I recently stopped using my insulin pump and went back to MDI. I use vial and syringe now. It was hard to give up such great control, as my basal insulin was perfect on my pump. I’ve had to re-learn how to use Levemir and this time around is a lot different than when I used it six years ago. Prior to having an insulin pump, I used Levemir and injected it once a day. Now I am splitting it and injecting three times a day. But why?
First, I want to touch on why basal insulin is so essential. Basal insulin, or known as long acting insulin, is given to ensure that blood sugar stays level throughout the entire day, regardless of fasting or eating. If you don’t use enough basal, blood sugars will trend high during the day. If there’s too much basal, blood sugars will trend low. Therefore, it is imperative that basal is dosed correctly so that blood sugar stays level. Theoretically, blood sugar should stay level while fasting and not require food to keep it up. Read here on how to run a basal test.
Now, here’s the controversy:
I split my Levemir (long acting, basal insulin) three ways; not just one shot in 24 hours as directed by the manufacturer.
At first, I started to use Levemir twice a day, morning and night. I originally thought that this would be okay, since my basal needs barely changed throughout the day while I was using my pump. I quickly learned that this was not going to work. My daytime basal insulin worked just fine, the shot I gave in the morning. But the shot I took before bed, for nighttime, was not working. I would rise sometime between 2:00 and 5:00.
As it turns out, Dr. Bernstein suggests splitting Levemir basal insulin three times in this YouTube video on his channel, Diabetes University. He also suggests that Levemir will not be effective longer than 8.5 hours during the night (minute 7:45 of video). This is exactly what I experienced. I would give my injection around 19:30 and rise anywhere from 2:00-5:00. I knew it wasn’t Dawn Phenomenon, as I haven’t experienced this in YEARS. I knew after watching the video that it was the Levemir wearing off.
So I recently came up with a new schedule for my Levemir three shot coverage and it’s working! Here’s what I do by following Dr. Bernstein’s method:
When I wake up, I take my normal, full Levemir injection for the daytime. In the evening, around 19:30, I take HALF of my Levemir nighttime injection and then take the other HALF at 2:00.
One thing that has really saved me time and energy is pre-filling the syringes with the amount that I need, especially for the 2:00 shot. By doing this, I can get up, half asleep, and take the shot without any major sleep issues.
So that’s how I worked through trial and error to find the right basal splitting to meet my insulin needs.
P.S. It goes without saying that any change like this should be discussed with your healthcare team. I chose not to do this, but it’s a choice I am comfortable with and I hold all liabilities for myself and myself only.
P.S.S. It’s important to remember that these times are MINE and you will more than likely require different times to inject!
P.S.S.S. Another huge disclaimer, I have only tried this with LEVEMIR and cannot give any thoughts on other basal insulin.