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Here I am changing my insulin regimen again. It seems that DM1 is an advanced course to how to deal with changes in your life!!! The situation now is that after using NPH for so many years I’ve started some months ago with Levemir. The simple fact that it was an ultra-long acting insulin and therefore that I could have 1 injection instead of 2/day was for me more than enough to take this step. I really had the feeling that my life was getting easier…But…my HbA1c did not respond well to it and also my BG pre-dinner was incredible getting high. To compensate this high pre-dinner BG I had to use more rapid acting insulin with the consequence that I’ve started to have more nighttime hypos! Nightmare , literally and figuratively meaning! So now my doctor suggest we split the dose and here I am changing my Levemir! Any advice is appreciated! Specially about how do I do with splitting the dose, I currently inject 42U/day.

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Hello! What you are experiencing is very common. So many people that injects Levemir at night have this, while people who injects in the morning usually wake up with higher BG levels and correct them with the pre-breakfast rapid acting insulin injection (at least they have less risk oh night hypo). The fact is that for some people the levemir works good the first 20 hours and in the last 4 hours they have higher BGs.The way you will split the insulin of course you will discuss with you doctor, but I tell you that the most common is 50/50. So if you take 42/day you will do 21/21. A lot of people repot that the bg control really got better with the splitting. But be aware that even with the splitting you will still have 2 period of 4 hours where your basal BG can be higher. For example if you take it at 8am this first dose will act well until 4am next day but then  from 4-8am you will have less effect from the first dose . But instead of having no effect you will be having the effect of the night dose (the 20.00h dose). The end of the effect of the night dose will be around 16.00h but here again you won’t be completely uncovered because you will have full effect from the morning dose. Did you get it? It’s at the end as you’ve said all about making changes and adjusting dose throughout of your life. 

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