# help: overdose of levemir



## Patricia (Mar 8, 2009)

We *think* we are okay. But if anyone sees this: my son inadvertently took 12 units of levemir tonight instead of 8. This is because we recently split his does into 8 morning/8 evening, and he just did it absentmindedly.

What this means is that 8 units are still in him from this morning (gone by tomorrow morning), so we figure that tonight is the only dangerous point (when he will have one and a quarter normal amount in him). We are planning to a) test him through the night and b) leave him on a slightly lower dose all tomorrow (eg don't give him more in the morning).

This happened just before we ate, so we did not give him the normal novorapid with his evening meal, which was low carb anyway and he shouldn't have too much of a spike. Therefore when the meal is digested, his level should at least be fairly stable through the night, if we are correct? Although of course we will keep testing him.

My son is cross at himself -- but these things happen. We have phoned our local children's ward, but they were of the 'give him a couple of extra biscuits at bed and test him' persusion (eg pretty useless).

Does this plan sound okay?


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## Freddie99 (Mar 8, 2009)

I would give him some levemir tomorrow morning. Not giving any at all is a pretty bad idea as you always need the back ground insulin ticking over and doing its thing. However, I would reccomend that you reduce the dose from the normal eight units to six or maybe four. 
Checking blood sugars throughout the night is a good idea as you will be able to catch any hypos and get them treated. I would advise testing every hour before he goes to bed and perhaps every two or three hours when he goes to bed.

I hope this helps and best of luck for tomorrow.

Tom H


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## bev (Mar 8, 2009)

Hi , we have done it the other way round once - giving him novorapid instead of levemir!

I think what your planning sounds fine - except i think i would give him some full fat milk before bed - I know levemir is slow acting - but it may help a bit?

Also the novorapid will have worn off in the early hours - so its good to test as you will get a more accurate figure.

I would check with his team in the morning to see what they think about the novorapid.
( i am very new to all this - so apologise if i am not right).
Bev


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## tracey w (Mar 8, 2009)

Tom Hreben said:


> I would give him some levemir tomorrow morning. Not giving any at all is a pretty bad idea as you always need the back ground insulin ticking over and doing its thing. However, I would reccomend that you reduce the dose from the normal eight units to six or maybe four.
> Checking blood sugars throughout the night is a good idea as you will be able to catch any hypos and get them treated. I would advise testing every hour before he goes to bed and perhaps every two or three hours when he goes to bed.
> 
> I hope this helps and best of luck for tomorrow.
> ...



I have never experienced this, but would agree with tom. Monitoring is key and then if you need the biccies so be it. I would still take levemir tomorrow but a reduced dose, and speak to your dsn asap. Try not to worry


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## Copepod (Mar 8, 2009)

Actually, I'd have gone along with the 'give him a couple of extra biscuits at bed and test him' advice. Why are you reluctant to believe them? Are any diabetes specialists available to contact "out of hours"? Now that you have omitted evening meal short acting, there's probably no need for extra biscuits at bedtime, but worth checking with your team, if you can.
The extra biscuits at bedtime would see him through the spike (12 instead of 8 is 1.5 times the intended dose. In any case, test before morning dose, but certainly have some, if not the whole 8 units long acting. And continue to test more than usual through tomorrow daytime until evening, by which time he should be back to normal levels of insulin in his body.
He's right to be a bit annoyed with himself, but most people who use insulin have had similar incidents at some time - and lived to tell the tale! Just makes you think more about getting future doses right.


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## Patricia (Mar 8, 2009)

Hi all

This is so quick and helpful, thank you. Copepod, thank goodness for being quite laid back!  We just felt the ward were too quick to say, nah, no worries. When for us (well,me) it felt a little out of control...But I'm sure you're right. And no, we don't have any diabetic specialists out of hours, more's the pity.

The dose tomorrow am is the confusion, I think, and this is something to think about. We feared messing up tomorrow evening's dose of 8 units because of overlap, but it does seem right to make sure the background is always there. We'll test in the morning of course and see where to go.

Two more things: 1) this has made him realise with a start how important dosing is. It really, really scared him and 2) sorry about my maths. It started at 1.5, and somehow I just re-thought it wrong upon revision! 

Thanks for everything. Reassuredly yours.


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## diagonall (Mar 8, 2009)

Hiya, I doubt you will be the 1st or the last to do this. (((((((((hugs))))))))

All that is needed is a slow release carb over night to make sure he doesn't go low.
Milk as suggested or the chocolate bar 
Tomorrow he needs to make sure he has extra carbs on him as the levemir is long acting. So will have the tail off from it.

Cheer up worse things happen at sea.
Next time it wont feel so scarey 1st time is always the worst (Fear of the unknown)


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## Patricia (Mar 8, 2009)

Thank you type1_Sue. We're about to test him now and see where he is before bed. Sigh. Every new thing feels so frightening, yes.

I'll check in tomorrow morning and let you know how it went.

Best and thanks again.


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## Patricia (Mar 8, 2009)

Forgot to say the good thing about this: he realised partway through the injection his mistake, and stopped it at 12 units rather than the 15 he'd dialled up. For which he was heartily congratulated. There is the possibility that he actually injected the full 15, because when we got to the pen it read all injected -- but he is certain that he realised, looked down, saw 3 units remaining, and pulled it out. He then thinks that in his panic he re-set the pen, so it read 0 by when we saw it.

So there is the slight possibility of him being even 3 more units of levemir in...but again, the same procedure follows, I can see. More tightly followed. But he feels certain he had some left, and *must* have reset it in his flurry upon realising his mistake...

Anyway, at least he realised. Phew.


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## diagonall (Mar 8, 2009)

If any doubt at all Patricia, and you are worried about Alex going to low then it's better to have extra carbs overnight and then correct at breakfast time.
Always better safe than sorry.


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## Patricia (Mar 8, 2009)

He's 21 before bed. Lordy. And the only carb was mash. We're going to wake him in two hours when the food may be through and see where we are, and two hourly thereafter. Loathe to put more carb in when he's so high (higher than we thought we would be) now. AND last few days he's been surprisingly high at first thing (11), so we were wondering if evening dose okay anyway...although on top of it all, he's been unwell with one thing and another for ten days, so things sort of up the creek generally...

Oh my. Deep breath.


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## diagonall (Mar 8, 2009)

oops no he doesn't need carbs with a reading of 21. 
Sounds as if you need to check in a couple of hrs and then correct.
Mashed spuds are awful on the blood sugars 
If he has been unwell then his readings will be higher than normal too.


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## katie (Mar 8, 2009)

Don't panic Patricia, just don't give him any more carbs because it is very unlikely he will drop low now.  Unless he is low when you check again of course...


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## Patricia (Mar 8, 2009)

Thank you! All reassuring. 

Yes I've heard mash is awful -- only it actually wasn't that much, as was the only carb in the meal. AND he absolutely adores them.

Anyway. His readings have been coming down generally after a really unpredictable patch from being ill, very high. BUT we've been hammering and they've been dropping, except the morning one...but it's been the same as the bedtime reading, generally, so we wondered if in fact we weren't being aggressive enough with dinner novorapid...Anyway (again), we'll set about solving it as soon as a) he's a bit more stable and b) we get through tonight!

Huge thanks to all. Once again.


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## diagonall (Mar 9, 2009)

Patricia said:


> Thank you! All reassuring.
> 
> Yes I've heard mash is awful -- only it actually wasn't that much, as was the only carb in the meal. AND he absolutely adores them.
> 
> ...



If he is high morning and evening then it sounds as if he needs more levemir anyway.
I wouldn't have anything to do with his meal bolus at those times.

Mashed spuds, the easier way to deal with them is to have a higher carb ratio for the spuds them what ever else is on the plate.
It's a personal thing but the carbs from spuds hit me at the 3 - 3 1/2 hr mark instead of 2 hr peek.
As you have found all is trial and error. And no 2 days are the same 

Hope all is well this morning.

Sue


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## sofaraway (Mar 9, 2009)

Hope that he was stable overnight. From what you wrote last night I think you handled it well. It's just one of those things that sometimes happens. i think that i gave my lantus twice on one occasion last year, i don't remember doing it but the hypo's all the next day suggested that i had. 

I'm not surprised that the ward didn't give you very much advice or anything specific. it would really have been wrong for them to have done so.


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## Patricia (Mar 9, 2009)

Thanks all. Last night was okay -- 16, then 12, then at 4am, 5mmols. We woke him up and gave him a biscuit and a little milk just to cover the last three hours in case. Woke up this morning at 13, which he thought was awful but we had sort of expected. Also because he didn't go particularly low in the night, we have taken the line that he gave himself 12 instead of 15 levermir by accident, so indeed as suggested here last night topped up his levermir for today by 4 units. We've told him not to correct if he's a little high unless he phones us. We expect him to be a little high, but at school better to be so than for him to be combatting hypos all day. He's sensible anyway, 13 yrs old tomorrow!

It's astonishing how much his level dropped between 2am and 4am though. Yikes. Would have thought that the levermir would be more stable than that in the night?

Type1_Sue -- yes, we've now left a message for the DSN about raising his evening levermir, and perhaps lowering the day, eg altering the split balance. And your thoughts about mash are useful -- his level was certainly so much higher than we anticipated last night, at almost exactly 3.5 hours after eating...Hmm!

On top of all this, he's still battling with a cold and feeling rather sick alongside it for some reason (he feels sick when high often, but this has been whether high or not last few days) -- so although he's at school and soldiering on, I'm sure we all feel like wet dishcloths. Fed up to the eye teeth really!

I'm grateful for all the support here. We made it. He made it. All best wishes.


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