Of course I'll be calling our endo this afternoon but I'd love to hear from those with experience.
I've mentioned our insulin regime in another post so forgive me if this sounds repetitive. My daughter was recently switched to Levemir at dinner instead of NPH at night. Our old regime was as follows:
2NR/13NPH @breakfast
2NR @dinner
3NPH@10pm
Our new regime is this:
2NR/13NPH @breakfast
2NR/3Levemir @dinner
We do have a carb to insulin ratio of 1NR to 20carbs so NR can vary according to meals.
This is the problem. Brooklyn's been waking up WAY too many mornings in a row with a BG range of 10 to 14. We test before bed and again around 10pm or 11pm and she's always been in the acceptable range - between 5 and 7. Clearly the Levemir isn't working to stabilize her sugars! We've already increased it on our own to 4 Levemir with dinner. Sigh.. This is so stressful and it's really hard to not take it personally :-( I can already tell I'm going to have a bad day where I beat myself up with all the "I should have done this..etc"
I pulled the info below off diabetesnet.com. Because it's duration is so long the morning and evening doses might both be active in the early morning. Has your daughter tried taking it just once a day (think a lot of people do it at bedtime)? At the very least the am dose may need to be lowered too.
And try testing at about 3am for a night or two. When I took long acting insulin that's always when the lows would start. Please let us know what the doctor advises.
THis won't really address your question, but are you doing NPH in the morning so that she doesn't have to do a shot at school for lunch?
Here's my take - you have 3 different insulins working; that all have different effects. You will have to be really careful bumping up the Levemir, because I think you should assume it is working 24 hours right now. If you bump up too much to get the overnight numbers in range, then you will need to be careful to watch her numbers during the day so that the NPH and NR on top of the Levemir are not causing her to go low. If I were you, I would make an adjustment, and then wait 3 days before making another one. Just so you have plenty of data to go on and can really see what effect your change made.
The thing we were told with Levemir is that it stands for 'level'. It can have a peak, but it is no where near the peak of NPH or of NR. If your daughter's body needs more insulin at certain times, then she will run high as the Levemir is not sufficient at those times, like in the morning. Conversely, if she needs less at other times, then she will tend to drop low. I think you really need to add a 3am check (or a 1 am and 4 am check) to see what her BG really is doing overnight. We had to do this whenever we changed Levemir doses. If her BG is in range for all night checks and, and she is running in range the rest of the day, you (and your endo) may decided to accept high numbers when she wakes up, as you can correct those with some extra NR. But without those extra checks, you don't have the data you need to make sure she is not going low at 3am and the high morning BGs are the result of her liver dumping glucose to bring her back up. (Which is the way a body is supposed to work).
Remember you are a mother, not a pancreas. Do not take it personally. I KNOW you want to do it right and have in range numbers for her most of the time. It sucks battling thru phases when the numbers are not working in your favor. And it sucks waiting 3 days in between adjustments, esp. if you don't see the effects you want. Please come back and vent and ask questions as you need to!
I was on Levemir and I didn't have much success with it. I took it at bedtime and would wake up with BS in 30-40's basically everyday. So my doctor switched me to lantus and I've done much better on it. Maybe ask your endo if switching is an option.
Sometimes it may take weeks for a body to adjust to a new insulin. I'm not sure how long Brooklyn has been on levemir so maybe that is happening. For me it took about 3 weeks to adjust to the lantus. It made me think that it wasn't even working and one day it worked !!
One last thought about levemir you could also discuss the possibilty of taking 2 injections instead of one. Levemir doesn't tend to last as long as lantus in some people.
I tried Lantus and had zero luck. Was switched to Levemir and did much better. I did take two shots of Levemir though, bedtime and morning. Instead of one big shot we split into two. But now I am on a pump and don't use either.
My endo recently switched me from Lantus to Levimir, and it seems to work much better. My numbers have improved, but he's thinking about splitting the dose so I take one short in the morning and one at night. Taking 2 different doses is supposed to be much more effective. I'm trying to take as least shots as possible though, so I'm going to stick with one dose at night for now and see if it keeps working. I've been diabetic for almost 10 years and he said that the Lantus just wasn't working for me anymore.....
If her daughter's taking the levemir before bed and waking up high (If I'm reading the chart right, lol!), then splitting the dose wouldn't help that problem. I agree w/ JVDMom that raising the dose could be tricky for the daytime numbers when NPH is also on board. I think I mentioned on a previous thread about asking the endo about just doing more levemir (maybe twice a day) and ditching the NPH? Until then, I agree that you'll have to do some nighttime tests, :P If she's just high in the morning you may just have to correct then. If she's running high all night, maybe try going to bed a bit lower?
Thank you all! I really appreciate the advice - it truly means a lot :-)
As a few of you mentioned, our endo's advice was to add in some nighttime checks for the next 3 or 4 days Midnight and 3am. We'll then have some numbers to work with and dose will be adjusted/corrected. As well we might ditch the levemir all together and return to NPH (even tho' I must prefer the routine of levemir)
It seems coverage is happening on case by case basis and a number of providers are wavering in their commitment. Aetna approved mine due to my hypoglycemia unawareness.If you have coverage, I would at least talk to the rep at the CGM provider of your choice and see whether they are obtaining coverage for people through your insurance provider. The CGM manufacturer will likely have a good idea what kind of a fight you may have ahead of you.
I didn't really give you much of an answer, did i? - sorry...
I'm covered until the end of March. My endo says that LESS insurance companies are going to cover them because there is no "reported" proof that they improve better glucose control. HOGWASH!!! BUT - we called our insurance company, rated number one in the country, and they said that I couldn't even use the pump that I'm using because it has a chip in it that will allow sensor readings. I have to go back down to the MM 715. They said if I chose to pay for my own sensors, if anything happened to me related to diabetes, it would not be covered because I would be using a device not covered by them! I have hypoglycemic unawareness and I was on a pancreas transplant list, so having the security of alarms in the middle of the night with the sensor, made my life much easier. I hope you have better luck!
Regarding the proof, I am not sure if you or your doctor saw the JDRF study but it has gotten a fair bit of press and has given us a definite bit of study data to point to when having these talks.The link is here: