Levemir

My daughter is on levemir and I’m so frustrated because all of a sudden shes high when she wakes up. I split her doses. 2.5 at 8pm and 2.5 at 4am and shes waking up a little over 200 she went to bed at 270. Should I just keep increasing or what? She was on basaglar but with those same doses she was waking up dangerously low like 50 and by lunch she would be 200+ . Please any advice

I would make a visit to the doctor, and nutritionist. I also take levemir. I have woken up with highs as well. When I took tresiba I woke up with lows. It is probably a diet issue. Children tend to think of carbs a lot when eating. Bread potatoes pasta rice. I wouldn’t want to give you advice that is dangerous, but levemir is supposed to not cause as many lows as some of the other long term insulin’s. Her weight would have to be taken into account for how much she takes, her diet too calories wise. This could be tricky. If you do increase it especially since she’s a child I would only increase it one unit at a time to see.

Her doctor isnt really going by her weight for dosage of levemir as far as her calories or carbs her ratio is 1 unit of novolog over 200 and 2 units over 300. Many times if shes at 230 1 unit of novolog can drop her to 80 in 2 hours. She just had an endo appt 3 weeks ago and he doesnt want to change anything. Her a1c is usually in the 7 and under but this time it was 9.2 which is why om concerned. Its steady increasing every visit since being on levemir

I’ve only treated my own diabetes as an adult. From the reading I’ve done, a growing child is more complicated with things like growth hormone spurts.

One general tactic that has never failed to teach me the answers to my own particular situation is to keep a journal for a while. Record insulin doses, meal composition, timing, exercise, and anything else you might think affects your daughter’s blood glucose levels. There are so many factors in play, it’s easy to miss the forest for all the trees!

Keep in mind that basal insulin, whether delivered via long-acting insulin like Levemir or a pump, is theoretically only meant to metabolize the pulsed release of glycogen from the liver. It is not needed for any nutritional or correction purposes.

While I think that doctors are generally good resources for these kind of questions, I’d favor the dosing tactics of a well-motivated parent who is keeping a journal and conducting their own experiments.

Also understand that diabetes is a moving target. The perfect basal dose of Levemir today for your daughter is not necessarily the perfect dose that will work next week. Your ability to flex is a key skill to develop.

Good luck with this. Keep a record, do the experiment, implement a plan. Wash, rinse, repeat.

By the way, you don’t need to keep a journal forever. You’ll learn some things that you will roll into your overall understanding of how insulin works on your daughter and won’t likely need to keep a diary for a long time.

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That’s very interesting what you’ve suggested. My daughter has been diagnosed for 4 years and initially I had to keep a lof for the docs for a while then I didnt have to anymore because she was pretty stable. Now I’ve started back with a log until I feel some source of stability. I fully agree a doctor is great resource but because I see and care for her every day I have begun to play around with her foods and timing of insulin on top of journaling

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How old is your daughter now? During puberty, hormones can cause lots of variability in insulin requirements, and few endos seem to really understand this. The impact can vary greatly.

Are you using CGMS?

You give levemir at 8:30 and 4:30
you correct with novolog when at 200 with 1U and 300 with 2U.
she just had an endo and he is happy and doesn’t want to change.

If You haven’t been given sick day rules, this link may be the best part of my post. It will be your bible when your child is sick.

You poor thing, how are you coping? Your endo is of no help and you haven’t had a nights sleep for a long time. I assume you don’t want to get up at 4:30.
There are two ways to go, one is to find out what T1 courses there are from your hospital or medical center. You need an endo or nurse, to work with on a daily to weekly basis. Till you have a handle on this. I would ask about having levemir when your child or you go to bed and the morning dose with pre-breakfast bolus, It may not be a 50/50 split.

You haven’t said anything about mealtime bolus? I would think the problem isn’t the levemir basal, I would think it’s a bolus issue. Novolog can have a 0.5 pen. If this is still too coarse, it can be given by syringe in smaller or finer amounts. With a basal rate of 5U a day, she may not be using much as a bolus.

assuming she went to bed 2+ hours after her meal, the 270 bedtime may be the problem. Whether the levemir dose is right, we don’t know. Overnight the BG went down to 200, a drop of 70 points. What and when was the mealtime bolus, did you give a correction of 1U of humolog at bedtime? Once the bolus is sorted, there may be too much or too little levemir? The medical advisor you get to help you, will also help with the basal rate.

This will give an overview

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My daughter is 7. Yes we use syringes because of the .5 markers. Weve been using them for years. Yes I bolus anytime shes over 200. So she she was blouses for her dinner but by 8 PM she was at 270. She eats dinner between 5 and 545 PM. I think I will start giving her the 2nd half of her basal later than 4am the only reason I do that is because I go to work at 430 but her sitter can give it to her when she wakes up . Weve just always done it at 8 PM and 4 am with no issues until now with the levemir or lantus until insurance stopped covering lantus.so just like last night she was 278 before dinner I gave her insulin before she ate and by 8 she was 183 now at 4am shes 287

8 hour split is ok for levemir and stay at 4 if it suits. The bedtime and breakfast is for DP, it may not be an issue yet and the split is also if it doesn’t last 24hrs. I’d prefer levemir, because if you hit a vein, she won’t hypo. It works different to lantus

someone may have a better idea and I encourage them to post.
This is what I would do, I would seek medical advice as a safeguard. I would start with the standard stuff and see if it fixes it. 2 new vials, from different boxes if you can.

You need a BG test after the novolog is finished, so just the 6pm meal if you can. That would finish the novolog around 10-11pm and then one at 4am. Correct if too high. Finish the test and depending how high, add 5-10% more night time levemir basal with the syringe, the next night… With your medical teams approval

It’s hard doing miss a meal basal tests with a 7yr old. one of the other moms may have an idea.

I’m a little confused was your suggestion after dinner once she has her 8 PM shot check her at 4 correct if high if shes high adjust the 8 PM shot the next night ? And when you say new vials are you saying 2 new vials of novolog and levemir?and yes the missed meal is basically impossible for a 7 year old

I think I corrected a bit.

1 levemir vial and 1 humalog vial

. I meant give her her meal and novolog, then 8pm levemir, BG test at 10 or 11 when the humolog is finished, then again at 4…if too high, correct and add 5-10% to the levemir the next night.

The afternoon to evening meal is going to be the harder one to test

Ok great thanks I can do that. Great suggestion

One more question if I check at 10 or 11 do I wait until 4 to correct if high or correct at 10 if shes high

If she is high you correct and don’t do the test. You want an in range number at 11pm.

It’s picking the time when the bolus is finished and not affecting the basal test. then see how much it rises or falls from there. the 11 to 4am is a nice 3 hour window, if you don’t give a supper. extending to pre breakfast bolus, if you shift the 4am levemir to pre breakfast, I would ask your medical team, but I think the 4am basal would stop the test.

Ok I understand only thing I cant skip supper she gets really hungry

I’m not that clever. This is where it come hard for me to tell if it’s basal or bolus. If she has supper, make it just low carb and fibre as a filler, no protein or fats, Cabbage comes to mind. (yuck, best of luck with that) You would also need to swap to levemir pre breakfast and the carer taking the pre injection BG. unless your med team said the 4am wouldn’t impact. I think it would.

I don’t know, you might even try a supper of psyllium powder with no carb flavoring of some sort to make it palatable

Ok thanks for all your help