• Guest - w'd love to know what you think about the forum! Take the 2025 Survey »

What a relief!

R

richard64

Member
Messages
6
I am type 1 and I have been using insulin for 33 years. Three years ago when Nova withdrew Actrapid (disgraceful behaviour, in my opinion) I was moved from Actrapid/Insulatard to Humalin S/Levemir. The first choice of the consultant was to move me to Humalog/Lantus but I had previously been on Humalog and lost my hypo warnings and gained 15Kg before I moved back to Actrapid so I didn't want to go through that again. Lantus was out because the pen could not deliver a big enough dose. So that meant Humalin S/Levemir (Humalin S, I was told, was equivalent to Actrapid as a non-analogue human insulin, and levemir, I was told was equivalent to Lantus). I am 100Kg (and 188cm, so I am not small). Although that is not the weight I would like to be, as I've said, that extra 15Kg appeared when I was using Humalog. My doses are high, and in total I am taking 140 units a day, (my doctor gave me a rule of thumb of 1 unit per Kg as an acceptable amount, so I have exceeded that). My Levemir dose is around 70 units, in one injection before bed.

Very occasionally I get a problem of very high blood sugars. I have just been through such an episode. I have to stress that this is not a case of Christmas overeating. Definitely NOT.

So it started with a very high morning blood sugar - 20 mmol/ml or so. The first reaction is "did I take my insulin last night?" the second is "did I overeat?". Although I could confirm that the latter was not true, I could not deny the former (how can you remember if you forgot?). Anyway, I brought down my blood sugar to something nearer normal (10 or so) by large doses of Humalin. The next morning, my blood sugar was up again. So that's no Christmas fare for Richard this year! Over a week I have been trying to get my blood sugar under control - is it the Levemir or the Humalin? Is it the Levemir pen, or the Humalin pen? Too many combinations and it takes too long to see the results of the changes I've made.

Last night I used a cartridge from a new box of Levemir (coincidentally, one from a recent prescription from a different pharmacy than I had used before). This morning my blood sugar was almost normal and it is now time for lunch and my blood sugar has retuned back to a figure that is normal for me.

The difference? A cartridge from a new box. What a relief to feel normal again. What a relief to know that the next blood test will be in single figures again! But this is not the ffirst time that this has happened, so there is apprehension that it will happen again.

So, am I the only person to have experienced something like this? Since the only change is using a cartridge from a different batch (I am very careful about this, there was no other change), it was clearly the fault of the Levemir. How can I tell that my insulin has been properly stored by the pharmacist/wholesaler/manufaturer? Indeed, even though the cartridge says U100 how do I know that it is not U40 mispackaged?

Richard
 
If you have any of the "suspect" batch left. Take it to the pharmacy that dispensed it to have it checked. Do they still have U40 in this country?
 
hanadr said:
If you have any of the "suspect" batch left. Take it to the pharmacy that dispensed it to have it checked. Do they still have U40 in this country?
Click to expand...

I do - one full and one half used. The problem is that I've already had polite words with that pharmacist, so they may think I am making a fuss. (In brief, a couple of months ago I put in a repeat prescription for statins and when I went to get the prescription my doctor told me that I had already ordered it. So I went to the pharmacist across the road and the statin prescription was there. I do not think that they have telepathy, instead, I think the pharmacist may have mixed me up with another man in the area with the same name - they have a service where you can phone in a repeat prescription and they will take the script to the doctor, and collect it for you. I tried to explain this, but both the pharmacist and the doctors said that it was not possible - they say that they use birthdate as a check, but I have never been asked for my birthdate only my address which can sound the same as the other man's. I always make sure I spell out my address to avoid this confusion. Neither would accept that as an explanation, clearly implying that I am a hapless idiot who cannot remember what prescription he's already ordered.)

I mentioned U40 because I read recently that in the US there was a case where there was a mix up with ReliOn insulin syringes and some U40 syringes were filled with U100 insulin. I also spoke to a paediatrician a while back who told me that a drug she prescribed to a patient had had no effect and after some detective work on her part she found that the pharmacist had provided the drug at ten times the dilution that the paediatrician had prescribed. So mix ups do occur. The problem is that we have no way of checking, other than the effect of the mix up on our health.

Richard
 
I don't think you have to worry about strength, I'm certain levimer only comes in one variety. If you are worried about that particular cartridge as Hana says then you should return it to the pharmacy .
Some speculations
I have read of other people reporting a problem with one vial or cartridge .
It could be from a badly stored batch(too cold fridge at the pharmacy?).On the other hand if it once 'worked' I don't think it would lose potency overnight in a normal temperature room. I've read of people (normally who have to pay for their insulin who seem to be able to use their opened vials beyond the official 42 days with no loss of potency .
A possibility is absorption variability. Athough levimer (detemir) is supposed to be far less variable than older insulins, there can be still be variability in absorbtion from day to day and (I believe) larger doses lead to more variability .Maybe you used an injection site with particularly poor absorption..... and you may as you say have missed a dose which also might make a difference

I'm glad you seem to have got control back, but its a shame that it mucked up Christmas :(
 
WE have a pharmacy based prescription re-ordering system here too, but they won't take requests over the phone. ONLy by email or calling at the pharmacy and filing in a form. They only check addresses, not birthdates too. Still It's no a problem for me, because I taught most of their children and everybody knows me.
How about contacting the other patient and asking him if he got the right repeat?
 
Hi,

I haven't suffered similar problems...but that doesn't mean that it doesn't happen! Have you been suffering with a bug/cold etc? This always send my blood sugar out of whack for a bit?

If you are sure that it is the insulin, maybe it is worth notifying the manufacturer? I have no idea whether they will admit that there is a problem, but I would imaging that they have a complaints policy, and if a particular batch is reported as dodgy, they should recall it? Alas, it doesn't give us much confidence in their product.
 
Levimer like all insulin supplied in this country is the same strengh u100, you can get a u500 (not levimer though, but short acting insulin) strengh insulin but this isn't on general script as it has to be ordered by a consultant via America (special import)

As for syringes, if these had been missed packaged you would have noticed the difference in size... As in the days both hubby and I (who's also a T1 diabetic) used syringes his u100x 1mm were a lot bigger than my u100 x 0.5mmm syringes easily distinguished apart..

So what other reason could there be for this increase...

Eating more carbs than one realised...
A cold or other infection increaseing BG
Stress could also do this...
Even a agrument can be enough to make your BG raise
Rebound from excerise can have this effect
Rebound from hypo can also have this effect
A night time hypo that you slept through, where the liver have dumped to raise your levels then the body hasn't enough insulin to deal with the dump!

You said that your weight increased with humalog insulin, It's not so much the insulin type that makes a individual put on weight, it is more to do with that insulins and regimes aren't adjusted properly, so the person ends up feeding the insulin with carbs to maintain levels or with dealing with hypos that causes the weight increase rather than the actual side effect of the insulin..

Hope these give you some ideas to where you can look to see where your problems may lay..
 
Back
Top