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R, NPH and Levemir Nightmares HELP!!!!! I can't take it anymore

Discussion in 'Parents of Children with Type 1' started by lrvesquire, Jun 27, 2009.

  1. lrvesquire

    lrvesquire Approved members

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    Ok so we are not new to diabetes. In fact my 3.5 year olds dx date is 7.5.07. We started out on a nph and r regime based on the fact that he goes to daycare and i have to give him his shot at 630 but he doesn't eat breakfast until 83o (he does get a snack before he goes to cover him until breakfast).
    He gets the following:
    615 am .5 r and 9.5 n
    515 pm .5 r
    800 pm .5 nph
    then we went to the endo and she switched him to .5 levemir at night for no peaks. Then his lunch numbers started going low, like 34 and 54 etc. So the latest thing we have done (per the cde) is if he dinner number is good then no r, but .5 levemir any way. Then we cut the r at breakfast. But he has had a few lows from the levemir in the AM. Last night 244 at bed and this am 70. WHAT THE Heck is going on, :mad:
     
  2. Amy C.

    Amy C. Approved members

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    NPH and regular are tough insulins to match with the food eaten. You need to be aware when the insulins given kick in.

    R is strongest two hours after the injection and lasts about 5 hours.
    NPH is strongest 4-5 hours after the injection and lasts about 8 hours.
    Levemir slowly raises the sugar and lasts about 14 hours.

    You have to eat the right amount of food at the right time to match the peak of the insulins to avoid a low. If your son is always out of range at a certain time, change the insulin that is most effective at that time or add a snack.

    This insulin schedule your son is on is quite rigid. If your son doesn't eat the right amount of carbs, he will be out of range.

    Many people have switched from NPH and regular to a fast acting insulin like Humalog, Novalog or Apidra at meals with a long acting insulin like levemir or lantus.
     
  3. selketine

    selketine Approved members

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    There is another poster named Wilf (board name) that is familiar with these insulins and often posts when there are questions about them. Perhaps look up the board name and send him a PM or email if he does not see this post.
     
  4. wilf

    wilf Approved members

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    Interesting combination of insulins.. :rolleyes:

    I have some questions for you:

    1) How much does your son weigh?

    2) Was everything working well back when he was getting .5 NPH in the evening? If it was, then why not just switch back?

    3) Do you ever test overnight?

    4) Why not give him breakfast at home (6:30 am) and a snack at daycare (8:30 am)?

    I think I may have some useful ideas, but I'd like to see your answers to these questions first.. :cwds:
     
  5. Chrissy

    Chrissy Approved members

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    Good info above and surely more to come...

    I suggest a food diary, then you can see how foods interact with your child.
    ie: goldfish crackers cause a food spike, balance bars keep things level between breakfast and lunch, etc
    I find it helpful.
     
  6. lrvesquire

    lrvesquire Approved members

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    Devon weighs 35 lbs.
    My husband and i dont really think there was a problem on n but the endo didn't like his number in the am. He has only been on it since 5.22.
    We test overnight if he is below 150 at bed. He usually peaks but has gone low on the levemir twice. Once at 330 from a 151 at bedtime and once at breakfast with a 244 night before.
    It is very important for him to be like the other kids and eat with them plus he eats wonderfully for them whereas it is a battle with me. I also have a 5 month old to rangle in the am as well.
    We have been playing with the endo lately re: his numbers and doses. Today he got no r at dinner and was 220 at bedtime.
    SO i will see in the am. Any thoughts would be great. please feel free to pm me or post here
     
  7. wilf

    wilf Approved members

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    Thanks for this further information.

    Based on what you've posted, he is not honeymooning at this point though still maybe producing some of his own insulin.

    I would like to hear more about the rationale for the switch to Levemir - what were his waking numbers on the Levemir, and what are they now?

    You didn't say whether you were testing overnight.

    How many carbs are his early-morning snack and his breakfast?

    In terms of my thoughts at this point:

    1) Overall, my sense is that the morning NPH dose is pretty high. It maybe has to be (since it's trying to cover breakfast and lunch), but I don't think this will be workable over the longer term.

    2) It is VERY difficult on injections to try to bolus for a meal that is to be eaten 2 hours later. There is no insulin that can really do the job - Regular peaks too soon, NPH peaks too late, and nothing else is available to do the job. You current approach of using a mix of Regular and NPH is the only possible one that could work, but I have my doubts as to whether you will be able to make it work going forward.

    3) If it were my DD and if there was no way to change the eating schedule, then I'd be doing a LOT of testing on weekends (keeping to the same carb and injection schedule) to try to figure out how well the current regimen is working and where it needs to be tweaked.

    But if it was my DD I'd also switch things around like I said in my last post - giving a small breakfast at waking and a big snack with the kids.

    4) If there's lows happening, it's not the 1/2 unit of Levemir that's the cause. It's the 9.5 NPH. NPH is known for being quite unpredictable at higher doses (for us, it gets very quirky above about 7 units in a single injection), and so I would be working with your endo to reduce the morning NPH somehow.

    I wish you good luck! :cwds:
     

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