# Levemir - giving me some real trouble here
**URL:** https://forum.fudiabetes.org/t/levemir-giving-me-some-real-trouble-here/10245
**Category:** Type 1 & LADA
**Created:** [September 12, 2020, 3:41pm UTC](https://forum.fudiabetes.org/t/levemir-giving-me-some-real-trouble-here/10245 "2020-09-12T15:41:43Z")
**Posts on this page:** 16
**Page:** 3
### Author:  [@john\_coburg](https://forum.fudiabetes.org/u/john_coburg)
#### Post date: [September 22, 2020, 9:10am UTC](https://forum.fudiabetes.org/t/levemir-giving-me-some-real-trouble-here/10245/41 "2020-09-22T09:10:20Z")
> [@Scotteric](#):
>
> My basal needs can be several units higher depending on what I eat for dinner or if I eat late at night, for example. Tresiba was awful for me because it can never be adjusted for the short term. You can argue this isn’t really basal needs increasing, but it requires more insulin over several hours, regardless of how you classify it. On MDI Levemir is a great basal to deal with these situations because it can be taken at different amounts every night without affecting the next day.
This sounds like music to my ears… but it just turned out utterly dreadfully for me. I can’t work out why. it seems like the answer!
---
### Author:  [@john\_coburg](https://forum.fudiabetes.org/u/john_coburg)
#### Post date: [September 22, 2020, 9:19am UTC](https://forum.fudiabetes.org/t/levemir-giving-me-some-real-trouble-here/10245/42 "2020-09-22T09:19:59Z")
> [@Scotteric](#):
>
> I can’t take additional boluses while I’m sleeping unless I want to wake up every 3-4 hours.
In my case at least, agreed. (which is what i’m stuck with now)
> [@Scotteric](#):
>
> Some meals can digest for 8 hours or more, so an additional shot of bolus before going to sleep isn’t going to cut it.
I never realised a dinner could take so long… but they seem to in my case, unless it’s the Dawn effect. My dinners are typically low/medium carb, and fairly-high-but-not-ridiculous fat (i.e. EVOO on salad, steak/ chicken with skin/ fatty fish). Sometimes i’ll have duck legs slow cooked in a dozen plums, and 50g of jasmine rice… i’ll need to get up at least twice during the night to bolus for that. seems to take hours to process.
> [@Scotteric](#):
>
> I don’t even believe in ICR or ISF anymore. There are too many variables, including quality of sleep, absorption at the injection site, how quickly food digests at a given moment, activity level, stress level, etc. I used to spend hours trying to fine tune these ratios only to get different results every single time.
Very interesting. I have long-doubted their theoretical and practical efficacy… but ended up thinking i was just doing it all wrong as my endo and nurses insisted it’s the only way.
Crucially, the CIR is NOT a linear function, i.e. it might be 10 for 30g carb, but is 5 for 60g carb… not to mention the second order impacts of other variables. Practically speaking, it’s useless. Each and every meal has turned to being an eyeball guess… which inevitably, due to the law of large numbers, causes (frequent) errors. But what else can we do?
---
### Author:  [@john\_coburg](https://forum.fudiabetes.org/u/john_coburg)
#### Post date: [September 22, 2020, 1:16pm UTC](https://forum.fudiabetes.org/t/levemir-giving-me-some-real-trouble-here/10245/43 "2020-09-22T13:16:14Z")
Heard back from both the nurse and my endo…
re. Rise in TDD: seemingly no worries about it, as “Levemir doses are often higher”. The scale of this rise seems egregious to me, but they seem unconcerned.
Re. the c. 6% weight loss, they suggested i see my GP, unless my control is terrible and ketones present from being high etc… this isn’t DKA, but surely it is endocrine-related? i suspect my GP will just say “hmmm, go and see your endocrinologist”…
Re. NPH: he’s keen for my swtich to Tresiba to ‘bed in’ before looking to add NPH.
Fair enough.
---
### Author:  [@Sam](https://forum.fudiabetes.org/u/Sam)
#### Post date: [September 22, 2020, 3:37pm UTC](https://forum.fudiabetes.org/t/levemir-giving-me-some-real-trouble-here/10245/44 "2020-09-22T15:37:01Z")
> [@john\_coburg](#):
>
> NPH or Humulin
R and NPH are over the counter. In the USA anyway…
---
### Author:  [@Scotteric](https://forum.fudiabetes.org/u/Scotteric)
#### Post date: [September 22, 2020, 3:40pm UTC](https://forum.fudiabetes.org/t/levemir-giving-me-some-real-trouble-here/10245/45 "2020-09-22T15:40:57Z")
> [@john\_coburg](#):
>
> as my endo and nurses insisted it’s the only way
If it worked so well there would be no market for the closed loop pumps being developed. I think no one really had a full understanding of what was going on until accurate CGMs came about in the last few years. Now it’s easy to prove how variable and frustrating insulin dosing actually is, but it’s also possible to dose in an entirely new and safer way using CGM data in real time.
---
### Author:  [@john\_coburg](https://forum.fudiabetes.org/u/john_coburg)
#### Post date: [September 22, 2020, 3:48pm UTC](https://forum.fudiabetes.org/t/levemir-giving-me-some-real-trouble-here/10245/46 "2020-09-22T15:48:08Z")
> [@Sam](#):
>
> R and NPH are over the counter. In the USA anyway…
not here in the UK of GB & NI.
---
### Author:  [@john\_coburg](https://forum.fudiabetes.org/u/john_coburg)
#### Post date: [September 22, 2020, 3:49pm UTC](https://forum.fudiabetes.org/t/levemir-giving-me-some-real-trouble-here/10245/47 "2020-09-22T15:49:19Z")
> [@Scotteric](#):
>
> Now it’s easy to prove how variable and frustrating insulin dosing actually is,
Yes - and to prove we are not just being idiots… which i often fall into the trap of assuming, when things don’t go to plan.
---
### Author:  [@Scotteric](https://forum.fudiabetes.org/u/Scotteric)
#### Post date: [September 22, 2020, 4:03pm UTC](https://forum.fudiabetes.org/t/levemir-giving-me-some-real-trouble-here/10245/48 "2020-09-22T16:03:45Z")
> [@john\_coburg](#):
>
> My endo says the same, but i thought he was just lazy/sick of my emails
I think most endos (except very old school) prefer pumps because it’s easier to see the data and to manage only 1 type of insulin. I’m agnostic personally, think both regimes have pros and cons and that for most people a CGM is much more important than a pump. However, in your case there may be an advantage since I think it is just too difficult for you to deal with the specific issues that you are having overnight using just NovoRapid and Levemir or Tresiba. Why not try it if you can get NHS funding? Worst case scenario you are right about the site issues and you just go back to MDI.
---
### Author:  [@john\_coburg](https://forum.fudiabetes.org/u/john_coburg)
#### Post date: [September 22, 2020, 4:19pm UTC](https://forum.fudiabetes.org/t/levemir-giving-me-some-real-trouble-here/10245/49 "2020-09-22T16:19:55Z")
> [@Scotteric](#):
>
> using just NovoRapid and Levemir or Tresiba.
But what about NovoRapid & Levemir/Tresiba **& NPH**? Isn’t that the easier next step, vs a pump (which i don’t like the idea of anyway) ?
> [@Scotteric](#):
>
> Why not try it if you can get NHS funding? Worst case scenario you are right about the site issues and you just go back to MDI.
True. He’s offered it me on the NHS, so i could do it…i just think it’s a huge overhaul that i’m not sure i’m ready for, and that trying NPH before sleeping is potentially an easier solution to the current problem.
As i often explain to him (much to his dismissal) my diabetes goes through periodic phases. In a given phase, certain rules need to be followed, and if they can be successfully followed, things work out … and then, in 3-6mtths time, the chess set is thrown into the air and the pieces land all over the place…and i then need to figure out the new rules and try and follow them…and at the moment, they aren’t followable (due to nighttime rises) given my current tools, hence the (supposed) need for NPH. in a few months time, there’ll be another phase shift and i’ll have to recalibrate again… and all these phase shifts are in the ostensible absence of any other exogeonus changes. This has happened too many times over the last 17yrs for me to be making it up.
---
### Author:  [@Eric](https://forum.fudiabetes.org/u/Eric)
#### Post date: [September 22, 2020, 5:42pm UTC](https://forum.fudiabetes.org/t/levemir-giving-me-some-real-trouble-here/10245/50 "2020-09-22T17:42:56Z")
@john_coburg,
Sorry about your experience with it so far.
A few things.
Not sure if this has been mentioned already on this thread, but if your basal needs are **not** flat - like maybe you need more during the day or night - consider using Tresiba as the base, and adding a dose of Levemir in either the morning or night to cover the higher needs for that time. At low doses, Levemir does not last very long, so this might be a good way to manage different basal needs.
So you might consider taking enough Tresiba to cover your lowest basal needs, and enough Levemir at the right time to consider the higher basal needs. The two basal insulins would stack up to meet your needs.
Sorry if this was already discussed on this thread.
Here is a very simple picture to show this as an example. Here, the Levemir is taken in the morning and only covers the higher needs during the day, and Tresiba covers the entire day at the lowest basal requirement.
> [@john\_coburg](#):
>
> I have lost weight (down to 61 from 65)
> [@john\_coburg](#):
>
> Re. the c. 6% weight loss, they suggested i see my GP, unless my control is terrible and ketones present from being high etc… this isn’t DKA, but surely it is endocrine-related?
Yes, if your blood sugar is high, you will lose weight! That’s the way it works.
The reason is, the carbs you eat (which get turned into glucose in your digestive tract) have nowhere to go if you don’t have enough insulin.
Your liver can take some of them, but your liver can only store about 100 grams worth of glucose. And your liver can convert some of the glucose to fat, but it does not do that as much with insufficient insulin (insulin signals the liver with various enzymes, which tell the liver what to do).
But with insufficient insulin, your body will end up losing most of that glucose through your urine. Without enough insulin, the glucose can’t get into your cells, so it ends up being peed into the toilet. (sorry for the description there 😀)
Anyway, the short answer is that weight loss is a common and expected result of high blood glucose levels because your body does not process all of the food you eat. It gets disposed of instead of being stored or used by your body.
Apologies if this is old hat.
---
### Author:  [@john\_coburg](https://forum.fudiabetes.org/u/john_coburg)
#### Post date: [September 22, 2020, 6:48pm UTC](https://forum.fudiabetes.org/t/levemir-giving-me-some-real-trouble-here/10245/51 "2020-09-22T18:48:56Z")
Thanks @Eric.
> [@Eric](#):
>
> if your basal needs are **not** flat - like maybe you need more during the day or night - consider using Tresiba as the base, and adding a dose of Levemir in either the morning or night to cover the higher needs for that time.
Interesting concept. I guess at low doses, Levermir approximates NPH, profile-wise. I can certainly try that. Obviously goes against the instructions (“don’t mix with other basals”, not to mention endo advice, but hey ho)
> [@Eric](#):
>
> Here is a very simple picture to show this as an example.
Is this part of an app/piece of software, to model insulin and food responses? I would love something like that, but don’t have the time or skillset to put together.
That Tresiba line looks suspiciously flat though… not sure that’s quite right? It might vary from person to person (or, knowing this area, day to day…)
> [@Eric](#):
>
> Yes, if your blood sugar is high, you will lose weight! That’s the way it works.
Yes, fully on board with that. But I thought that needed DKA, and i don’t think i am anywhere near that. When first diagnosed 17yrs ago, i had lost 5-6kg, but was drinking gallons of water and urinating every hour or so… classic type1 symptoms. By BG was at 25+ for days on end. Whereas currently, my 30d ave BG is 6.8mmol and ‘time above 8mmol’ = 29%… okay, fairly high, but i rarely go above 12…although i do spend hours between 9 and 12mmol at night, asleep. But would this really start the process of glucose spilling into urine and the resultant weight loss? I thought it needed REALLY high BG for this processs to kick in. If so, surely people wanting to lose weight (and nefarious types wanting to make money out of people wantingt to lose weight) would take advantage of this method…? And if so…perhaps explains why i have struggled to put weight on for the vast majority of my life. But is ave BG of c. 7 really high enough to drive that?
---
### Author:  [@Eric](https://forum.fudiabetes.org/u/Eric)
#### Post date: [September 22, 2020, 7:32pm UTC](https://forum.fudiabetes.org/t/levemir-giving-me-some-real-trouble-here/10245/52 "2020-09-22T19:32:48Z")
> [@john\_coburg](#):
>
> That Tresiba line looks suspiciously flat though… not sure that’s quite right? It might vary from person to person (or, knowing this area, day to day…)
It was just a representation of the idea that Tresiba is supposed to be flat and last throughout the day and Levemir might last only 12 hours.
The picture was just for illustration of the concept, not an actual curve of either of the basal insulin’s.
> [@john\_coburg](#):
>
> But is ave BG of c. 7 really high enough to drive that?
I think it is generally around 8-10 where it starts to spill over.
But in your case, an **average** of 7 means what?
It means that you spent some time above and some time below…
And there are certainly other things that could be contributing to your weight loss. And you should investigate other possibilities.
But I am simply saying that high BG is a reason people might be losing weight. It may not be the reason for you, and may not be the only reason, but it is definitely a possibility for you to consider.
---
### Author:  [@cardamom](https://forum.fudiabetes.org/u/cardamom)
#### Post date: [September 22, 2020, 7:44pm UTC](https://forum.fudiabetes.org/t/levemir-giving-me-some-real-trouble-here/10245/53 "2020-09-22T19:44:43Z")
You definitely do not need to be in DKA to lose weight from high blood sugars. Otherwise diabulimia would kill people too fast to “work.” You will however likely be spilling some amount of ketones, but possibly just trace or small amounts, but that’s often true with weight loss, even when not due to high blood sugars. Burning fat results in the byproduct of ketones, just not necessarily enough to cause the extreme imbalance of DKA.
---
### Author:  [@jag1](https://forum.fudiabetes.org/u/jag1)
#### Post date: [September 22, 2020, 9:23pm UTC](https://forum.fudiabetes.org/t/levemir-giving-me-some-real-trouble-here/10245/54 "2020-09-22T21:23:40Z")
> [@john\_coburg](#):
>
> But what about NovoRapid & Levemir/Tresiba **& NPH**? Isn’t that the easier next step, vs a pump (which i don’t like the idea of anyway) ?
I think you should back up here and decide what your goal is. Having had T1 for 46 years I have used all these insulins and more, for more than a decade each. So if your goal is to test out all the different insulin formulations you haven’t tried yet, then by all means, add another one to the mix, since there are certainly benefits to knowing how you react to all the different insulins. I have done this and think it is a worthwhile exercise.
But if your goal is to simplify your insulin regime and achieve better control, then I would send you in a different direction based on my experience. It would require some changes to your eating patterns - but not change the foods you eat - only when you do it. Of course these may be specific to me, and may not help you, but I can go into detail if you’re interested.
Sorry, I don’t post here that much. I don’t check in often, and when I do I find my contributions are often lost or ignored. But I have had T1 for a long time, and my last A1c was in the low 5’s, and my G6 shows a std dev of 24 mg/dl, so I thought I would mention it in case it would be useful to you.
BTW, I would not be at all concerned about the different amount of Tresiba and Levemir that you have found you need. I found exactly the same thing when I switched from Levemir to Tresiba. In short, I found that I needed 30 units of Levemir (in two 15 unit doses, at waking and at 10pm) but only 20 units of Tresiba, full thread here: [https://forum.fudiabetes.org/t/anyone-interested-in-switch-from-levemir-to-tresiba/5780/3](https://forum.fudiabetes.org/t/anyone-interested-in-switch-from-levemir-to-tresiba/5780/3)
---
### Author:  [@Scotteric](https://forum.fudiabetes.org/u/Scotteric)
#### Post date: [September 23, 2020, 3:21pm UTC](https://forum.fudiabetes.org/t/levemir-giving-me-some-real-trouble-here/10245/55 "2020-09-23T15:21:03Z")
> [@john\_coburg](#):
>
> But what about NovoRapid & Levemir/Tresiba **& NPH**? Isn’t that the easier next step, vs a pump (which i don’t like the idea of anyway) ?
It’s possible, as I’ve said in many posts I’ve had good experience using Regular insulin (what you might call either Humulin I or Actrapid?). I have not really tried NPH. The issue with it may be that it is not known to be consistent from injection to injection since it is a suspension. Some people say that it will peak at different times each day, may not peak at all, or may have an extreme peak one day and a slight peak the next. This is based on anecdotal comments I have read from people who have used it though, I could be mistaken. I have found Regular insulin to be extremely consistent and effective in small doses, despite its bad reputation. @Eric’s advice to add Levemir may make more sense, given how consistent Levemir is designed to be from day to day.
---
### Author:  [@incidentals](https://forum.fudiabetes.org/u/incidentals)
#### Post date: [August 12, 2021, 9:01am UTC](https://forum.fudiabetes.org/t/levemir-giving-me-some-real-trouble-here/10245/56 "2021-08-12T09:01:04Z")
I was moved to levemir fron lantus to help with a dive in sugars at 3am regardless of of what I took or didn’t when going to bed at whatever sugar levels.
The idea was to give me more control over the day time,night time basal
My son who has been Type 1 a lot longer than me suggested most people over egg their basal so I reduced the intake a little and that has worked to give a better night time experience.
I have in the past had basal that simply put notched in the still increasing 45 degree line on my charts, that is to say for an hour my sugars dropped 4 units and then nearly instantly rise to where they would have been without the bolas.
Levemir gives me a roller coaster of a line on the chart rolling some 3 to 4 units every hour rather than the flat line I got with Lantus. Note the waviness is present in all traces regardless of angle (if that makes sense)
I of course have the dawn reaction and often arrive at breakfast with between 14 and 20 units present.
I was wondering if the waking rush of sugars is a possibility for the someone waking during the night to bolas a high sugar and is they are suffering the same “notch” effect as they bolas for a sharply rising excess of sugar, but are only “bolasing”(sic) for what is currently evident.
BTW what is HPH?
Just thinking out loud
[Previous page](https://forum.fudiabetes.org/t/levemir-giving-me-some-real-trouble-here/10245.md?page=2)