I think you're smart to do smaller injections. Until I found this site, I had never heard of injecting Lantus in multiple shots nor ever heard of Levemir. If I were staying with MDI, I would now be looking into breaking the injection into smaller multiple doses.
When it happened, I had not taken a bolus since almost 5 hours before that and it was only 0.5 unit of Humalog. I agree that splitting the basal doses sounds to be the best route though given my experience last night.
well, i'm just glad you're OK...!
I wish I were better at being the positive and supportive type, but I'm not. =/
Every diabetic goes through a period where they just feel like they can't do it anymore, I suppose. I know I did, and all I have to show for it is a case of retinopathy. The take home message for me was, yousue do have have a chance of beong damned if you do (take care of your diabetes). You're more likely to be damnded if you don't, and it's probably gonna hurt a lot more for a lot longer.
I gues that's why I liek the Omnipod. At the very least, it gives me the illusion of feeling like I'm in more control of teh situation. My numbers tell me that I am though and thit it really isn't an illusion.
Lantus is different than Levemir. Lantus works by forming little crystals when it is injected and these crystals dissolve over time releasing the insulin. If you inject into the blood stream, the crystals never form and the insulin is released immediately. Levemir on the other hand is bound to a protein (called albumin in the literature). This binding is affected but not broken if injected into muscle or the blood stream. In truth, there is a hypo risk with Levemir and the prescribing information explicitly states "Intravenous administration of the usual subcutaneous dose could result in severe hypoglycemia." Such a warning should be in the Lantus prescribing information, but it is not.
I suspect that the risks of such a severe hypo with Levemir are smaller, but I can't be sure. In either case, both insulins must be injected subcutaneously, into the bodyfat layer. There are almost no large blood vessels to inject intravenously in the abdomen layer. So generally the risk of these types of hypos should be really rare when you inject properly. But still, it is prudent to carefully pinch up and use good technique with a proper needle length.
I would not hesitate to use Lantus myself, but it is good to know about this issue.
ps. And splitting the doses will reduce the severity of risk, but it does mean more injections.
No I've never been told that. When I talked to the endo on call, he told me that it sounded like I was doing everything I needed to do and to call my endo tomorrow (meaning today - which I did this morning but he hasn't called back yet). I can understand them saying that if they're trying to express that it's only to be used in an emergency situation maybe?
I do multiple shots a day. For 2 reasons 1. Lantus - no matter what the company says - does not work in my body for 24 hour - it works for 16 max. 2. having one shot only at night made me scary low in the morning - like worse that what you just experienced only at the time I lived alone.
So I changed when I took my largest dose - 14 units in the morning (needle) and then I have 6 at night with dinner just so that when the Lantus stops working after 16 hours I have a bit more to get me through the night, but wasn't waking up scary low like before.
I'm so glad you are ok. And I'm glad people told you that once your liver has dumped the sugar it dumps it ALL. So a second shot won't work. So if that does happen it's a good idea to eat as well. But it sounded like your liver had a good storage if you ended up being high. Just keep in mind that it will take a few days for you liver to rebuild it's storage. I think it takes 3 days. Eat lots of carbs to build it back up. Do be careful over the next 2 days.
Big Hugs to your hubby.
well, i guess that's reassuring, regardless of whether one accidentally injects into 'the blood stream', hypos happen with basal all the time. i keep going hypo with my levemir because of the dose..not where i inject or how i inject, it's not servere..but any insulin basal or bolus, if the dose is too much, can cause hypos..we all know that..all companies put labels on their insulins, stating hypos can occur, they have to.
i think i maybe would have gone to the ER right away or had your husband call 911 if you're THAT LOW...just to be safe...that drop is dangerous and you don't know why or how it happened..at least they could have monitored you and given you IV glucose (or whatever the heck they do) over a period of time. the thing that is so scary...it's for those of us who live alone...! i'm gonna ask my endo about this..yeah, I could go get hit by a car tomorrow, but I'm also injecting insulin 4 - 5 - 6 times a day. this is scary.
Thanks so much Amy, this is really good info. I had read somewhere that if you have a low then you are more susceptible to having another in the next 48 hours but I never knew why. I've been purposely running on the high side today and will do that for the next couple of days for sure now.
that's what I'm doing now too, two shots - levemir, more am less in pm...!
Your pharmacist is trying to have you be safe. Remember I said that you get one shot with the glucagon. Normally, when you have a low, your body will attempt to fight off the low by dumping glycogen from your liver. In a T1, this counterregulation is often abnormal, but it is there. If you have ever had the rebound high from a severe low you have felt it. But once you have depleted that store you don't have any protection. A subsequent severe hypo could be your last. Going to the ER is actually a good idea.
The thing is that it happened so fast that we didn't have time to think or do anything - if I had been alone I don't think I could even have dialed the phone and spoken to an operator. By the time I sat down and said "I need help" and he ran in the room with gatorade, I was below 50 and 5 minutes later at 28. The whole thing was over and done in a matter of minutes. I could have gone to the ER or called 911 (and almost did) after but it was slowly but surely edging upward.
When he called the on call doc I was already at 130 and I was still drinking gatorade. You can bet if I had started to drop again, we would have called 911 in a heartbeat. You know I always run through these what if scenarios in my head but then when it's happening so fast it just all goes out the window.
Glucagon isn't glucose. It causes the liver to take stored glycogen and turn it into glucose.
If the liver has no stored glycogen (maybe due to a series of earlier hypos where the liver did the conversion without glucagon injections) it won't work so well.
I've had glucagon once. I was in the low 40's and unconscious when they gave it to me, and shortly after I came to I was at about 90. Then about two hours after that the super-nausea kicked in. I'm told that's a rarely mentioned, but no so rare, side effect. And a few hours after that I was in the 200's.
Just talked to my endo. He of course said that we'll probably never know exactly what happened. The first question he asked was about the possibility of mixing up the two insulins but I'm certain on that one. The second thing he said was that if you contaminate the lantus with humalog by even inserting a syringe used with humalog into the lantus vial, then the lantus begins to act like short acting insulin. I don't think I did this but who knows...I keep a separate supply of syringes with each vial because I know not to mix them but sometimes life gets distracting so never say never. Good thing is that I discarded that vial. Another good lesson here too for not reusing syringes.
He also said it may not have had anything to do with the Lantus dose itself but the timing. He said that I could have been heading into a low anyway and the Lantus dose taken at that time just sped it up basically. This is possible because I'm sort of between 2 Lantus doses thanks to syringe 1/2 units - a little high with one dose but drifting slightly on lower side all day with next higher dose. Yesterday I was drifting down all day but controlling it with a few jelly beans. When I got home I ate a few more jelly beans then took my Lantus dose but had not eaten dinner yet. Not the smart thing to do I guess.
Bottom line is he told me to back off on my I:C ratio for lunch at least for a few days and cut my Lantus dose back by 2 units for a few days and to eat dinner before I take my Lantus for a few days. Eat carbs and let it run a lttle higher for a few days. Then proceed with the OmniPod! Basically everything the smart people here advised before he got around to calling me! :) Thanks guys, you're all awesome.
Thanks for sharing that Tim. This helps me alot because I always thought that glucagon would make you go really high really fast - no idea where I got that idea from. Once I had the glucagon it started to slowly rise within minutes and it topped out about 117 for about an hour but it would dip a little here and there and I was so nervous that it was going to fall fast again. Lesson learned. If I had a do-over I'd go to the ER once it got to 100.
I've had glucagon twice - once in the hospital after surgery and I had severe nausea with that shot, made me feel horrible so I know what you mean. This time I really didn't have nausea, thankfully..
glad you made it through. I've never used the glucagon kit yet on my son but went through a similar thing with my dad. He didnt have the kit for emergencys but used glucos gel. Took 5 hours to get him up and stead kept going down. Seems there is so many varieables with each person that can play into the up and down sugars. My son is on Lantus to and hasn't wanted to take it at night but I've been incouraging him to because he was in DKA in Sept and has had alot of problems since so I'm trying to help him get rid of the keytones. The world of diabetes seems to be growing. Scary. Glad you are ok now and I hope you dont go through that again. Have a blessed day.
Thank you angelic1. Best wishes to your son as well. And you are an angel for encouraging him to take care of himself.
yeah..again, I'M just SO GLAD you're OK...!
well, that's the thing, isn't it...it happened so fast. I truly believe any type 1 diabetic who wants a CGM should get one, insurance should pay (most of them do)..and the Endo should Rx one! I mean, it's just a tool, but it's the only tool we have really that will monitor us 24/7, even that isn't 100% but it's better than nothing.
You're lucky you weren't sleeping when this happened. I took my Lantus shot of 20 units one night, or so I thought, got very tired and lay down on the couch and fell asleep. I woke up in the ER at the hospital. When I fell off the couch I woke my husband, who was upstairs sleeping in the bedroom. When he came downstairs to see what was happening, I stopped breathing and gave him a good scare. He called 911. When I came to the nurse told me I was lucky to be alive. I came to the conclusion that I must have taken 20 units of Humalog. After that I made sure I put the two insulins in separate areas in the kitchen.