# Basal (Levemir) Dosage



## Tom1982 (Jul 19, 2022)

Hello all.

Since Josie came out of hospital her Levemir dose has been 4.5 units. How do we know if that’s right? Any signs? How do we know if it should be increased?


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## helli (Jul 19, 2022)

Basal should hold our levels stable in the absence of food, exercise, etc.
If Josie is taking one dose of basal each day, the easiest way to tell if it is right is whether her levels remain reasonably stable throughout the night. If they go down between going to bed and waking up, her basal dose is too high. If her levels rise, her basal dose is too low.
Bear in mind this should be a typical day or average of days. Given the hot weather is playing havoc with many people’s insulin resistance/sensitivity, I would not consider this week to be typical.


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## SB2015 (Jul 19, 2022)

Hi @Tom1982 this current weather is not going to give a realistic picture of what is going on, with all this excessive heat, so perhaps wait for more usual weather to monitor this.

Is Josie on one basal injection each day or is it split?
Checking overnight level changes gives a good measure of the correct dose.  
During the day our basal is mingled in with meal boluses and correction doses so more difficult to check.  We would do fasting checks but I would suggest talking to Josie’s team about what they would advise for children.


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## Tom1982 (Jul 19, 2022)

helli said:


> If Josie is taking one dose of basal each day, the easiest way to tell if it is right is whether her levels remain reasonably stable throughout the night. If they go down between going to bed and waking up, her basal dose is too high. If her levels rise, her basal dose is too low.
> Bear in mind this should be a typical day or average of days. Given the hot weather is playing havoc with many people’s insulin resistance/sensitivity, I would not consider this week to be typical.


I’d say it’s possibly too low then. She’ll go to bed at say a 7.0 and wake up at 12.5. This has been happening for a while now. Do we just increase it by 0.5 and see how we go?


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## helli (Jul 19, 2022)

Tom1982 said:


> I’d say
> 
> I’d say it’s possibly too low then. She’ll go to bed at say a 7.0 and wake up at 12.5. This has been happening for a while now. Do we just increase it by 0.5 and see how we go?


I cannot (and should not) advise on dosage . It should be your diabetes team but I understand from your other posts they are not very responsive. In which case, if it was me, I would increase the dose by the minimum possible (0.5 units) and monitor closely for a few weeks.


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## rayray119 (Jul 19, 2022)

Tom1982 said:


> Hello all.
> 
> Since Josie came out of hospital her Levemir dose has been 4.5 units. How do we know if that’s right? Any signs? How do we know if it should be increased?



If she gets a few days in a row of unexplainable  highs that might be a sign that something needs to change


Also though what are her carb ratios and do you know if those are okay


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## Tom1982 (Jul 19, 2022)

helli said:


> I cannot (and should not) advise on dosage . It should be your diabetes team but I understand from your other posts they are not very responsive. In which case, if it was me, I would increase the dose by the minimum possible (0.5 units) and monitor closely for a few weeks.


Lovely thank you. Will try that and see. The team do there best but they seem a bit stretched, not really been much help to us.


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## rayray119 (Jul 19, 2022)

Can I ask is she only Livermir once a day?


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## rayray119 (Jul 19, 2022)

rayray119 said:


> Can I ask is she only Livermir once a day?


Oh I now see that's already been asked.


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## Tom1982 (Jul 19, 2022)

rayray119 said:


> Can I ask is she only Livermir once a day?


Oh yeah sorry, it is only the one a day for the Levemir. Do some people have two?


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## Inka (Jul 19, 2022)

Tom1982 said:


> Oh yeah sorry, it is only the one a day for the Levemir. Do some people have two?



Most adults do, I think, but I don’t know about young children.


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## rayray119 (Jul 19, 2022)

Tom1982 said:


> Oh yeah sorry, it is only the one a day for the Levemir. Do some people have two?


As @Inka says most adults do as Livemir doesn't really ask for 24 hours but that could different for small children as there small @everydayupsanddowns has a graph somewhere about the length of Livermore doses lasting(I myself couldn't really get my head around it but you might be able to)


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## everydayupsanddowns (Jul 19, 2022)

It’ll be this one from the former DSF I think - which you read by units per kilo of body weight. 

A bit mind-bending but interesting once you find your way around it.


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## Tom1982 (Jul 20, 2022)

everydayupsanddowns said:


> It’ll be this one from the former DSF I think - which you read by units per kilo of body weight.
> 
> A bit mind-bending but interesting once you find your way around it.


So I’m just doing a rough calculation and it goes like this: her weight in pounds (56) divided by 4 (why is it divided by 4) which gives a total of 14. So 56 divide by 4=14. This is actually about right for her standard daily intake. And the Basal should be 50% of that? So 7 units of Levemir at night??? That sound right? She’s still on 4.5 since diagnosis.


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## everydayupsanddowns (Jul 21, 2022)

everydayupsanddowns said:


> It’ll be this one from the former DSF I think - which you read by units per kilo of body weight.
> 
> A bit mind-bending but interesting once you find your way around it.



forgot to add the link 



			https://forum.diabetes.org.uk/boards/threads/levemir-activity-graph.97469/


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## everydayupsanddowns (Jul 21, 2022)

Tom1982 said:


> So I’m just doing a rough calculation and it goes like this: her weight in pounds (56) divided by 4 (why is it divided by 4) which gives a total of 14. So 56 divide by 4=14. This is actually about right for her standard daily intake. And the Basal should be 50% of that? So 7 units of Levemir at night??? That sound right? She’s still on 4.5 since diagnosis.



I don’t think anyone here is in a position to comment on specific doses suggested for any one person - least of all a child - we only have our own experiences to go on.

There are some ‘rule of thumb’ calculations that can be used to try to estimate starting doses, but I am only aware on ones based on data for adults. And in my experience these are only ever a starting point - not a hard and fast ‘correct’ dose.

If you have concerns about the doses and numbers you are seeing, I think the best bet would be to discuss your worries with her DSN, and work out a plan of how to tweak and titrate the doses in a safe and cautious way?


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## helli (Jul 21, 2022)

Even as an adult, I would be incredibly reluctant to increase my basal by so much in one go. 
These "rules" are guidance and don't take into consideration things such as how active someone is. 
For myself, I have never used them but adjusted my dose by minimum increments when they are proved not to be correct over a period of time.


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## rayray119 (Jul 21, 2022)

Yes when I feel like I need a change I do it half an unit of at a time.,(I would probably even do smaller if I could)


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## Inka (Jul 21, 2022)

I ignore all those rules mainly too. Firstly, they’re based on Mr/Ms. Average, and there’s a lot of variation between people; and secondly I know they don’t work for me as my basal to bolus ratio has never been 50/50. If I adjusted my basal to fit that, I’d be hypo’ing and in danger.

Think of it like this @Tom1982 What’s the clothes sizes and measurements of an average man? When you go clothes shopping, do you use those measurements or do you actually go for what fits *you* as an individual? Insulin is a bit like that - it’s what works for *your daughter* not what the average is or according to a rule that might not apply.


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