03-13-2012 06:02 AM
I take 15 units of Novolog at each meal, and I take 50 units of Levemir at bedtime. Is 50 units a lot for this type of insulin? It seems like my bs is still all over the place. 140 one
minute and 200 the next. I'm watching my diet very carefully and of course I'm going to call my DR. but I was just wondering if maybe I need more Levemie
03-13-2012 11:23 AM
You need as much insulin as you need. The basal insulin provides a background level of insulin sufficient to maintain your fasting blood sugar levels at a normal level (basically offsetting the glucose generated by your liver). As a type 2, you may have some insulin resistance and generate more glucose from your liver than a non-diabetic. So it doesn't make sense to compare yourself. What you should do is do basal testing to establish proper levels of your Levemir. I found the books "Using Insulin" and "Think like a Pancreas" really helpful in learning how to use insulin.
I currently use about 50 units of Levemir, split into two injections daily. Clear signs that you need to adjust your basal insulin levels are waking up with a high blood sugar (> 140 mg/dl) and having lows when fasting between meals during the day or overnight.
03-13-2012 11:31 AM - edited 03-13-2012 11:59 AM
I take 15 units of Novolog at each meal, and I take 50 units of Levemir at bedtime. Is 50 units a lot for this type of insulin? It seems like my bs is still all over the place. 140 one minute and 200 the next. I'm watching my diet very carefully and of course I'm going to call my DR. but I was just wondering if maybe I need more Levemie
Dolly, the amount of insulin a type 2 uses can vary quite a bit depending on the degree of insulin resistance, and whether the insulin is just being used as a supplement or as a total replacement. Total insulin in the day can range from 0.15 units per Kg of body weight to 0.5 per Kg or more. To convert lbs to Kg just divide by 2.2. You can see where you stand in that range by converting your body weight to Kg and dividing the total insulin in the day (50+15+15+15) by your weight in Kg. Again just typical but about 50-60% of the total insulin is basal or long acting. In your case Levemir. Your split is in that range.
Normal practice to determine if your long acting insulin is correct is to compare you bedtime BG to your morning fasting BG. When you bedtime fasting is in a good range then your morning fasting should be about the same. If it goes us consistently overnight then the long acting may be low. If it consistently goes down then you may have too much.
For meals you either take a fixed amount and then control the number of carbs you eat to achieve a good BG two hours after the meal, or the other way around. You figure out how many carbs there are in the meal and adjust the insulin to give you a good BG two hours later. Either way works, but the latter give you more flexibility to vary meal size. To use it you need a carb to insulin ratio. That needs to be figured out individually but can be in the range of 5 to 15 grams of carbs per unit of insulin, and it may vary by meal of the day. If for example it is at the 5 end your 15 units would cover 75 grams of carbs.
Are you taking an oral meds? Metformin or Actos can reduce the amount of insulin you need as they increase sensitivity to insulin. When are you having most trouble controlling your BG? Are you taking your Levemir all in one dose? At 50 units a day, it may make sense to split it into two doses twelve hours apart.
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