Levemir acted like a rapid : big low

[bhk]

As discussed in other threads, it is clear that levemir is much safer than lantus, and that is a very stable basal insulin. Since I did the switch from lantus to levemir, my life is so better and I can sleep without being terrified of waking up with a big low in the middle of the night.

Apparently, that was the case until yesterday. I took a shot of levemir at 11:00 pm, and one hour later, my sugar dropped considerably, I took some rapid cards, I would still get lower, and on and on, and I finally had to take 100 g. of sugar to get back to 8.5 mmol (app. 165).

Has levemir ever acted way too fast ? Would you know the causes ? I haven't done more exercise or any particular thing...

 

[Heathenlass]

Are you 100% sure that it was the Levemir you injected, and not the rapid acting by mistake ?
That sounds classic for a mix up .

Signy

 

[bhk]

I have not mentioned something and here is why : I was at 10.9 mmol (apprx. 200) and I took 1 unit of rapid (humalog) to correct that, also at 11:00 pm. The thing is, 1 unit, at this hour, usually gives me a 2mmol or 3 mmol drop. I would have been at 8 mmol most likely. Not in a severe hypoglycemia : the only remaining variable is the levemir...

 

[tim2000s]

Is it? What rapid acting had you taken prior to that and when? Was your glucose level higher than normal due to poor absorption of an earlier fast acting?

I have observed cases in myself where NovoRapid seems to do very little so I take a correction shot and all of a sudden it causes a massive plummet that doesn't correspond to what I've injected.

 

[bhk]

You know what? You might be right for that. My ratios are barely the same each day, and I had taken a little less than my night ratio. Usually, it is 1:25 but the range is 1:20 to 1:30, and I took 1:20 yesterday, at 8:00PM, being at 5.0 mmol (95). The high was out of the blue, and your theory of a very late absorption of rapid insulin is very logical. What confuses me though is that lately, some highs after my night meal have happened frequently, while taking high doses of rapid would not correct it. But that might be because the meals contained way more grams of fat. Which is another reason for us to calculate our protein and fat intake...

 

[noblehead]

I have not mentioned something and here is why : I was at 10.9 mmol (apprx. 200) and I took 1 unit of rapid (humalog) to correct that, also at 11:00 pm. The thing is, 1 unit, at this hour, usually gives me a 2mmol or 3 mmol drop. I would have been at 8 mmol most likely. Not in a severe hypoglycemia : the only remaining variable is the levemir...

Are you sure you just injected 1 unit of Humalog and didn't inject your usual levemir dose instead, with taking both insulins at the same time you might have had the levemir dose on your mind and accidentally given that dose instead of the 1 unit you intended to do.

 

[bhk]

I am 100% sure, I have a lot of tricks to avoid this from happening. And knowing my case, I know it would have been WAY worse if I injected 14 units of rapid !!

 

[noblehead]

Just put it down to one of life's mystery's, I think we have all had a similar experience at some point and as much as we try and find an answer its never there, needless to say just be careful tonight and maybe check your bg for 1-2 hours after injecting your basal.

 

[bhk]

I will not hesitate to check it, as always. Of course we all face "mysteries" but I think that things are evolving, and that we have to stop saying "it is a mystery" for every unexplainable situation. We have tools, we have brains, we have the opportunity to communicate here through this forum and we got to take advantage of all of that and start being able to explain more things. I am just tired of hearing doctors replying "it is stress" to every situation they can explain in 30 seconds.

Ratios don't exist. Carbs are not the only factor that play in the rising of blood glucose. It is time that we learn to deal with new factors in order to get a better control. You will notice that if you ask any doctors : the best "controlled diabetes" are seen in "routine people". People that do the same activity each day. That eat at the exact same hour each day. That burn the same amount of calories each day. That walk the same total of miles per day. That eat the same food everyday. That stay in the same city/country 365 days a year. I am glad that some people live this way and are happy like that, but we have to understand that for most of people, this isn't "life".

I hope that more research will be done (to know the exact effect of proteins and fat pathways on the blood sugar, to know the exact effect of muscle training on the metabolism, and so on). Of course perfection will not be reachable, but for know, let's help each other analyze and hypothesize our "situations"...

 

[tim2000s]

@bhk there is a lot of research already out there on the topics you mention. If you look around the topics you mention, both the forum and the Web throw up a huge amount of information.

 

[smidge]

@bhk - obviously I don't know what caused your hypo, but I recently switched off Levemir because my BG would not stay stable on it - random highs, increasing doses needed - it was all a bit of nightmare really. I used to take a split dose at 6.30am and pm. I was almost always waking with high fastings - except when I woke with a hypo once or twice a week. There really was no pattern to it. I would almost always hypo mid-morning (9.30 ish) - only mild, but even so, not really acceptable. I always had a niggling feeling it was the Levemir I'd taken at 6.30am - but obviously I'd also taken Apidra with my breakfast plus a correction because of the high fasting, so I couldn't get my diabetes team to take that seriously.

However, the 6.30pm Levemir dose was the only active insulin I would have at that time having eaten lunch and taken my Apidra at about 12.30pm - my BG would generally be a bit too high late afternoon and early evening because the morning levemir dose had worn off - but within two hours of taking my evening Levemir, my BG could drop 3 mmol - not always, but frequent enough for me to not trust Levemir. My diabetes consultant said he'd never heard of anyone else having this type of drop on Levemir - Lantus yes, but not Levemir - so I don't know, but it certainly didn't agree with me.

I've moved onto Tresiba now and my BG is much more stable and I've almost halved my total basal dose. So far so good. If you get the same problem again, it might be worth asking your consultant to try Tresiba.

Smidge

 

[itconor]

As discussed in other threads, it is clear that levemir is much safer than lantus, and that is a very stable basal insulin. Since I did the switch from lantus to levemir, my life is so better and I can sleep without being terrified of waking up with a big low in the middle of the night.

Apparently, that was the case until yesterday. I took a shot of levemir at 11:00 pm, and one hour later, my sugar dropped considerably, I took some rapid cards, I would still get lower, and on and on, and I finally had to take 100 g. of sugar to get back to 8.5 mmol (app. 165).

Has levemir ever acted way too fast ? Would you know the causes ? I haven't done more exercise or any particular thing...

This happened to me once, i took it and an hour later had the single worst low of my life so far,

 

[smidge]

As discussed in other threads, it is clear that levemir is much safer than lantus, and that is a very stable basal insulin. Since I did the switch from lantus to levemir, my life is so better and I can sleep without being terrified of waking up with a big low in the middle of the night.

Apparently, that was the case until yesterday. I took a shot of levemir at 11:00 pm, and one hour later, my sugar dropped considerably, I took some rapid cards, I would still get lower, and on and on, and I finally had to take 100 g. of sugar to get back to 8.5 mmol (app. 165).

Has levemir ever acted way too fast ? Would you know the causes ? I haven't done more exercise or any particular thing...

Jut a thought, could you split your Levemir if you don't already to make sure you are not taking big doses in one shot and maybe pull the evening dose earlier so that any issues with it working too quickly can be picked up and dealt with before bed time? This might help minimise the risks and your stress while you wait to see if it happens again.

Smidge