Levemir

Parents
1

My son was just switched from NPH (humalin) to Levemir. His Endo gave me a hospital issued hand-out but I'm sort of flying blind. Plus the package insert is typed so tiny, I may get an aneurysm trying to read it! 

Is there a reason the injection is to be given at bedtime? My mother is the only other person I know on it and she gives hers in the morning only. She was experiencing terrible Hypo bedtime BG so she switched it; but she's 60 y.o & my son is and over active 7 y.o.  

I'm so used to a peak with NPH, does Levemir have a peak at all?  Because at day 2, his evening sugars are reading way too high.

LAST QUESTION!

He plays flag football and is on the field for the entire hour. Should I leave him a bit higher that the 180 that is his norm? 

OMG! if someone could assist me I'd appreciate it greatly!

2

First, I'm ticked at your endo for giving you new meds and not explaining them to you! Is there a nurse at your clinic that you can call and ask questions?

You can give the Levemir at any time of day, as long as it is the same time of day everyday. (We were told within +/- 1 hour) . When my son was on it we gave it at dinner time. It was just so that he had 2 shots at that time (with the other being his Novolog) and then didn't have to have another shot at bedtime.

You can also give it in the morning. Levemir doesn't (or isn't supposed to) have a peak, but some people say that they notice it does, it may just be that bodies require less insulin at certain times and so the flat amount of Levemir is too much at some times and not enough at others. It CERTAINLY does not peak like NPH does. It also may not work for the full 24 hours in some people. So you may need to split the dose to half at bedtime and half in the morning. (But would be more fine tuning, probably not for right now.)

Is your son also on a short acting like Novolog or Humalog that he takes with meals or for corrections? You will need to keep good records of his carbs and activities for the next week or so, because I think you will need to make some changes to the Levemir and or his Insulin to carb ratios with his short acting. If he is not on a short acting, call your endo, because it seems weird to me.

If you can test during the flag football, that would be best. Be sure to test right afterward and then every couple hours after to make sure he isn't going low from it. I would think 180 is fine to start the game at, but you can't be sure unless you are testing during and after.

Let me know if you have more questions and I'll help as much as I can. (As will the rest of the parents on here!)

3

If you're not able to get in touch with someone at your endo's office to discuss the insulin change, then try talking to your pharmacist.  I've found I can get more information and straight answers from our local pharmacist about drugs (including insulin therapy) than most doctors will take the time to discuss (that does not include our ped endo, who I adore, but does include our primary care physician).  Not only does or pharmacists, Jennifer, answer all questions, but she also know how to work the insurance systems to we get the maximium benefit from our rx plan at the lowest cost to us, and is very communicative whenever we have a glitch.  So, don't underestimate your pharmacist as a possible resource.

Our son (age 9) is on Lantus, which is also a slow-acting insulin, as his basal.  We give it at 7:00 pm each evening, and it does a good job of keeping him level overnight.  Long acting insulins aren't supposed to peak, but from my own experience I think they have periods of more-or-less effectiveness.  For kids, it's important that the long-acting insulin be working through the night, because that is when most kids are secreting growth hormones (I think usually between 2:00 and 4:00 am) which will increase BG, and kids can also experience a BG increase during the morning hours.  William can have a  BG of 110 at 10:00 am, eat nothing, and have his BG higher two hours later.  Go figure.

In older diabetics (like my MIL), I think it is generally recommended they take it in the morning, or split doses 1/2 in the AM and 1/2 in the PM.  They're not going to have a secretion of grown hormones in the middle of the night to push their BG up, so they would be more likely to experience low BG if they took a full dose of long-acting in the evening.  Also, they're more likely to have a secretion of strees hormones during waking hours, so would need their basal to be working during those hours.

Particularly in kids, diabetes management is all about hormones and activity levels.  I highly recommend reading "Think Like a Pacreas" to get a handle on insulin therapy, BG, and how it can be effectively managed.  It also helps to remember that every hormone secreted by the body (growth, stress, sex, etc.) INCREASES BG, with the exception of insulin which decreases BG.  So, your son could be participate in a high-sugar-burning activity, such as football and be burning lots of BG which would require more glucose to counter-act.  But, if he gets really worked up and stressed during the activity, the stress hormones could push his BG higher and counter-act the burn.  (Did that make any sense at all?).  So, basically, be sure he's in a safe/higher range of BG before beginning, and test frequently until you get a good idea of this fluctuations during that particular activity.

Okay, that was a little scattered.  Sorry.  Wish D-management was cut and dried, but it's not :)

Blessings,

Mo

 

4

Thank you! His Endo nurse is usually that this.  I actually was not at the visit, I hate to say his Dad misses the mark sometimes. From 10pm -4am his sugars were reading HI.  I added 2 units to the Levemir on today's dose, so we will see what happens. I do believe he will eventually have to be on a split dose of Levemir. He does take Humalog for corrections.