Insulin change - Lantus vs. Levemir!

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1

My daughter Olivia will be 3 years old on Feb. 8th and she was dx on 6/12/07. Our last endo. appt. was last week and our Dr. was concerned about her high numbers between afternoon snack and dinner and was also concerned about her lows during the night, so he decided that changing her insulin would be a good idea. She was pevious on ...
Breakfast 6:30am humilin N (NPH) - 3 1/2 units, a sliding scale of Humalog (<150=1/2 unit, 150-250=1 unit, and >250= 1 1/2 unit)
Lunch 11:00am - nothing
Dinner 5:00 pm - same sliding scale of Humalog listed above and 1/2 unit of Lantus.
Bedtime 8:00 - <150=0, and >150 = 1/2 unit Humalog

She had an A1C of 7.6 (1st a 10.2 then previously a 8.2) and a monthly average in the 150s. So overall, we were happy.

<u><b>She is now on...</b></u>
Breakfast 6:30 am Novolin N (NPH) - 2 1/2 units, a sliding scale of Novolog (<150=1/2 unit, 150-250=1 unit, and >250= 1 1/2 unit), and 1 unit of Levemir.
Lunch 11:00am - nothing
Dinner 5:00pm - A different sliding scale of Novolog (<150=1 unit, 150-250 = 1 1/2 unit, and >250= 2 units) and also 1/2 unit of Levemir.

It has only been a week on this new insulin, but her numbers are <u><b>TERRIBLE</b></u>. They are above 200 and the Dr. and Diabetic Educator have changed her doses to what they are above, but it really hasn't lowered her numbers. We are faxing her readings to Pittsburgh children's hospital again and without a doubt I know that they will change her doses again. I FEEL FRUSTRATED!!

I know that everyone is going to say put her on a pump, but she is just not ready for that - she won't leave a bandaid on for more than 5 minutes and I'm scared to go to the pump when she does that. I need to get her a year or maybe two years older - so she understands better! Am I crazy???

I know inside that I have to give this new insulin a change and I know that We will be changing her doses every three days or less until we find the right combination just like we did when she was dx, but I can't stop feeling what these high numbers are doing to her body - and it makes me on the edge.

I'm interested to know what everyone else is doing with their children that are dx so young. How many units? Has anyone else switched from Lantus to Levemir? ETC.?

2

NPH is what they call “peaky”. It isn’t really a basal insulin, but partly a basal and partly covering meals. It is also VERY unpredictable about when the peak will occur.

A real basal insulin only covers the fasting state. Levemir does this. Then you cover the meals by using an insulin to carb ratio. You figure out how many units to give for a given number of grams of carbohydrate, and use humalog, novolog, or R for that.

So what’s happening is that you are on a better insulin regimen, but you are used to having the NPH also cover meals. So you need to work with your doctor to adjust the doses.

The sliding scale approach is usually considered outmoded in the U.S. A much better approach is one that relates the dose of the insulin to the incoming carbohydrate. Ask your doctor why you can’t learn to do that. It works a lot better.

3

I’m not a child, but a few years ago I switched from Lantus to Levemir. I am also on shots and not a pump. The Lantus worked for me for the first couple of years, but my fasting bg was creeping higher and higher. When I switched to Levemir, my fasting bg was much more consistent.

I like that your daughter is taking the Levemir in the morning and evening, because even though it is a “24 hour” basal insulin, I have read that it sometimes does not cover the 24 hours. 2 separate shots should take care of that. Maybe your daughter needs an adjustment/slight increase to her Levemir. Then, maybe she should use the fast acting Humalog for meals based on carbs and activity. I think NPH is the most variable is her regimen. Ask your doctor about a Levemir (basal / all day) and Humalog (fast acting with meals) dosing.

4

Thanks for your input! We are hoping her numbers get better soon.

5

A different diet will change your world like you probably won’t believe. And it’s easy.

I’ve cut my doses by 2/3, and bloodsugars are now constant, just barely over a “normal” persons, and I can even skip a meal if I want!
I’m type one, and either the diet book or the solution book will do the trick - but the solution book is more detailed.
Herb.