the Byetta. Personally, I would not hesitate to use a Levemir/Byetta regime.

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