Mixing Humalog (50/50) With Levimer

[harreni]

Hello everybody,

My mum is 65 years old and 90 Kg weight, she is taking Humalog (50/50) 3 times a day with these dosesbreakfast 42 / Launch 46 / Dinner 44 ?

The issue is fasting BG is little bit high (220 Mg/Dl) and want to know if can mix Humalog (50/50)
With Levimer to stablize BG throughout the day and decrasing Humalog doses. Also, if mixing is not possible how can I calculate correction doses ?

Thanks a lot in advance.

 

[Juicyj]

Hello @harreni Unfortunately no one here can advise you on whether you should mix your mum's insulin doses, you need to run this past your Consultant/Diabetic nurse, for any medication advice as a forum we are not allowed to give advice on changes to medication.

In regards to calculating her correction dose, there is the 100 rule, so:
Divide 100 by the total daily insulin dose (TDD - include all insulin doses), this should give you the amount that 1 unit of insulin will drop blood glucose levels by.

So for instance 100 divided by 60 units = 1.7 mmol/l drop (and also bear in mind you will need to round this up to the nearest unit of insulin, so in this case 2 units)

This is purely a guide, and I would suggest you confirm this with your consultant/nurse and with any correction close monitoring would be required to watch BG levels.

 

[alphabeta]

This is not an advice but Humalog Mix is an insulin that contains both a rapid acting and an intermediate acting insulin. Taking Levemir alongside with an intermediate acting insulin is a recipe for disaster! I have tried it with Lantus and NPH which is an intermediate acting insulin and my sugars fell dramatically within 2 hours. I used it to treat the same problem but I was better with Lantus and Humalog. Hope this helps

 

[scotteric]

Hello everybody,

My mum is 65 years old and 90 Kg weight, she is taking Humalog (50/50) 3 times a day with these dosesbreakfast 42 / Launch 46 / Dinner 44 ?

The issue is fasting BG is little bit high (220 Mg/Dl) and want to know if can mix Humalog (50/50)
With Levimer to stablize BG throughout the day and decrasing Humalog doses. Also, if mixing is not possible how can I calculate correction doses ?

Thanks a lot in advance.

I don't see why you would want to do this. Levemir is a long-acting insulin that can last between approx. 8 and 24 hours depending on the dose. What most people do is take it in 2 doses, morning and night, at doses that last ~12 hours, and then take only Humalog for meals. I am a freak and use Actrapid as well since I find many meals digest longer than the duration of Humalog/NovoRapid, but not too many doctors would sanction this even though this is what insulin pumpers are taught to do on day 1 using extended boluses. The trend since the 1990s and the adoption of insulin pens and pumps has been to get away from mixing insulin and just take more injections. It may just be that Humalog 50/50 is not adequately covering her basal needs and Levemir, Lantus or Tresiba would be the solution, but there could be many reasons and she should consult with a doctor.

 

[harreni]

Hello @harreni Unfortunately no one here can advise you on whether you should mix your mum's insulin doses, you need to run this past your Consultant/Diabetic nurse, for any medication advice as a forum we are not allowed to give advice on changes to medication.

In regards to calculating her correction dose, there is the 100 rule, so:
Divide 100 by the total daily insulin dose (TDD - include all insulin doses), this should give you the amount that 1 unit of insulin will drop blood glucose levels by.

So for instance 100 divided by 60 units = 1.7 mmol/l drop (and also bear in mind you will need to round this up to the nearest unit of insulin, so in this case 2 units)

This is purely a guide, and I would suggest you confirm this with your consultant/nurse and with any correction close monitoring would be required to watch BG levels.

Thanks a lot Juicyj for your explanation.

Is 100 rule specific for Humalog 50/50 only or for any types of insulin like Levimer with novorapid?

 

[Daibell]

Hi. That insulin regime is strange. Mixed insulin is normally taken twice a day with no other insulin - that's why it's mixed. You can't really do a correction dose that reliably as the correction dose is intended mainly for Bolus users but no doubt possible. I suggest your Mum talks to the GP/DN about changing to Basal/Bolus regime e.g Novorapid and Levemir if she wants the best overall control. Using mixed means fewer injections and only one insulin but has the downside of poorer control.

 

[iHs]

It's easier to adjust the carbohydrate in food to the action of the mixed insulin affecting bg levels than adjust the mixed insulin to the food that is going to be eaten. Lots of blood glucose testing throughout the day will enable the food to be adjusted so smaller main meals, then possibly small snack mid morning, mid afternoon and before bed.

 

[Juicyj]

Thanks a lot Juicyj for your explanation.

Is 100 rule specific for Humalog 50/50 only or for any types of insulin like Levimer with novorapid?

You cannot do corrections with your mums current regime on mixed insulin, if your mum is running high then her insulin doses will need reviewing with her team, if the regime is not flexible enough then switching to a basal/bolus regime would be better for her, however she would need to be able to carb count for her food, so as long as she's confident with calculations then this would work for her, however it's really her team who need to make these decisions for her.

 

[harreni]

Hi. That insulin regime is strange. Mixed insulin is normally taken twice a day with no other insulin - that's why it's mixed. You can't really do a correction dose that reliably as the correction dose is intended mainly for Bolus users but no doubt possible. I suggest your Mum talks to the GP/DN about changing to Basal/Bolus regime e.g Novorapid and Levemir if she wants the best overall control. Using mixed means fewer injections and only one insulin but has the downside of poorer control.

Thanks a lot Daibell, I understand now.

 

[harreni]

I don't see why you would want to do this. Levemir is a long-acting insulin that can last between approx. 8 and 24 hours depending on the dose. What most people do is take it in 2 doses, morning and night, at doses that last ~12 hours, and then take only Humalog for meals. I am a freak and use Actrapid as well since I find many meals digest longer than the duration of Humalog/NovoRapid, but not too many doctors would sanction this even though this is what insulin pumpers are taught to do on day 1 using extended boluses. The trend since the 1990s and the adoption of insulin pens and pumps has been to get away from mixing insulin and just take more injections. It may just be that Humalog 50/50 is not adequately covering her basal needs and Levemir, Lantus or Tresiba would be the solution, but there could be many reasons and she should consult with a doctor.

Thanks a lot scotteric for this great explanation.

 

[harreni]

Lots of blood glucose testing throughout the day will enable the food to be adjusted so smaller main meals, then possibly small snack mid morning, mid afternoon and before bed.

Thanks a lot iHs, I agree.