# Should I lower my Levemir dose?



## drahawkins_1973 (Apr 26, 2013)

I'm recently diagnsoed as type 1 diabetes. I am currently taking 10 units of levemir long acting insulin with my pre-dinner Novarapid dose at about 6:30 in the evening. For the first week after my diagnosis my levels seemed to be levelling out all through the day but over the past 3 days I have been getting low sugar readings at about 10 am in the morning (3.8-4.3). This is about 3-3.5 hours after my breakfast insulin. My pre-bedtime readings have been slowly dropping over the past few days and last night I awoke at about 2am with a sugar level of 3.3. Do I need to drop my Levemir to say 8 units in the evening?

My sugar reading at 2hours after eating all seem to be good within 6-9.

Any advice welcome.

Thanks
Andrea


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## Northerner (Apr 26, 2013)

Hi Andrea, welcome to the forum  Are you on fixed doses for your novorapid? What is your level before breakfast?It sounds to me like your breakfast novorapid might be slightly too high for what you are eating rather than a problem with your levemir. The levemir is intended to 'cover' the glucose trickled out by your liver rather than any food consumed, and the novorapid covers the food. Novorapid can last for up to 5 hours, so although most of it will have gone by 3.5-4 hours, there is still a possibility of you dropping further. Are you still being advised by your DSN about dose adjustment? If so, give them a call and ask if you should reduce your breakfast dose, and by how much. As people vary so much in their insulin requirements it's not possible to give advice on amounts without full knowledge of the person's normal requirements.

Have you been told about carb counting? This is a way of calculating your dose according to the carb content of your meals. As it is very early days for you still, it is likely that you will still need to be in contact with your team for adjustments.

When I was diagnosed I found that the initial doses I was given from the hospital had to be rapidly decreased, and within a few weeks I was on much less overall, so you should probably expect the same for a little while. How did you come to be diagnosed?

I would highly recommend getting a copy of Type 1 Diabetes in Children, Adolescents and Young People by Ragnar Hanas, it will explain so much for you, and I wish I had known about it when I was first diagnosed!


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## drahawkins_1973 (Apr 26, 2013)

Hi Northerner,

Thanks for your quick reply!

I havent had a follow up meeting with my DSN so am but I'm trying to carb count given by advice on the internet.  My levels before breakfast have been dropping over the past few days 6.9 to 6.4 to 4.7 yesterday.  I have dropped my Novarapid level before breakfast from 6-4 and eating the same food to try to counteract the lower levels in the morning but it doesnt seem to have made any differnence. 

I also lowered my pre-dinner Novarapid from 6-4 but again I still seem to be dropping after about 3-5 hour.  I ate the same dinner for the 2 evenings to see if I was taking too much rapid acting comapred to what I was eating but again I was lower last night hence me thinking it was the long acting.

I think you're right I should probably call the nurse to get some advice as I stilltrying to learn and understand what I should do.

Thanks for the link to the information 



Northerner said:


> Hi Andrea, welcome to the forum  Are you on fixed doses for your novorapid? What is your level before breakfast?It sounds to me like your breakfast novorapid might be slightly too high for what you are eating rather than a problem with your levemir. The levemir is intended to 'cover' the glucose trickled out by your liver rather than any food consumed, and the novorapid covers the food. Novorapid can last for up to 5 hours, so although most of it will have gone by 3.5-4 hours, there is still a possibility of you dropping further. Are you still being advised by your DSN about dose adjustment? If so, give them a call and ask if you should reduce your breakfast dose, and by how much. As people vary so much in their insulin requirements it's not possible to give advice on amounts without full knowledge of the person's normal requirements.
> 
> Have you been told about carb counting? This is a way of calculating your dose according to the carb content of your meals. As it is very early days for you still, it is likely that you will still need to be in contact with your team for adjustments.
> 
> ...


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## Northerner (Apr 26, 2013)

drahawkins_1973 said:


> Hi Northerner,
> 
> Thanks for your quick reply!
> 
> ...



This does sound so much like my own experience. It sounds to me like you are doing a great job, and from what you say then the levemir may need reducing as well since your fasting/pre-meal levels are falling. I originally started on 20 units of lantus (similar to levemir) and 45 of novorapid a day, but after a couple of weeks I had reduced to 14 lantus and about 35 novorapid. It can be a tricky period but you are getting to grips with things and understanding things well - just make sure you always have a hypo treatment to hand, and it may be worth doing some tests in the middle of the night to see how you are doing then - 3 am (I know!) is usually the time that our levels are the lowest in the night, and it gives you some idea of what is happening.

Let us know what your nurse advises!


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## drahawkins_1973 (Apr 26, 2013)

I spoke to my DSN and as you suggested she advised me to lower my morning Novarapid a little and to reduce my evening Levemir 2 units so hopefully that will sort me out!

Thanks!


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## Northerner (Apr 26, 2013)

drahawkins_1973 said:


> I spoke to my DSN and as you suggested she advised me to lower my morning Novarapid a little and to reduce my evening Levemir 2 units so hopefully that will sort me out!
> 
> Thanks!



Sounds good! Hope it does the trick!


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## drahawkins_1973 (Apr 29, 2013)

Hi again,

Followign  everyone advice I lowered my morning novarapid dose and also my Levemir dose that I take with my evening meal.  However I'm still low before lunch (4.1) and yesterday evening I dropped 5 mmol (8.3-3.3) within 1.5 hours of eating.  I hadnt eaten anything particluarly different from other evenings or done any physical exercise so am a bit confused.

Is my body making its own insulin when I inject, is this the infamous Honeymoon period I have read about?? should I continue to lower my doses?

Thanks for all your help, really appreciate being able to talk to everyone about this!
Andrea


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## Northerner (Apr 29, 2013)

drahawkins_1973 said:


> Hi again,
> 
> Followign  everyone advice I lowered my morning novarapid dose and also my Levemir dose that I take with my evening meal.  However I'm still low before lunch (4.1) and yesterday evening I dropped 5 mmol (8.3-3.3) within 1.5 hours of eating.  I hadnt eaten anything particluarly different from other evenings or done any physical exercise so am a bit confused.
> 
> ...



What are you waking on now Andrea? If your waking levels are good then it looks like you need to lower your novorapid doses a little more, assuming you are eating a similar amount of carbs. This is basically what I did originally (and still do to some extent!) i.e. if I found I was going low a couple of hours after eating then the next time I ate that meal I would use less novorapid until I was happy with my post meal levels. The same really with my long-acting (I used lantus) - if I was waking low, or waking much lower than I went to bed on meaning my lantus had dropped me a lot overnight, then I would reduce the lantus.

Unfortunately, things do change over time, so possibly just when you think you've got things sorted things will change again just to keep you on your toes!


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## drahawkins_1973 (Apr 29, 2013)

Thanks Northerner. Think I will just lower my novarapid and see how I get on.  I'm sure I'll get there eventually


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## Northerner (Apr 29, 2013)

drahawkins_1973 said:


> Thanks Northerner. Think I will just lower my novarapid and see how I get on.  I'm sure I'll get there eventually



You're already doing really well Andrea  The main thing you are lacking at the moment is experience, which means that things will be frustrating at times, but you will build on each discovery and gain confidence as time goes on


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## drahawkins_1973 (May 3, 2013)

Just a quick update.

I gradually lowered my levemir dose and am now taking 7 in the evening.  This seems to be working really well for me.  My pre-meal levels are around 5 -6 and my bedtime about 7.  I've been getting much better consistency over the past 3 days so feeling much more in control now.  

thanks again for the advice


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## Northerner (May 3, 2013)

drahawkins_1973 said:


> Just a quick update.
> 
> I gradually lowered my levemir dose and am now taking 7 in the evening.  This seems to be working really well for me.  My pre-meal levels are around 5 -6 and my bedtime about 7.  I've been getting much better consistency over the past 3 days so feeling much more in control now.
> 
> thanks again for the advice



That's terrific news Andrea! Hope it continues to behave!


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## fencesitter (May 3, 2013)

Sounds like you're really getting on top of things, good for you  Do watch out for the honeymoon though, my son had a very strong one for about 9 months which began kicking in about 2 months after diagnosis. At one point he was on 2 units of Lantus and 1 unit of novo for every 75 grams of carbohydrate!!!


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## drahawkins_1973 (May 8, 2013)

Thanks for the heads up Willsmum.  After being pretty stable for quite a few days I have had to lower my levemir again!  Its quite a frustrating time as as soon as I seem to be doing ok I have to adjust things again.  I guess I just need to keep testing and changing my doses as I need to.

This diabetes thing likes to keep you on your toes doesn't it. I think the worst thing is that no-one can tell you how long this goes on until you stabilise as everyone is different but I'm staying positive and tryng to just deal with thigns as they come along.

Did you find that the honeymoon period stopped quite suddenly or just that levels started to rise over time (just so I know what to look out for)?


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## delb t (May 8, 2013)

I think no two people are the same !They say we are still in honeymoon 17 months on-we still have to tweak ratios and lantus still- you sound really on top of it! well done you. Id be interested too-to know the honeymoon ending signs from those who have been there done that for future ref


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## fencesitter (May 9, 2013)

In William's case it was a gradual increase, maybe over a period of six months. He seems to have fairly steady requirements now. He's a teenager though, so that probably affects things too. Might be different for someone past all that hormonal stuff  I think you do just have to be vigilant about testing. For his Lantus, he relied on his morning readings for clues and if they were consistently a bit high (ie. for more than a few days) he upped his dose. He didn't always get that right though as there was a period before Xmas when he was having too many hypos, so he dropped it again. I do think hormones played a role there as he's grown about a foot in the last two years


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## fencesitter (May 9, 2013)

As far as Novo is concerned, it's a similar thing - look for patterns in your test results, particularly 2 hours after eating/injecting. William has been quite fed up with testing so in practice he was looking at his readings before the next meal. Seemed to work well enough, but it might not be the same for everyone.
Right now he hardly tests at all, which is another story, but he does seem steady when I push him to do it, and he does seem to catch hypos. The next hba1c will reveal all ... He will probably start testing again shortly as he has an appointment in early June and likes to avoid a telling off from the consultant!! Also doing his GCSEs and seemed to agree with my point that steady sugars would help him keep a clear head. He is away at school during the week, so I can't hassle him too much which is probably just as well.


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## drahawkins_1973 (May 10, 2013)

Hi Willsmum,  thanks for the info.

I do feel for you, it must be difficult making sure a teenager is doing regular testing.  As I'm still new to this and a little bit older  I am quite vigilant about testing but I can really appreciate it might not have been the same when I was younger.

Hope the exams go well!


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## Tina63 (May 11, 2013)

Willsmum said:


> He will probably start testing again shortly as he has an appointment in early June and likes to avoid a telling off from the consultant!! Also doing his GCSEs and seemed to agree with my point that steady sugars would help him keep a clear head. He is away at school during the week, so I can't hassle him too much which is probably just as well.



Just a head's up here Catherine, please do impress on him the importance of testing before an exam.  We were told that if my son failed exams due to diabetes issues, having a full range of recorded BG levels was vital.  Not just handwritten, but proof from a meter with a memory, or if you can download them, even better!  We don't have that technology, nor as you know, the figures on a meter to prove anything anyway!  If you did need exam results tweaking though, they would need proof of BG levels before, during and after.  Might encourage him to test a bit more maybe.......

And Hi and welcome to the forum Andrea.  

Sorry to have hijacked your thread.  You sound like you are doing really well.  I can't answer the question about the honeymoon period as my son went into full rebellion 9 months in and we have horrendous HbA1cs now.  All I can say is that he started on a total daily insulin dose of around 55 units, it came down to around 48u and is now up to 80u and rising! (2 years and 4 months after diagnosis now)  Everyone is so different.  Some people use minimal doses, others use what seem dramatically large doses, it's so very individual.  As long as you keep testing regularly you will notice patterns and as and when you get consistenly low or high morning readings, you will know it's time to tweak things.  As other will tell you, there is no exact science in all of this, so many thing will affect you, exercise, illness, even the damn weather (too hot or too cold) so you just have to look out for patterns and bit by bit build up a strategy to cope with each new situation.  Don't be afraid to phone your DSN regularly though.  As my son was technically a child at diagnosis (almost 16) we had amazing early care, home visits, phone calls daily (twice daily to begin with) but the impression I get is that if you are diagnosed as an adult, you are just thrown out of hospital and expected to get on with it.  It's such a complex condition and there is so much to learn.  Be a pain to your DSN if you have to, but you do need support in the early days and weeks.  GPs seem to know next to nothing about it unless you are really lucky, so use your diabetes team as much as you need to.

As you are on fairly low doses, I do wonder if you have been given a half unit pen?  It might be worth asking your DSN for one if not.  You may get to the point where lowering by a whole unit is too much, but a half unit change may suit.  I do remember with my son in the early weeks we just had him stable for a couple of weeks, then he would start having hypos, so after 3 or 4 the DSN would alter his evening Lantus, then it would settle again for a few weeks then start causing hypos again, so she would alter it again.  

Good luck with it all, you do sound like you have made a really positive start.  Well done.

Tina


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## drahawkins_1973 (May 11, 2013)

Hi Tina,

Thanks for the advice.  I didn't realise that you could get 1/2 unit pens.  I think this would really help as I do often find that one unit can be too much but if I drop it down one then its not enough, so 1/2 I think would be perfect.

I have my 6 week follow up meeting with my DSN in a week so I'l be sure to disucss this option then.


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