Accidental levemir overdose, what now?

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Scrumpyjack65

Scrumpyjack65

Well-Known Member
Relationship to Diabetes
Type 1
I live with T1 and have done for the last 45 years. This is the first time I have ever accidentally overdosed on insulin. I have previously been on a pump but am having a pump break with two injections of Levemir morning (9 units) and (2 units) at night, with Novorapid during the day. I accidentally gave my 9 units last night, and as a result, had a seizure during the night. I haven't given any more Levemir today, and feel far from brilliant. Any advice would be very gratefully received, thanks. Sally
 
I'd have thought give yourself the dose for the day (maybe a bit reduced, just for safety). Do you have a CGM (Libre, for example) with alarms, and did that fail to wake you in time overnight? (Can happen, but I find mine wakes me up fine even though it's just buzzing under my pillow.)

Not sure what else to suggest other than the obvious: try to contact your hospital team and talk it over with one of them; keep monitoring your BG so you can keep in range with the Novorapid.
 
Wow! That must have been scary. Really sorry to hear that happened but don't beat yourself up about it because we all make mistakes..... I injected Fiasp instead of my morning Levemir (24 units of it!) a few weeks back and that was a scary experience but thankfully I realised straight away and started eating carbs like my life depended on it..... which of course it almost certainly did and I got away with it but it was touch and go.
Were paramedics involved or did you wake up after the trauma of the seizure?

In your situation I would have taken a reduced amount of Levemir this morning because without it you are likely to be on a bit of a rollercoaster getting it balanced again possibly for a couple of days, but since we are now mid afternoon I would not take it now but wait until tonight for your usual 2 unit dose and just manage any highs with NovoRapid until then. Better to be a bit high than have another nasty low.
 
Bruce Stephens said:
I'd have thought give yourself the dose for the day (maybe a bit reduced, just for safety). Do you have a CGM (Libre, for example) with alarms, and did that fail to wake you in time overnight? (Can happen, but I find mine wakes me up fine even though it's just buzzing under my pillow.)

Not sure what else to suggest other than the obvious: try to contact your hospital team and talk it over with one of them; keep monitoring your BG so you can keep in range with the Novorapid.
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Hi Bruce, thanks for your swift response. Yes, I am using a Dexcom G6 sensor, thankfully as that annoying beep we sometimes hate woke me up, when I tested I was 1.2. I have been correcting during the day with Novorapid as a safety measure. I've now renamed the Levemir pens that say simple morning and evening and put the morning one somewhere else. Thanks for your help.
 
rebrascora said:
Wow! That must have been scary. Really sorry to hear that happened but don't beat yourself up about it because we all make mistakes..... I injected Fiasp instead of my morning Levemir (24 units of it!) a few weeks back and that was a scary experience but thankfully I realised straight away and started eating carbs like my life depended on it..... which of course it almost certainly did and I got away with it but it was touch and go.
Were paramedics involved or did you wake up after the trauma of the seizure?

In your situation I would have taken a reduced amount of Levemir this morning because without it you are likely to be on a bit of a rollercoaster getting it balanced again possibly for a couple of days, but since we are now mid afternoon I would not take it now but wait until tonight for your usual 2 unit dose and just manage any highs with NovoRapid until then. Better to be a bit high than have another nasty low.
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Hi Barbara, thanks for your swift response. It is much appreciated. Glad I'm not the only one who makes mistakes, it was a first and hopefully last for me! I didn't have to call the paramedics thankfully and woke up after whatever it was that was happening. Such a weird sensation.

Think you're right, it's too late to do anything practical now with the Levemir and I'll just wait until tonight. I dozed off early last night and when I woke at 10 pm, and thought it was morning, silly girl. Anyway, like you say far better to be a bit high than too low. Here's to a better evening, best wishes, Sally
 
Scrumpyjack65 said:
Hi Bruce, thanks for your swift response. Yes, I am using a Dexcom G6 sensor, thankfully as that annoying beep we sometimes hate woke me up, when I tested I was 1.2. I have been correcting during the day with Novorapid as a safety measure. I've now renamed the Levemir pens that say simple morning and evening and put the morning one somewhere else. Thanks for your help.
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Hi. Pleased you are managing things with NR. I am curious to know how 2 different pens for your Levemir will prevent this? Surely you dial up the number of units each time so you could still dial up the wrong amount regardless of having a morning or evening pen.... Just trying to get my head around what you are hoping to achieve with 2 pens? Not a criticism, just trying to learn...:D
 
rebrascora said:
Hi. Pleased you are managing things with NR. I am curious to know how 2 different pens for your Levemir will prevent this? Surely you dial up the number of units each time so you could still dial up the wrong amount regardless of having a morning or evening pen.... Just trying to get my head around what you are hoping to achieve with 2 pens? Not a criticism, just trying to learn...:D
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Hi, well I just thought if I put my morning pen in another room, say my office and my evening pen by my bed, then it would be easier for my brain to remember, ah yes its evening. I know there is still a margin of error, although small I feel that I would dial up 9 units in the evening.

BTW, I see you are using Fiasp as am I, I sometimes forget that I changed over. Seems like you are loving the fast reaction of Fiasp. Sally
 
Scrumpyjack65 said:
Hi, well I just thought if I put my morning pen in another room, say my office and my evening pen by my bed, then it would be easier for my brain to remember, ah yes its evening. I know there is still a margin of error, although small I feel that I would dial up 9 units in the evening.

BTW, I see you are using Fiasp as am I, I sometimes forget that I changed over. Seems like you are loving the fast reaction of Fiasp. Sally
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Ah Ok, I see. Yes, I guess it is just an extra prompt to make you think before you inject.

As regards Fiasp, no, sadly I don't actually find it that fast at all, but marginally better than the sluggish NovoRapid. I still need to prebolus 45 mins on a morning (I needed 75 mins with NR! 😱 ) and usually 15-20 mins at other times of day. I wouldn't go back to NR again now but I am not a fan of Fiasp and I find it a bit quirky, but we have found a way to muddle along together. It took me two frustrating trials of 3 months each to find a way to make it work for me, so I am reluctant to change now, but I'm not overly enthusiastic about it. We are all different! I guess if, it had worked quicker on me that massive overdose the other day would have landed me in hospital, so I guess there are silver linings to it not being so quick. Hope you find it good. On the other hand, I absolutely love my Levemir for it's flexibility and would fight tooth nail to retain that if a swap was suggested as I need to adjust my basal doses on an almost daily basis due to not having a settled routine.
 
Hypo seizures are terrifying @Scrumpyjack65 I wouldn’t have any more Levemir until your next dose is due. I’d also run slightly higher than I normally would, just to be safe.

With your pens, you could also stick a ‘9’ and a ‘2’ on them very prominently. When I have a pump break, I talk to myself when I do my basal. Sounds mad, but I say to myself something like variations of this “Ok - morning basal. I’m having 9 units, ok? Dial up 9. Stop! This is the morning and my dose is 9. Yes - inject” The point is to get my brain off auto-pilot and double-check by repeating the salient points to myself, allowing myself extra time to spot a mistake. It works for me and I feel safer doing it.

Take it easy and I hope you feel ok.
 
I like that idea @Inka. I think the main reason I made my mistake the other week is that I wake up an hour early to inject my Levemir so that it is active when I get up to tackle "Foot on the Floor" and I am barely conscious because I intend to go straight back to sleep. Thankfully I opened my eyes enough to register that the pen in my hand was red and not blue when I put it back in the case.... and BOY!... did that wake me up and clear the brain fog very quickly!! I don't want to think what would have happened if I hadn't noticed and went back to sleep for an hour! I barely managed to eat enough carbs in the time I had!
 
I also talk to myself quite a lot so shouldn't be a difficult habit to form. 🙄
 
Inka said:
Hypo seizures are terrifying @Scrumpyjack65 I wouldn’t have any more Levemir until your next dose is due. I’d also run slightly higher than I normally would, just to be safe.

With your pens, you could also stick a ‘9’ and a ‘2’ on them very prominently. When I have a pump break, I talk to myself when I do my basal. Sounds mad, but I say to myself something like variations of this “Ok - morning basal. I’m having 9 units, ok? Dial up 9. Stop! This is the morning and my dose is 9. Yes - inject” The point is to get my brain off auto-pilot and double-check by repeating the salient points to myself, allowing myself extra time to spot a mistake. It works for me and I feel safer doing it.

Take it easy and I hope you feel ok.
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Hi Inka, thanks for your response. I'm not going to have any more Levemir until later on just before bed. As I said I've never had a seizure before and yes it was absolutely terrifying, I didn't know where I was, who I was or anything else. I've been on a pump for about 12 years and this is my first time back onto pens. It's certainly been a good lesson, I'm aiming for a quieter few next days.

As you say it's the autopilot bit that kicks in, I hadn't realised. Thanks for your kind thoughts.
 
rebrascora said:
I also talk to myself quite a lot so shouldn't be a difficult habit to form. 🙄
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Me too so I’m glad I’m not alone! When I’m feeling particularly dopey or stressed, I repeat the number of units to myself more times and even ask myself if I’m sure. Once actions become routine it’s so easy to make a mistake. I’d far rather do my little commentary/questions than have to deal with a mistake. I’d have been very scared if I’d injected 24 units of bolus. I don’t think I could cram enough carbs in to compensate even if I realised immediately. I think I’d have phoned for medical help.
 
Don't forget to write the date on your pen. If you're doing your morning and evening doses from different pens you'll need to throw away some of the insulin as can only have it out of the fridge for one month.
 
Inka said:
Me too so I’m glad I’m not alone! When I’m feeling particularly dopey or stressed, I repeat the number of units to myself more times and even ask myself if I’m sure. Once actions become routine it’s so easy to make a mistake. I’d far rather do my little commentary/questions than have to deal with a mistake. I’d have been very scared if I’d injected 24 units of bolus. I don’t think I could cram enough carbs in to compensate even if I realised immediately. I think I’d have phoned for medical help.
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I have to say I was panic stricken which probably worked in my favour because the stress will have caused my liver to throw out even more glucose to slow the drop but the panic also made me feel sick and trying to eat that much sweet stuff when your heart is pounding and you feel nauseous and terrified is challenging! I rang Ian and asked him to keep ringing me back every 10 mins to check on me and to come down if he didn't get an answer, so I had at least some back up. I was so proud of my graph because I only just dipped into the red and then came back up to about 7 and levelled off, but it was a frantic hour and being low carb I actually wondered if I had enough carbs in the house at one stage! Of course I did but it just seemed like a massive quantity was needed. I actually itemized everything I ate as I went along so that I had a running tally of carbs to keep track of it.
 
That sounds very organised! I once had a hypo that wouldn’t go away and I was almost sick from stuffing carbs in swilled down with Coke. I was trying to think of what was concentrated carbs but it’s hard when you’re panicking. I didn’t write anything down - just stuffed my face. Stress can make me both high and low. I didn’t even stop to test my blood sugar until I’d eaten loads. I was shaking and sweating with fear so that didn’t help either!

After that, I kept meaning to source small size high carbs foods but I keep forgetting! They need to be long-lasting too.
 
Yes, I was surprised how organized I could be when I felt my life depended on it as I am normally terribly disorganized, but my mind was in such a panic that I was struggling to do the very simple maths involved in totting all the carbs up. I resorted to coffee with 3 sugars in towards then. Should really have just eaten honey if I had been thinking straight but I had JBs Dextrose, prunes, 2 coffees with 3 sugars apiece.... boy did I want to throw up!

Interestingly Glucogel has suddenly appeared on my repeat prescription list since it happened and yet no medical persons were involved or informed and I have never asked for or been offered Glucogel before! Not sure what it is like for being sickly. Have you ever used it?
 
I’ve never used Glucogel but I have used HypoStop which was vile. I suggest you have a try of the Glucogel when not hypo. I remember spitting out the HypoStop because it was so gross - obviously not ideal for a hypo! I do buy the Lift GlucoJuice shots for emergencies and they’re great. Easy to drink and very pleasant.

Edited to add that the Gluco Shots are 60ml and contain 15g carbs. They’re not cheap but often on offer, and worth it in my opinion.
 
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