I am Type 1, so please ony answer this relative to being a type 1.
So, I have had severe hypokalemia (low potassium) for about a year that has perplexed my doctors. I was just reading the Levemir insert which says one of the possible side effects is hypokalemia. Levemir works so much better for me than Lantus, but I am wondering if there is another alternative. I don't think I would go back to Lantus.
I have been on Levemir for about 4 years. I was sleep eating on Lantus, for no reason (other than my bg was inexplicably low). Since I started Levemir, I have never woken with my roommates oreo cookie crumbs in my teeth (I hate oreos), and I have not woken sitting in the middle of the kitchen eating left over spaghetti or stew with no idea how much I had eaten, or getting the food out of the fridge.
If Levemir is my problem, any ideas what different insulinn I should use? Is this going to force me to use the pump?
While ago I posted similar post. I did not want lanthus because of the studies possibly indicating carcinogenicity and did not want levimir because It would give me 5 injections a day (2 levimir and 3 apidra). Anyhow, long story short, I switched to Novomix 2 inj a day (I am type 1 too) against everybody’s advice (including my endo who was convincing me that this is not good insulin for type 1). It work wonderfully for me, much more predictable than lanthus + apidra (I was on that for 3 months). I take less that the previous combination (14 u in the morning and 6 in the evening). The only trick is to follow the regular eating schedule:
• morning 7 ish : injection 14 u +breakfast
• 11:00 =11:00 lunch (important because of the peak of the slow acting component)
• injection 6 u +supper at 5:00-6:00 PM
• snack at 9:00PM because of the peak again
It does work for me (A1C on lanthus + apidra was 6.2 and on novomix A1C is 5.7) and much less lows at night (it happened once in 6 months)
Low, but not to the point of having to take supplements.
I am taking 80meq (3120 mg) of potassium daily. That is to keep my potassium levels betweek 3.5 and 3.7 (3.5-5.0 is normal at my lab.). The doctors are flabergasted. = )
I also take humalog, so if Humalog and Lantus both cause potassium defficiency…ugh!
Low potassium seems to be a potential problem with all insulin, so not sure why your docs are perplexed. Glad to hear yours isn’t very low. Does eating potassium rich foods help?
This wikipedia article says that Insulin itself may cause Hypokalemia:
In addition to alkalosis, other factors can cause transient shifting of potassium into cells, presumably by stimulation of the Na-K-ATPase.[3] These hormones and medications include insulin, epinephrine, and other beta agonists (e.g. albuterol or salmeterol), and xanthines (e.g. Theophylline).[5]
So to me this is not a question of insulin brand or pump. It is more a question of reducing insulin intake in the first place. How is your TDD for Levemir and Humalog? Is it possible that you are insulin resistant too so that your insulin needs are abnormally increased? One possibility is to combine Insulin with a low dose of Metformin to increase the sensitivity for insulin. This would lead to much less active insulin in your system. As a consequence the Na-K-ATPase mentioned in the article above should be reduced IF and this is the big question here this mechanism is the root of the problem. Some people reported that the pump reduced their TDD so this may be another idea to follow.
Actually I don’t understand why your doctors are perplexed? For a patient with hyperkalemia also know as high potassium the doctors will admin. A insulin/glucose drip to A patient to lower the potassium since if your potassium is out of range either way it can lead to abnormal heart rates and beats. Thus it is important to keep that potassium under control. I personally have had issues with it while I was on shots enough to warrant IV bags of potassium in the hospital but after going on the pump I have not had any since. I don’t know if it is due to the constant infusion of insulin so my body is okay with it now or if because switching over I went from about 45 units tdd to 25 - 30 units tdd. humm
I acutally use less TDD of insulin based on weight and activity level than is suggested a normal place to start in “Think Like a Pancreas”.
Low potassium, for me, is mostly weakness, fatigue, and feeling lethargic. I have no apetite, and would prefer to not eat at all. Also, muscle cramping in the calf muscles, diziness, and nausea when it gets really low. Everyone is different, though. Fortunately it hasn’t been too low for a while, because I have been on supplements.
Sounds like the pump may be something to try. I hate the endo’s my insurance lets me see, because they are idiiots, so I go to my pcp. My pcp won’t set me up on a pump and I would have to go to an endo for that.
