Changing Basal Insulin - Observing what happens and hopefully providing some "lessons learned"


#1

As I’m changing from Lantus to Levemir for reasons documented elsewhere, I thought it may be helpful to others to keep a record of what I’ve been doing, steps taken and a variety of things that have gone on so that if others do it, they’ve got some idea of what to expect.
I’m not going to suggest that this is the 100% correct way to do this, but it will be my experience.

This isn’t the first time I’ve changed basal insulin. I moved from Insulatard to Lantus some 10 odd years ago, however this is the first time I’ve moved to one with greater hypo indication.

So let’s get started. First things first. Getting set up.

Having agreed to move to levemir, I was told that to start with, use the same doses as I used for my split lantus. This is 10u at 9am and 10u at 9pm. Many people who move in the same direction as I am find that Levemir requires larger doses, so we will see what happens.

Having taken Lantus at 10u the night before, I took the decision to not do the second split on the am following so that it would be flushed out before starting on the Levemir. I also have the libre so that I can keep tabs on what’s going on with my bg level, which helps a lot.

With these decisions made, I took my Levemir dose at 9pm yesterday, into my bum (first time in 26 years), and decided that as my blood sugar was in the 6 range, I still had a couple of hours of novorapid on board and I wasn’t sure what my reaction would be, I would take my bg level up to ~8 for safety reasons.

Then off to bed I went. Now I know I should probably have set an alarm to get me up in the night and test, but I figured that a hypo would be as effective at that, and with the dose I had taken, this felt unnecessary.

On waking this morning, a quick scan with the Libre revealed the following:

It would appear that the combination of 10u of Levemir and my bum has induced a noticeable decline in bg overnight. The drop is roughly 4mmol/l. I’m very pleased I had that extra carb the night before. Now clearly one day is not a pattern so I’ll be doing the same process this evening and following results tomorrow morning, I suspect it is likely that my evening Levemir dose will drop by two units.

Once we’ve got that one stabilised, it’s on to the daytime checks, with the associated fasting, which I am much less looking forward to!

The observation I would make is that the Libre continuous data is invaluable in this process and makes the whole thing massively easier (and means that I get to sleep properly as well!).