Advice

[rebrascora]

@Inka I think they are going to introduce the NR into the equation once they have the Levemir dose near enough right. I believe it has been prescribed so this seems to be just an interim period of gentle adjustment into insulin usage.

 

[LittleSunflower]

I find the pain is much more down to the nerves at the site as I don't suffer anxiety with my injections and finding a place where I can't feel it when I just touch the needle to the skin makes a big difference. Are you just using your stomach at the moment? Just wondering if you might be less uptight injecting into your thighs or buttocks. I tend to inject my Levemir into my thighs or buttocks and keep my abdomen for my bolus insulin as it seems to absorb a bit more rapidly there, whereas it doesn't matter with the Levemir as it is slow release anyway. Just something else to consider.

I was told it has to be stomach only, no thighs, arms or anywhere else.

 

[Inka]

I was told it has to be stomach only, no thighs, arms or anywhere else.

Im on a pump but when I inject I use my thighs and arms. My favourite place is the thigh. There’s no reason why you can only use your tummy. Years ago, I always injected my basal in my thigh.

 

[Inka]

@Inka I think they are going to introduce the NR into the equation once they have the Levemir dose near enough right. I believe it has been prescribed so this seems to be just an interim period of gentle adjustment into insulin usage.

Ah, I read it as them possibly only giving the Lev (especially the second part of what I quote below:

“No mention of starting Novorapid either as they’d like to see how I react to Levemir first. I’m not a big meal eater, more of a snacker so the nurse said Levemir is fitting for me.”

I see @LittleSunflower liked your post, so you’re clearly correct. I’m obviously super-sensitive to any hint of substandard treatment. I think I mentioned before a friend was messed around for ages and became quite ill. I have a hair-trigger for that now

 

[LittleSunflower]

@rebrascora In regards to my levels this morning and you saying to keep my hypo treatment close was a good call. I felt really off so tested again, my levels had dropped to 4! No wonder.
I feel like I’m on a rollercoaster ride, with the fluctuating levels although I’m starting to have some sort of idea beforehand to what my levels might be due to how I’m feeling at certain times.

 

[Ljc]

I was told it has to be stomach only, no thighs, arms or anywhere else.

Oh dear . Nursie gave you a bit of wrong info on injection sites
Here is a pic of suitable sites.

 

[rebrascora]

Sorry to hear you had a near hypo but sounds like you have good awareness and it is better that you experience that first one particularly, at a time when you are half expecting it. Well you probably weren't expecting it when your levels were at 10 earlier but you were at least sort of half forewarned and hopefully in a nice safe environment when it happened. Unfortunately some of us struggle with swings like this quite a lot whereas other people's levels seem to have a damper on them and react more slowly or respond predictably. That isn't to say that you will always be like that but you will get more used to and confident dealing with these situations in the same way as you will get more confident doing your injections.

I am a little concerned about your Levemir dose being left at 6units again for tonight now that this has happened. I would recommend you push your BG up a little bit at bedtime perhaps with a couple of digestive biscuits and set an alarm to check your levels at 2-3am. Has the nurse suggested a BG level for bedtime that she doesn't want you to go below? Ie Don't go to bed with a BG less than 8mmols... or whatever? Because in the circumstances I would be aiming for at least 10. What was your reading last night at bedtime or were you not testing then?

 

[Ljc]

Mmm. Sounds like you need another reduction, see if you can contact your nurse again

Yes keep those hypo treatments glossed hy you
As you don’t want to attempt negotiating dangerstairs when your legs have gone to jelly .
I’ve even got some in my downstairs loo.

One good thing is, you now know your hypo signs.

 

[Inka]

I agree with @rebrascora I don’t think I’d take the full 6 units of Levemir tonight if I was you. Remember you’ve been high, then started the insulin and dropped quite quickly. You now have insulin working and your starting level of blood sugar is lower. If the Levemir made you drop to the 5s in theory it could make you drop lower overnight tonight.

I can only say what I’d do, of course, but I’d take 4 or 5 units not 6. Nocturnal hypos and hypos early in the morning are something to be avoided as much as humanly possible.

 

[rebrascora]

Must confess, I was reluctant to suggest a dose change for tonight (because we are really not allowed to give that sort of opinion), but @Inka, @Ljc and myself are thinking very much along the same lines. If you haven't had bolus insulin today and 6 units of Levemir have dropped you like that when it has been dealing with food as well as basal needs and bearing in mind that Levemir acts for approx 17-18 hours, so there will be some overlap with your dose tonight, albeit only slight because it tails off, you are theoretically going into tonight with slightly more insulin than last night and probably a lower BG. If you are able to talk to the nurse tonight please do so. Definitely set an alarm and check through the night and make your own mind up about a reduction in dose. We are all taught that it is better to err on the side of caution, which means safer to be too high than too low. Nurse might not be happy with you tomorrow if you make a dose change, or might be proud of you for using your gumption (depends how good she is) but she is not the one risking a nocturnal hypo.

 

[silentsquirrel]

I found breathing OUT as I inject helps if tense. Put pen and needle in place (and personally I find stomach easiest!), breathe in gently then sort of do a big breath out through your mouth against the needle, hardly any effort needed to push the needle in as you breathe out.

 

[Ljc]

@rebrascora , you have read my mind.

 

[LittleSunflower]

Oh dear . Nursie gave you a bit of wrong info on injection sites
Here is a pic of suitable sites.
View attachment 16641

Would the injection site change because of low body weight?

 

[LittleSunflower]

Thank you all for your replies. I have been unable to contact the nurse tonight in regards to dose I am reluctant to change the dose myself even though I am equally worried about going low during the night. I know my levels have dropped quite significantly, quickly which is concerning having read and been told it can damage eyesight.
For context
My bedtime reading last night was 12.4 and I had the 6 units of levemir for the first time. I had another 6, decreased from 8 (as advised from nurse) this morning as I was 5.5 upon waking. I had some breakfast and was 10.8 afterwards. I was unable to take a lunch time reading as my fingers weren’t drawing enough blood. This afternoon before dinner, I felt a bit off and was 4.2
I haven’t been told a recommended level to be before bed, I will definitely ask as I am expecting to talk with the nurse tomorrow. Since testing, I have always been double figures when checking BG at bed time so having had more low figures (than what I’m used to seeing) throughout today, I’m intrigued to see what it reads later on tonight.

 

[rebrascora]

I would take your levels back up to at least 10 tonight with the aid of some digestive biscuits or wholemeal toast. A digestive biscuit is about 10g carbs so should increase your levels by about 3mmol, a slice of toast is 15g carbs so will increase it by about 4.5mmols. Personally I would push my BG up to at least where they were last night and still set an alarm if I was you and I was sticking with the 6 units..... totally respect your decision on that.

The risk to your eyesight is much more to do with dropping your HbA1c too rapidly rather than these short term fluctuations. Obviously they are to be avoided if possible but for many of us that is not always possible.... it often happens to me. The concern for those of us commenting is that you will have a nocturnal hypo. These can be harder to detect because you are lying down and sleeping and the Levemir drops you much more slowly so you don't feel it so obviously. Please keep hypo treatment and test gear right next to your bed for easy access. At least 2 or 3 lots of hypo treatment, not just one, because sometimes the first one doesn't bring you up enough. Also if you live sleep with someone make them aware of the situation so that they can encourage you to take carbs if they notice you are not right. Some people become resistant when they drop too low. I don't mean to frighten you but nocturnal hypos are much more serious and to be avoided as much as possible. Really just trying to prepare you for any eventuality to keep you safe.

 

[LittleSunflower]

I take Levemir around 9:30pm, when would you suggest I eat the biscuits in order for levels to rise, for it to show up on the bed time BG reading and before insulin?

Thank you for all of the information, it is frightening but I’d rather be aware than for something to happen and not know what’s going on. If I do have a hypo and have to treat it, should I be testing afterwards to see if the treatment has raised my levels too?

 

[rebrascora]

Absolutely, you should retest. It is referred to as the 15 rule. !5 g carbs for a hypo and test 15 mins later and then retreat if still below 4 with another 15g carbs and check again in another 15mins, then a small longer acting carb like a digestive biscuit once you are above 4.
You are going to inject the insulin regardless so test when you do that and then again at bedtime. That will give you an idea of whether it is going up or coming down in that interim period. If you are say 8.5 at 9.30pm and 9.4 at bedtime then it is obviously rising slightly at that point and I would probably just have 1 digestive but if you are in the 6s when you inject the Levemir and an hour or two later at bedtime you have dropped and are in the 5s or 4s you are going to need a midnight feast of long acting carbs and maybe throw in some nuts or cheese to bring you up to be safe to go to bed and hopefully hold you steady. Most of us are more insulin responsive in the evening so it is possible that you will be dropping towards bed time rather than increasing or static, depending upon what you had for your evening meal and when you had it. Carbs usually release most of their glucose into the blood stream within 2 hours of eating them. If you had a lot of fat with them.... something like a pizza.... then that can delay the breakdown of the carbs for another hour or two. Lentils and other high fibre foods can take longer than 2 hours to break down but it is quite individual.

 

[LittleSunflower]

There’s still so much to learn. I didn’t retest earlier when my reading was 4 it’s too late to do it now isn’t it?
I have been advised to test before every meal, before bed and when I don’t feel right. Is it also correct that insulin doses should be 12 hours apart if I take one in the morning and one before bed? I am asking from your own knowledge, not medically as I understand we’re not supposed to comment on things like that.
I am reluctant to reduce my dose as I don’t feel comfortable, as I said but my anxiety is definitely rising thinking it may be too much as there is an overlap, even with carb intake beforehand.

 

[Inka]

Thank you all for your replies. I have been unable to contact the nurse tonight in regards to dose I am reluctant to change the dose myself even though I am equally worried about going low during the night. I know my levels have dropped quite significantly, quickly which is concerning having read and been told it can damage eyesight.
For context
My bedtime reading last night was 12.4 and I had the 6 units of levemir for the first time. I had another 6, decreased from 8 (as advised from nurse) this morning as I was 5.5 upon waking. I had some breakfast and was 10.8 afterwards. I was unable to take a lunch time reading as my fingers weren’t drawing enough blood. This afternoon before dinner, I felt a bit off and was 4.2
I haven’t been told a recommended level to be before bed, I will definitely ask as I am expecting to talk with the nurse tomorrow. Since testing, I have always been double figures when checking BG at bed time so having had more low figures (than what I’m used to seeing) throughout today, I’m intrigued to see what it reads later on tonight.

You want to bed at 12.4 and dropped almost 7mmol to 5.5 : /
You’ve only just been started on insulin (you should have had it earlier) and the amounts chosen are not ‘magic’ amounts that you need - they’re guesses You’ve already had one of your twice daily injections reduced by 25%....

I’d feel bad if I didn’t repeat what I’d do from above - I’d reduce your evening Levemir. Having had serious nocturnal hypos myself, it simply isn’t worth the risk.

 

[Inka]

Would the injection site change because of low body weight?

No, and if it did, it’s more likely that you’d be recommended to use your thigh or bum. I’m slim and use my thighs, arms, bum, tummy just as shown above on that chart.