@Aaron, how many hours does levemir last for you? Do you inject once or twice a day?
@Kaelan - It depends how much I give
Right now I am doing 2 shots a day 12 hours apart - 7am and 7pm.
Before I started pumping I was doing 2 shots a day - one at 7am and one at 10pm. I gave more insulin in the morning shot. This worked ok.
When I first started levemir ~2006-ish I was doing one big shot before bedtime. It was probably lasting about 22 hours for me and I was probably covering the missing 2 hours with my dinner bolus. I probably did this for about 8-9 years. For me there was a minor improvement moving to 2 shots a day.
My son does 2 shots 12 hours apart and for him it seems to last fairly well.
Both my son and I tend to use more insulin/kg of body mass than the average person, so this is probably why levemir lasts for us fairly well. We are both over 0.4U/kg per day.
EDIT: I think about 3 shots, but I do not know if it will improve things much. I find most of my problems are not the number of levemir shots I take in a day, but instead are my body’s basal needs. For example, I need a lot of insulin when I get up in the morning, and I can’t cover this with levemir so I end up having to give a basal shot to cover.
@Aaron, thanks very much for the info and the curves.
I am also way over 0.4U/kg too, even in times of the year when my TDD is lower (summer). Does your son (or you) notice the sharper peak around 8-10 hours? It must be a bit sharper for people like us who use more insulin than average.
I need a lot of insulin in the morning when I go to school. When I go to school I often use a +30% temp basal until about noon, and lots of bolus insulin. If I go back to MDI during the school year I think it will be hard to manage. In fact it is really hard now with my pump on school days.
As an update to this topic, I chose the levemir option. My omnipod was expiring a couple days before my MRI so I decided to switch to MDI for a few days for “fun”.
I went with levemir at 7am and 7pm. To get the dose, I added up my basal rates for each of the 12 hour periods. To be cautions I did a 1:1 Fiasp basal to Levemir conversion. (My gut said that levemir should be 1.2 x the fiasp basal).
I pulled off the pod on morning and injected the levemir at the same time. I was concerned that the remaining fiasp basal may cause problems, but this was not the case and I ran higher in the morning - likely because of not enough basal - and I gave corrections. I will come back to this issue at the end of the post.
That night I bumped up 120% at 7pm and still was doing corrections. By the next day everything was fairly settled down on levemir and BGs were good.
I did notice that with levemir, I needed to give 2u of fisap when I got out of bed to handle the morning BG rise I get. This is usually handled by my pump basal. I also needed a bit of a snack at about 3pm to avoid a low later in the afternoon - which again is usually handled by a lower pump basal in the afternoon.
With the “flat” profile of levemir I need to deal with these issues that are normally handled by my pump basal profile which is annoying but not super annoying.
Switching back to the pump from levemir, I just put the pump when I would have taken the next levemir dose at 7pm. All night I had to keep doing zero temps basals to avoid going low and may have eaten some cookies . From this experiment I could tell that the 7 am levemir does was actually around in my system for about 24 hours after I injected it. It was most active for 12 hours but the second 12 hours there was still some there doing it’s thing. The next time I do this, I will probably do a 12 hour 50% basal to cover this effect once I put the POD back on.
We talk a lot about levemir being a ~12 hour basal, but for me it does last 24 hours - but it is definitely not a flat line for 24 hours - It is strong for 12 hours and then slowly goes away for the next 12 hours. What this means is when switching to MDI from the pump, for the first 12 hours, there is not enough levemir because the stuff left over from the previous night’s shot is not there yet. I need to do regular fisap corrections to replace the missing insulin. And when switching back to the pump there is lingering levemir for another 12-14 hours which I need to do a lower temp basal to give time for the levemir to get it out of my system.
Levemir still offers some adjustment at 12 hour intervals for me, but I just need to be aware that it does not stop dead at 12 hours.
Anyways - a nice bit of practice on switching to MDI for me and was very happy to get back to the pump because I have much better basal control.
Glad it worked out for you and was not an issue for you.
Was thinking of you this morning as I was deciding last minute, of course, how to handle my early AM MRI. I decided to take off the pod and do 16 units of Levemir (I’ve recenrly been at 19). I was a little concerned that, as I’d probably have an hour or so without coverage right as I was having my coffee, I would go high, so I decided to hit it with a big IM bolus. Then plummeted. 3 bananas, 2 bags of Welch’s fruit snacks, one applesauce, and one Oats and Honey Kind bar later, I went in for a 45 minute MRI and came back out at a 176! For me, that was like being blindfolded, sedated, and spun in circles and throwing a bullseye. Don’t know how. Don’t know why. Don’t know who. But I’m going with it and heading off for a run. To burn at least 2000 of those calories.
@Nickyghaleb, I am curious—why did you decide on a big IM bolus for an hour of coverage?
Also, what is your favorite IM injection spot, and what needle length do you use? IM is a bit hit and miss with us.
For a couple of good reasons as well as for one bad one.
In general, my mornings are tricky, and I have the potential for big, stubborn highs. Since I was taking the OmniPod off just before doing the shot of Levemir, I was concerned with that hour taking place at such a delicate time. I would’ve been less concerned in the afternoon or evening. Maybe I was wrong about whether or not there really was an hour uncovered, but since I believed it to be true, a bolus wasn’t a bad call.
The reason I did a big bolus— and I’m honestly talking about a total of 6 units (4, of which, is a standard coffee dose)— is because coffee also has the potential to send me very high. One of these factors alone would’ve been less of a concern, but I was thinking snowball effect and was hoping to head it off. My MRI blood sugars are also notoriously very bad. 4-500s. I had brain surgery many years ago, so I’ve put in overtime doing MRIs. They used to be 1-3 hours in duration. I’m telling you this because experiencing hypoglycemia inside that machine has always been a real fear. But I’m not the same person I was then, so a big shot it was.
That last reason was also the bad reason. Well, not bad— just poorly selected. My priority this morning didn’t have to be an excellent number if I didn’t have time to really think through a plan. I’ve just spent many years justifying highs, and I’m learning now to put in that effort (and take some risks) on the front end.
My thighs. Those are my preferred IM spots, and I agree that it’s hit or miss. I use calves next, but that doesn’t always feel good. I am currently using 8mm syringes, but I’ve purchased 13mm ones. Which sit in my cabinet untouched. They’re a little more intimidating.
That was a long answer.
IM insulin injections: what techniques work best for you?
@Michel, my procedure is on January 3rd so I don’t have an answer for you yet.
I think that this will be my plan:
Right before I remove my pod I am going to give myself a bit of the basal that I will miss during the procedure (unless my BG is on the low end). My basal rate is 0.4/hr, so I will give myself maybe 0.2-0.3 units. Afterwards, for as long as I am a bit woozy and can’t apply a pod, I will give myself some Humalog via syringe (based on my BG). As soon as I can I will apply a pod, which may be right away depending on how I am feeling.
Cross your fingers for me! I will let you know how it goes.
Sounds like a good plan!