# Levemir question



## ScottishThistle (Sep 5, 2017)

Hi, my 8 year old daughter was diagnosed in June so we are still learning and I need advice about her evening levemir injection. She started having hypos in the night so my doctor advised lowering her evening levemir, she was still having hypos so for an experiment I stopped giving her the evening injection. She now has stopped having hypos and her waking levels are steady at 6.0 or just over. I am now worried if I am causing harm by not giving her any evening levemir though, but cannot discuss this with my doctor because the doctor would have a fit if I told him. The other change I have noticed though is that she can be within range waking up but have gone up to 7.7 before breakfast - is this because she is not having that evening injection? Thank you in advance.


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## novorapidboi26 (Sep 5, 2017)

You should probably back up that decision with a test during the evening with carb free meal for dinner.....just to confirm the absence of Levemir is holding her steady

But its perfectly possible she doesn't require any and even more so with a recently diagnoses diabetic whos pancreas will still be sporadically producing its own insulin....

the morning rise may be due to the absence of the evening dose yes.....when we wake a cocktail of hormones kick in as well as the liver which spits out a bit of stored glucose and increases insulin resistance to help us get going after the long fast....

ultimately i think you can deal with that small rise in the morning rather than start up with an evening levemir dose and risk hypo.....

just keep testing the Levemir dose as it probably wont last like this and you will need to start giving it again...

if you are really unsure don't hesitate to contact your team.....they wont be angry....


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## ScottishThistle (Sep 5, 2017)

novorapidboi26 said:


> You should probably back up that decision with a test during the evening with carb free meal for dinner.....just to confirm the absence of Levemir is holding her steady
> 
> But its perfectly possible she doesn't require any and even more so with a recently diagnoses diabetic whos pancreas will still be sporadically producing its own insulin....
> 
> ...


Thank you, you have given me some reassurance, I am not sure what you mean about doing a test in the evening though? How would a carb free meal confirm this - sorry I am still getting to grips with this.


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## novorapidboi26 (Sep 5, 2017)

ScottishThistle said:


> Thank you, you have given me some reassurance, I am not sure what you mean about doing a test in the evening though? How would a carb free meal confirm this - sorry I am still getting to grips with this.



I quite often make assumptions when I shouldn't but the diagnosis is very new so expecting you to know was silly....sorry.....

Basal insulin like Levemir and Lantus are designed to hold your blood sugar steady in the absence of food/mealtime insulin, so in order to confirm if the dose being given is doing that job you would test regularly between times of your choice when you have no food digesting or meal time insulin working.....hence the carb free.....

Its good practice to test in 5 hours slots which encompass each mealtime, breakfast, lunch and dinner.......testing each of these time periods separately and on different days.....

I wont go too much into it as your new to it...but I hope that explains the general jist of how the Levemir is meant to work and how you go about confirming its working....


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## ScottishThistle (Sep 5, 2017)

No need to apologise, I really appreciate you taking the time to help! I think I understand, at the moment her morning injection is working well but I have to give her a small carb snack inbetween meals otherwise she would hypo, there is a lot to it but thank you again for your help.


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## novorapidboi26 (Sep 5, 2017)

No problem....

Hopefully some dose adjustment training should come your way soon......

the daytime Levemir dose could be responsible for the low in between meals during the day......again, you could test that too.......if/when you find the dose is right for the Levemir and the lows still happen then you would want to look at the mealtime insulin carb ratios.....again, a lot to take in but worth learning.......the basics of carb ratios is you take 1 unit of insulin for say 10g carbs, this can be 15g for children......provided the Levemir dose is right you can adjust the ratios to 1 unit for every 20g, 25g, 30g, so on and so forth......you can go for more insulin too by going for 1 unit for 8g, 7g, 6g etc......

But don't try any of this without support form your team......

Its unlikely you will see any consistent patterns with the blood sugars at this early stage due to the honeymoon period but it should settle and then you can get learning hoe to adjust doses and count carbs..


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## ScottishThistle (Sep 5, 2017)

novorapidboi26 said:


> No problem....
> 
> Hopefully some dose adjustment training should come your way soon......
> 
> ...


Thank you so much, one more quick question if I may, what changes do I need to look for that would suggest she needs her evening injection again? Would I expect to see a rise in blood sugar through the night? Sorry if I am being a nuisance!


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## novorapidboi26 (Sep 5, 2017)

Yes, pretty much.....

if the blood sugar level rises in the time slot you are testing, in this case overnight, then that suggests you need to increase the dose....or in your case introduce a unit.....lol....

obviously you may see it going up and down in a given period but you are limited to what you can do on injections.....

if you can get a few tests done and report in to your team for advice that would be best.....you can ask in here as well but best to get your team to take the blame for any mistakes....


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## Copepod (Sep 6, 2017)

As long as you document everything, which includes insulin dose, food eaten, carbohydrate content of food eaten, other factors, such as exercise, stress, illness etc, and present this to your diabetes team, they shouldn't go mad.
Please do ask for more advice about carbohydrate counting etc. This might be done by a diabetes specialist nurse, dietician etc.


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