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Big mistake w/Levemir

Discussion in 'Parents of Children with Type 1' started by KHM, Nov 16, 2010.

  1. KHM

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    Ummmm... Lindsay has been getting all of her Levemir in one injection in the AM. For some reason I gave her the injection last night when I did her supper bolus. Ay Caramba! Up alllllll night trying to figure out why she was getting low alerts continuously. It wasn't till I had her test at 7 AM AND she was at 40 !!! That I figured it out.

    Advice on getting her back to AM routine and meal boluses today? I will definitely not give any this morning.... anyone?
     
    Last edited: Nov 17, 2010
  2. KHM

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    Bump

    Sorry for bumping my own post but I'm really needing some insight if anyone has something to offer...

    Thanks--
     
  3. mandapanda1980

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    My dd always got her levemir at bedtime to prevent nightime spikes. She was only on 1/2 unit though, when we first started her off at 2 units, which I was told was common for a 4 yr old, she ended up dropping low and seizuring with er visits. Now with the pump she gets hshe doesn't get a one sho dose of it....so I've never dosed in the morning to know how it effects your little one during the day. I definately wouldn't give the levemir today. Maybe give it like halfway between say 2am, and then the nect day be back to her regular am schedule? I dunno if that's still going to drop her before bfast....sorry :( hope there's better advice out there! Id try calling your endo as well...they've probably dealt with something similar before

    Hope you figure it out!
     
  4. 22jules

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    Sorry CA time here and just saw this--I would definitely call endo but I think you would give 1/2 dose tonight to get back to mornings. Just keep checking often today.

    Don"t beat yourself up, it happens.
     
  5. JeremysDad

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    Basal works for 24 hours. If you give a Basal in 12 hours to get her back on your schedule, give half of the dose which will cover her for 12 hours and not 24. This info came from our Endo. Other posters, feel free to dispute it if you need to.

    Before my DS went on the pump, I programmed my Blackberry to alarm every evening at 9:00PM. It became the running joke in my family. No matter where we were, as soon as my phone alarm went off, we all use to say in unison " Lantus Time!!"
     
  6. Emma'sDad

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    Ok, I'll dispute it! lol

    Here's my logic to my dispute. Levemir normally given at 8am, let's say 20 units for easy calculations and effect. Today, the injection wasn't done at 8am, but still has Levemir working from the night before and in a perfect 24 hour world, will end around supper tonight. You're suggestion to give half the dose tonight, so 10 units, would mean that by 8am, when KHM wants to be back on schedule, 5 units would still be working in her system. So normal dose of 20 units, plus the 5 units that are left would mean that Lindsay has 25 units of Levemir inside her at 8am. This means they would be chasing lows all day because the body only needs 20 units.

    So my suggestion is ride out the mistake until tomorrow's scheduled Levemir injection and correct with Novolog as needed. Giving Levemir at this point will just extend the situation.
     
  7. KHM

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    Thanks everyone. I think both approaches have merit and I have a few hours to decide if I'd rather chase highs tonight or lows tomorrow. I called my CDE... suffice it to say I value the insight here.
     
  8. GaPeach

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    If your endo was no help, I'll chime in on the above theory.

    I'll also use 20 units because the math is "pretty". The "oops" dose was given 12 +/- hours early. So, 1/2 of the previous dose was still working. Then, no dose was given in the AM.

    So using 20u, Original 8AM dose - 1/2 day = 10 units left.
    Then 20u more given at 6 to 8 PM(supper), would leave 30 units - causing lows because too high a concentration is working.
    1/2 would be "used" by 8AM leaving 15 units. Almost enough for a full day.
    HOWEVER, the "life" of the PM "oops" dose of Levemir will begin to diminish tonight so there is not really a full 5 units left by evening to last to tomorrow's next dose.

    If it were me, I'd give 1/4 a dose tonight or 5 units in this example. This would give 10u in theory although some of that will "fade" away before the next 12 hours is complete. Numbers may run a bit higher, but you can correct with Novalog in the AM and go back to the regular Levemir dose in the AM.

    *** So, I vote for 1/4 of the normal full dose tonight and regular dose in the AM. ***

    Let us know what you decide and how it plays out. Unfortunately, someone else will make this "oops" in the future and need to learn from your experience.
     
  9. Deal

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    I would think that during that night, starting about 2 hours after the 'bonus' shot you would see lows for about 12 hours needing about 25% of your normal Daily carb intake to treat. (assuming 50% basal/bolus ratio)

    Then for the next 12 hours your basal should be good. Now for the last 12 hours you would have basically no basal working for you. If you had access to NPH it would be a great option for this period. Two shots of just under 1/4 normal Levemir shot 6 hours apart would cover fairly nicely until morning when you could go back to your Levemir.

    Not a lot of sleep to be had as you recover unfortunately...

    GL with whatever you choose to do.
     
  10. GaPeach

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    Here is my "simple" version. Again, I am using a 20u dose as an example.

    20u AM plus 20u PM = 40u
    0u AM plus 5u PM = 5u
    Two day total = 45u
    Divided by 2 days = 22u - almost the correct dose and some of the last few u will have already been "used" up.

    Still voting for 1/4 the regular dose tonight and regular dose tomorrow AM.
     
  11. wilf

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    For what it's worth, this is exactly how we'd deal with this situation. :cwds:
     
  12. KHM

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    Each of these approaches are well reasoned, all would get us where we need to be soon. We did see a reasonable mid-day and evening with a slight rise as the evening has turned to night. Yes, I certainly had a lot of time last night to ponder my question and I'm sure tonight I'll spend evaluating my response. I'm going to go for 25% of daily dose tonight, full dose tomorrow AM. I'll update tomorrow pm when things should be returning to normal. Hopefully that will help the unfortunate others who may make my mistake in the future. I need some tags...

    I have to say--to no ones' surprise: these are collectively the best ideas I've heard today. I appreciate it much.
     
  13. GaPeach

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    Just curious -

    How did yesterday go?
     
  14. Emma'sDad

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    Ditto :) :)
     

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