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Occasional Contributor
tchadwick1
Total Posts: 6
Registered on: ‎06-03-2010

Levemir not working?

Hi:

I was recently put on levemir 30 units at bedtime.   I started with 12 units and moved up 2 units each night.   The first couple of mornings I had great numbers.  Now all of a sudden I have been having over 200 each morning.   These highs remain sometimes during the day as well.   I am also on metformin 2000 mg a day and glimpride 4 mg a day.   I was on Byetta and that was working well for quite a while and then my AC1 started to go up.  Dr. then which me to victoza to see if that would work... my AC1 actually got worse.   I'm careful with my carbs.. usually have not more than 40 carbs a meal.   I don't know what to do right now... I'm so tempted to go back to Byetta because that was working and also controling my appetite.    I don't know if I'm suppose to go above the 30 untis at night... my prescription says 30 units per day.   My doctor wasn't very clear.   I'm so frustrated right now.   Anyone else have this issue with Levemir?
Frequent Responder
cactus8
Total Posts: 1,181
Registered on: ‎11-07-2009

Levemir not working?

What are your numbers like when you go to bed, ie is there a jump by the time you wake?

Could be you rgoing too low during the night and then re-bounding by the time you wake up. Glimepriide (amaryl) can cause lows as well as the insulin.  You may be compounding the problem by adding more insulin but there should be are more insulin informed people than me along shortly to comment.
lizzylou
Total Posts: 13,840
Topics: 561
High Fives: 1,931
Solutions: 139
Registered on: ‎10-31-2009

Levemir not working?

Hi Teresa, I have a few questions to ask you.

Has your doctor requested that you report your numbers during the time that you're increasing the Levemir?  With insulin the most doctors can do is guess at the amount and increase until the desired numbers are reached.  I hope that you write down all of the numbers to refer to.

Where are you injecting, that could make a difference although it should still have some effect regardless.

Have you checked the expiration date on the insulin?  Also, has it been exposed to heat or freezing, because both of these things can affect it and cause it to loose strength?

Although the carb amounts that you're eating might be a little too high for you, Levemir really doesn't work on meal numbers but is a "basal" insulin made to be effective overnight and at times when you're not eating so you still have to practice control of carbs at meals.  The Levemir should effect your fasting numbers however.

It's possible that you'll need more than 30 units, and a  lot of people inject Levemir twice a day because it doesn't give them 24 hour coverage with just one injection.

In any case you need to contact your doctor asap and tell him/her what you've just told us.  Someone should be overseeing this change with you, you certainly shouldn't be on your own with it.  If not a doctor than a CDE should be working with you.  Insist on it, you deserve better treatment than this.  Don't settle for bad treatment!

Lizzy

It's All In Your Perception.

Here's some useful links, click on the titles:

Testing 101

All About Carbs


 
Knowledge is Power!





Here's some useful links, click on the titles


Testing 101
 
 All About Carbs

Resources For The Un-insured and Discount Medicine and Equipment

LizzyLou Videos



Lizzy's Blog
for lots more  


Trusted Contributor
morrisolder
Total Posts: 10,430
Registered on: ‎11-28-2009

Levemir not working?

Lizzy knows a lot more about insulin than  I do, so I hope she, or one of our other experts, will correct anything I am about to write that could be misleading, but I think I have learned here that--

Levemir, which I do not take, generally would be increased until you reach the point that you wake up with about the same number as you went to bed with.

So if you are at 200 in the morning, then two things could be going on:

If you were at 120 when you went to bed, then that is not enough Levemir.

If you were at 200 when you went to bed, that is enough Levemir, but your meals are bumping you up too high. 40 grams of carbs might be too much per meal, perhaps more so at some meals than others, and/or you might need more of the Glmepiride or a meal time insulin to keep your numbers from increasing with meals, and thus leaving you at 200 at bedtime.
Morris

Diagnosed Type 2, with an A1c of 11.4 in 2003; averaging a 5.0 A1c since then with diet, exercise and Glipizide XL + meds for blood pressure and cholesterol. 
A bit dated, but scroll down on this page if you want to know more ...


mollythed
Total Posts: 5,598
Topics: 74
High Fives: 880
Solutions: 104
Registered on: ‎10-31-2009

Levemir not working?


Morris, What youve said so far is pretty much correct.

Levemir is a basal insulin and its job is to hold blood sugar steady when you are not eating.  It doesn't really help with mealtime increases in blood sugar, except that by starting a meal at a lower blood sugar level, a person may be able to keep the after-meal number lower than they would without insulin.

The "right" amount of insulin is whatever amount it takes to keep blood sugar steady overnight.

Too little insulin will mean that a person's blood sugar rises overnight.

There is a third, less likely possibility that cactus8 mentioned.  That is too much insulin.  If a person takes too much insulin, and blood sugar drops low in the middle of the night, significantly below 70, the the liver can get involved, a send out extra sugar to avert what it sees as an emergency.  The way to find out is to test in the middle of the night to look for low blood sugar, and the solution is to reduce the dose of Levemir.

One more possible complication is that a person can still have the dawn phenomenon on top of everthing else, where the liver does send out too much extra glucose to start the new day, even when numbers were good until wake-up time, or just before wake-up time.
Morris Older says:
Lizzy knows a lot more about insulin than  I do, so I hope she, or one of our other experts, will correct anything I am about to write that could be misleading, but I think I have learned here that--

Levemir, which I do not take, generally would be increased until you reach the point that you wake up with about the same number as you went to bed with.

So if you are at 200 in the morning, then two things could be going on:

If you were at 120 when you went to bed, then that is not enough Levemir.

If you were at 200 when you went to bed, that is enough Levemir, but your meals are bumping you up too high. 40 grams of carbs might be too much per meal, perhaps more so at some meals than others, and/or you might need more of the Glmepiride or a meal time insulin to keep your numbers from increasing with meals, and thus leaving you at 200 at bedtime.

"Molly" (aka mollythed)
Type 2 diabetes diagnosed in 1995, now managed with Lantus, Humalog and Metformin; diet and exercise.
My husband and three adult sons also have type 2 diabetes.





lizzylou
Total Posts: 13,840
Topics: 561
High Fives: 1,931
Solutions: 139
Registered on: ‎10-31-2009

Levemir not working?

One more possible complication is that a person can still have the dawn phenomenon on top of everthing else, where the liver does send out too much extra glucose to start the new day, even when numbers were good until wake-up time, or just before wake-up time.

However basal insulins such as Levemir and Lantus are made to address this issue, and are given often for DP alone.

Lizzy


It's All In Your Perception.

Here's some useful links, click on the titles:

Testing 101

All About Carbs


Knowledge is Power!





Here's some useful links, click on the titles


Testing 101
 
 All About Carbs

Resources For The Un-insured and Discount Medicine and Equipment

LizzyLou Videos



Lizzy's Blog
for lots more  


Occasional Contributor
tchadwick1
Total Posts: 6
Registered on: ‎06-03-2010

Levemir not working?

Hi, Lizzy:

Yes, my doctor had me write down my Fasting BS and my before bed BS.   I called the numbers into his nurse.  They wanted to know what my numbers were for a week.   On the day that I called the nurse to give her my numbers... my Fasting BS was 134.   So, it was close to being at 130 and that is what the doctor wanted me to be at.   At that time I was at 26 units of levemir.   Now, I haven't been 134 since then and I'm at 30 units at bedtime now.   My bedtime readings have been from 140 to 190.   I am injecting into my stomach.  Should I try another place?   Expiration date is good and I've been keeping it in the butter compartment in the fridge.   I will definitly be calling the doctor's office on Monday.  It's just frustrating because I feel like I'm doing what I'm suppose to be doing and yet my numbers are a mess.  They are now worse then they were when I was taking Byetta.  

Thank you for your help! 
mollythed
Total Posts: 5,598
Topics: 74
High Fives: 880
Solutions: 104
Registered on: ‎10-31-2009

Levemir not working?


You would think a basal might prevent the dawn phenomenon, but not for everyone.

It's common for people who use an insulin pump to adjust their basal rate so that starting an hour or two before wake-up time, they increase the continuous dose of insulin that they get in order to keep blood glucose done in the morning.

For myself, with Lantus as my basal insulin, my blood glucose stays rock solid steady overnight, but then even with breakfast and insulin, which should help fend off the dawn phenomenon, I need an extra 30U of my rapid acting insulin, in addition to what I need for breakfast, to avoid spiking up between 160 and 180.

I put a lot of effort into trying to find an overnight low, but found nothing.  This extra insulin in the morning is what seems to work for me.

I don't even want to begin to suggest that Teresa would react the way I do, or that the same solution would work for her, because I think it is very unlikely.  Just goes to show we are all different.
lizzylou says:
One more possible complication is that a person can still have the dawn phenomenon on top of everthing else, where the liver does send out too much extra glucose to start the new day, even when numbers were good until wake-up time, or just before wake-up time.

However basal insulins such as Levemir and Lantus are made to address this issue, and are given often for DP alone.

Lizzy


It's All In Your Perception.

Here's some useful links, click on the titles:

Testing 101

All About Carbs



"Molly" (aka mollythed)
Type 2 diabetes diagnosed in 1995, now managed with Lantus, Humalog and Metformin; diet and exercise.
My husband and three adult sons also have type 2 diabetes.





lizzylou
Total Posts: 13,840
Topics: 561
High Fives: 1,931
Solutions: 139
Registered on: ‎10-31-2009

Levemir not working?

It can be frustrating until you find the right combination.  The thing is that with the insulin and Byetta you're talking about two different functions.  The Byetta is to help with keeping the meal numbers lower.  It stimulates insulin production plus delays digestion of the food so that it doesn't spike quickly among other things.  The insulin is for fasting and times when you're not eating.  So they really have different functions.

How long have the numbers been a lot higher?  The fact that it was working well makes me think that either you're coming down with an illness or there's something that happened to make the insulin less effective.

Sometimes when we're coming down with something our numbers shot higher for no apparent reason.  Often it's still at a time when we feel just fine.  And this would be an across-the-board rise and you said that your numbers later in the day are higher too.

The injection method appears fine, just make sure you rotate the site.  The butter compartment is warmer than other places, correct? 

I'm stumped.  Sometimes you just get a bad batch of insulin, but it usually doesn't work for a time and then stop unless it's expired or exposed to heat/cold.

Make sure you call on Monday, and don't worry too much.  Insulin is a lot more work at first than other medications, but it works really well once you get the dose right.

Let us know what happens, I for one am really curious.

Lizzy


It's All In Your Perception.

Here's some useful links, click on the titles:

Testing 101

All About Carbs

Knowledge is Power!





Here's some useful links, click on the titles


Testing 101
 
 All About Carbs

Resources For The Un-insured and Discount Medicine and Equipment

LizzyLou Videos



Lizzy's Blog
for lots more  


Frequent Responder
cactus8
Total Posts: 1,181
Registered on: ‎11-07-2009

Levemir not working?