UPDATE: I no longer use Levemir basal insulin as I experienced an allergic reaction from it (painful, red injection sites).
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 scoop:
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.
Long acting cannot address something like the liver dump many have in early hours of AM. No matter when you take it even before bed, that insulin works too slow. Better off if your levels are high to take a small dose of fast acting after rising in AM and then a shot of long acting to even out the rest of day. Myself I do a little fast acting at lunch, then a good shot at dinner. Can’t do much to deal with dawn phenomenon because it happens, it spikes you and long acting was never developed to deal with it properly.
He says split it twice a day, no longer than 8.5 hrs apart
He says split it twice a day, but bedtime needs to be split too. So he’s saying three times. Most people who follow Dr. and methods agree that he means to describe three injections. The video is a bit confusing.
You are right. All this time I have done it wrong. Glad I came across your post. Thank you!!!!
Hope it helps! I’ve since stopped using Levemir. I developed an allergic reaction to it.
Why did you get off the pump? Just curious. And are you still using a cgm?
I decided to go off the pump because I was tired of always having it attached to me. Also, the costs are astronomical and I wanted to avoid this for a while after my move to the US. Still using my pump as a CGM though. Thankfully it doesn’t need to be in my pocket to continue receiving data. I can toss and turn all night without having to move my pump 😂👌
Dr. B in the video does not suggest three dosages of Levemir, unless I missed it? He said twice a day. Once upon waking up, and once at night before going to sleep. BUT, he said not to let the nighttime go for more than 8.5 hours, and if a child is sleeping for 10 hours, they will need it while they are sleeping.
Hi Scott. It’s a bit confusing because he says it should be split twice, but not every 12 hours, and that the nighttime dose needs to be split. So that is three doses. I know many people follow his lifestyle and book who split it three ways.
I didn’t hear that in the video. He says to split it twice, but that the nighttime dose won’t last but about 8.5 hours, so if you struggle with Dawn Phenomon you need to make sure to do the next dose no longer than 8.5 hours out.
He then gives the example of a child sleeping for 10 hours, they would need the MORNING shot, at 8.5 hours and if it can be given without waking them up, that’s great.
I didn’t hear 3 doses in the video anywhere.
Is there another video or article link I’m missing on it?
I guess I understand it as 3, and so does the whole Grit community on Facebook. He says Levemir will never last in just two doses (12h apart), and that nighttime will not last more than 8.5 hours. So the nighttime has to be split, effectively making that 3 injections per 24h. Does that make sense? I feel like him adding the gulf part just made it confusing. I’ll see if I can find clearer info!
I really liked my Levemir. I had to switch to Toujeo because of insurance.
Bummer. Is it working out with Toujeo?
Yes, it is doing ok