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Help! CDE has us mixing levemir with R

Discussion in 'Parents of Children with Type 1' started by lrvesquire, Jul 7, 2009.

  1. lrvesquire

    lrvesquire Approved members

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    That is the newest suggestion from CDE. Levemir in the am and mixing r with it. This is to avoid two shots in am BUT he is coming in sky high at lunch, 391, today, 400 yesterday so apparently the R is not touching his sugar at all. We are so frustrated at this point i don't know what to do. Two shots in am?
    His current dosing is as follows:
    7 levemir and 1 r in am
    .5 r at dinner
    Now the other problem is that he has to get minimum of 60 carbs at night to avoid going low. he is 3.5 and weighs roughly 35 lbs. We have to feed his insulin at dinner and can't bring lunch down. We did not have these problems with NPH. Any thoughts or suggestions re: levemir and should we stick with it?:confused:
     
  2. danismom79

    danismom79 Approved members

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    My daughter gets 2 shots in the AM, one of which is Levemir. It does not peak like NPH. Can you request the NPH again? Do you still have any? Did you let your endo know what problems you're seeing? With Levemir he will need a shot for each meal.

    Also, if they switched him to Levemir, I wonder why they didn't also switch the R to Novolog or Humalog. Where are you located? Pushing 60g at night to prevent a low and feeding the R means the dinner R must be too high. How many carbs does .5u cover? He gets no R at lunch, but is coming down a lot from 400 by dinnertime?

    ETA: Can you post a sample day or two, with times, carbs, BGs, and doses? That will help people see what's going on a little better.
     
    Last edited: Jul 7, 2009
  3. Becky Stevens mom

    Becky Stevens mom Approved members

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    Hi Loren, that is way too much carbs for Devon to have to eat at supper, does he get a bedtime snack? I forget. I think hes probably going to need some NPH again to handle that lunch time, thats what he had it for in the first place right? the R wont last quite that long, long enough for morning snack maybe but not till lunch i wouldnt think. So they are having you mix levemir and R? hmmm didnt know you could mix levemir
     
  4. lrvesquire

    lrvesquire Approved members

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    numbers and doses per request

    7.4:
    630am: .5 r/9 levemir
    BG: 382
    carbs: 50ish
    1015am:
    bg: 600 plus
    1100
    bg: 544
    500: 171/no insulin/50 grms carbs
    800: 409/no insulin no snack
    7.5
    630am: .5 r/9 levemir
    BG: 74/90
    carbs: 50ish
    1015am:
    bg: 398
    1100
    bg: 297
    500: 81/ no insulin w/50 grms car
    800: 256/no insulin/7 gms snack
    7.6
    630am: .5 r/9 levemir
    BG: 91
    carbs: 50ish
    1015am:
    bg: 416
    1100
    bg: 438
    500: 159/.5 r w/61 grms car
    800: 81/no insulin/21 gms snack
    7.7
    630am: 1 r/7 levemir
    BG: 223
    carbs: 50ish
    1015am:
    bg: 495
    1100
    bg: 391
    500: 350/.5 r w/61 grms car
    800: 140/no insulin/21 gms snack
    Tomorrow my plan is r and levemir separate shots. .5 r and 9 levemir. He gets r because of the delay between shot and breakfast. We give the minimum r at dinner and have to feed it each time with at least 60. it stinks. so i am about done with endo and going to adjust accordingly.
     
  5. Charliesmom

    Charliesmom Approved members

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    I won't pretend to be as knowledgable as others on this site but in my opinion he is getting too much Levimer and not enough R. That is a lot of carbs that he has to eat to keep from going low at night. To me that's a sign of too much Levimer. Charlie was on Lantus/Novalog when he was 3 1/2 years. He got 4 units of Lantus and 2 1/2 u Novalog for about 45 carbs for breakfast. He is insulin resistant in the am. Was 37 pounds.
     
  6. Becky Stevens mom

    Becky Stevens mom Approved members

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    Steven was on NPH and humolog at dxd he was 32 lbs and had 3 units of NPH in the AM with just a little humolog mixed in like 1/2 a unit usually then at supper he got 1 unit of NPH with just a bit more humolog mixed in that would cover him all day and night and he didnt need a lunch time shot , he had to have a snack in the afternoon and at 7:30 at night to catch the NPH peaks. I think that the endo should have left the NPH in there. I wonder if thats why hes going high all day now. The levemir isnt supposed to cover food its just supposed to provide basal. Why wouldnt they want Devon to try lantus? I think your right Loren, time for another endo
     
  7. Nancy in VA

    Nancy in VA Approved members

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    I find it hard to believe a child that age that 1 unit of R would cover 50 carbs for breakfast, thus the super high numbers.

    There also might be arguments for separation of levemir and Regular for better absorption.

    Regular should be given at least 20 minutes before eating, better to be 30 minutes. Its a medium acting insulin so you need to give it a head start. The highs could be coming because the Regular hasn't caught up with the food yet.
     
  8. Melissa

    Melissa Approved members

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    We just moved from Humulin-R & Lantus back to Humalog & Lantus 2 weeks ago.

    Just as a point of reference:

    Maddie is 32lbs, 3.5yo. She was getting 4.5 Lantus in the AM. Then for her R we had a carb correction plus BG correction for breakfast, lunch & dinner.
    .5units per 15g
    0-180 = no correction
    181-299 = .5
    300+ = 1

    She nornally eats about 30-45g per meal. We would give her the shot about 20mins before eating. I would test, give shot, then make her meal

    She would also get a morning & afternoon snack of 15gs and a 15g snack before bed.

    This is the same plan we are doing now with Humalog but our carb correction is a little different.


    Hope this helps! Give it time. It takes us about 2 weeks to learn a new type of I.
     
  9. danismom79

    danismom79 Approved members

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    Yes, please separate the Levemir into its own shot. And I'd either go back to the NPH routine, or ask the endo for a fast-acting insulin. Regular can only do so much. It tends to linger, so if he's getting it for dinner, it'll still be working some after bedtime. Having a fast-acting (Novolog or Humalog) will also help with correcting those highs. You should have a correction factor by now.
     

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