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Help, emergency Levemir dose

PattiEvans

PattiEvans

Well-Known Member
Relationship to Diabetes
Type 1
Pronouns
She/Her
Hello all

I am in Hospital in France ( hoping to be let out and repatriated tomorrow). My pump has just broken. I have pens, Levemir and Apidra, my level currently is 7.7. I've not long bolussed 2u for 20g carb. I can compute boluses. Just wondering how many units of Levemir to start with and how soon. Any ideas? I am thinking 3u within an hour. Any help please? Not asking cast iron advice, just an idea.
 
Is your CGM working Patti? Have they allowed you to keep and administer your own insulin or are you reliant on nurses bringing you your insulin and supervising you injecting?
If you have autonomy, how about doing what I did last summer and just injecting a few units of Apidra every few hours to keep you in range plus whatever you need for food. I set my high alarm at 8.2 and then injected 2 units every time the high alarm went off and that worked really well for me and I could manage with just one injection overnight which didn't seem bad.

I assume you can't find out from your pump what your basal usage was and do you know when it stopped working? Being laid up in hospital I am assuming your basal needs are probably higher than they would be normally but how much higher might depend on the issue you are in hospital I would guess. 3 units sounds like a very conservative dose for tonight but it depends on so many things. At least it is providing you with some cover and I assume you can correct with Apidra if necessary.
 
Well, the nurse caught me with the pens out, typing the message. Inquiry followed and phone call to Dr. I have to call them every time I inject. I'm figuring any Apidra lasts 3 hours I n the pump. Levemir takes 2 hrs to ramp up. Should be safe.

I'm over being sick and all was going well until the pump broke. As I pointed out, they nearly killed me when they took the pump off me and administered intravenous insulin in intensive care.

They'll be prodding me awake every hour now.

Found basal on .pdf of Ypsopump 13.6 per day.
 
Last edited:
PattiEvans said:
Well, the nurse caught me with the pens out, typing the message. Inquiry followed and phone call to Dr. I have to call them every time I inject. I'm figuring any Apidra lasts 3 hours I n the pump. Levemir takes 2 hrs to ramp up. Should be safe.

I'm over being sick and all was going well until the pump broke. As I pointed out, they nearly killed me when they took the pump off me and administered intravenous insulin in intensive care.

They'll be prodding me awake every hour now.
Click to expand...
Patti, I have nothing of value to offer you, but just wanted to say I hope you can be repatriated asap. Sounds like you've had a dreadful time of it.

Fingers crossed for tomorrow.
 
Patti I have been watching out for a post about your hospital stay after you mentioned it on Mikey's thread but I can't find it anywhere.

Shocking to hear that they got your sliding scale wrong and nearly killed you! 😱 At least I think that is what you are saying.
It is my absolute worst nightmare being taken into hospital and losing access to my insulin and autonomy over my diabetes management. I really hope you are well enough to come home soon. Good luck with the 3 units tonight.

How is Julian coping? It must be pretty scary for him!
 
I’m no expert but I’d probably have taken half of my daily basal as levemir, at least 2hrs after my pump died. Minus a bit if I’d generally been running low or wanted to be cautious. I wouldn’t want to be injecting every few hours in hospital I’d want to be getting any sleep I can, especially when a phone call is required to take the insulin.
 
The advice I was given about basal insulin if I ever had to come off the pump was to take it immediately. My back-up is Tresiba so I can’t advise about the dose, sorry. Take care.
 
As soon as your pump stops working or is disconnected, you have zero basal so you need your Levemir straight away.
As for the dose, do you have access to your pump settings? For example, my pump settings are available online. Or maybe you can see them on your pump if you still have it. I was told my pump basal is 15% less than injecting.
Once you are through this, it is probably worthwhile taking a note of your Levemir dose in case this happens again.
 
Discovered it's a 2u pen. Not used it over a period of 3+ pumps... so I had forgotten and therefore did 4u. I don't have to ring them. Just press the call button. Sometimes they take their time. Fair dos they have other patients

I haven't posted about the hospital stay because I've not had the energy. Long story short we were on a river cruise out of Bordeaux when I was rushed into a cottage hospital with pneumonia on our 40th wedding anniversary. The next day I was airlifted to Bordeaux, by which time I was delirious. I was operated on that afternoon (lung opened and washed out, packed with ABs) and then spent a week in intensive care.

Since then everything that could possibly go wrong has done. Pump is broken.... generally being kept in the dark about repatriation even silly things like a travel bottle breaking . You couldn't write it.
 
So sorry to hear how absolutely dreadful things have been Patti and didn't mean to pry. It was just when you said they nearly killed you in intensive care you made it sound like you had already told us about that. I had been looking out for a thread about you being in hospital and not seen one, so I wondered if perhaps it hadn't sent. Internet connection here has been absolutely shocking though so wondered if I had missed it.
Poor you and poor Julian. That must have been incredibly stressful and scary for you both. What a way to celebrate your 40th! Your 50th and 60th should be a doddle after this!!
 
I have had a number of planned pump breaks @PattiEvans and I build up my basal, starting on the same dose as my pump. I then adjust as needed over a few days, usually increasing slightly. I don’t use Levemir but I use a twice daily isophane. I take almost double the amount of isophane a.m. than p.m. I know this is what I need because I roughly know my pump hourly basal rates. As long as you’ve got some basal in and can correct if necessary, you should be ok.

It sounds a scary and very, very stressful experience. Wishing you a smooth recovery. Look after yourself xx
 
Thank you everyone. Helli. Thsnk you for your help. Pre-pump Lev was 10 + 12. Basal according .to Ypsomed .pdf was 13.6.
What I might have done sensibly when not unwell is possibly a different matter.


Pump is now alarming every few mins. I have wrapped it in 2 of the tea towels they call towels and shut it in the bathroom.. phone now alarming too. Hopefully have shut it off. Must try to sleep as it's 11pm and we are woken at 5.
 
helli said:
As soon as your pump stops working or is disconnected, you have zero basal so you need your Levemir straight away.
Click to expand...
Interesting. I would have thought you have all the apidra taken as basal over the last 3.5hrs ish still working.
 
Pre pump I used 18u Levemir daily but 14u AM and 4u bedtime. I have been known to go overnight using 4-hourly jabs of Novorapid though.

What the heck's up with your pump, though. Never rains without pouring, dangnabit. Hope to 'speak' in the morning.
 
Like others @PattiEvans I hope you are repatriated ASAP it all sounds quite scary and stressfull what you’ve just been through
TC
 
PattiEvans said:
Discovered it's a 2u pen. Not used it over a period of 3+ pumps... so I had forgotten and therefore did 4u. I don't have to ring them. Just press the call button. Sometimes they take their time. Fair dos they have other patients

I haven't posted about the hospital stay because I've not had the energy. Long story short we were on a river cruise out of Bordeaux when I was rushed into a cottage hospital with pneumonia on our 40th wedding anniversary. The next day I was airlifted to Bordeaux, by which time I was delirious. I was operated on that afternoon (lung opened and washed out, packed with ABs) and then spent a week in intensive care.

Since then everything that could possibly go wrong has done. Pump is broken.... generally being kept in the dark about repatriation even silly things like a travel bottle breaking . You couldn't write it.
Click to expand...
Sorry to hear this hope you get home and recover soon.
 
PattiEvans said:
Hello all

I am in Hospital in France ( hoping to be let out and repatriated tomorrow). My pump has just broken. I have pens, Levemir and Apidra, my level currently is 7.7. I've not long bolussed 2u for 20g carb. I can compute boluses. Just wondering how many units of Levemir to start with and how soon. Any ideas? I am thinking 3u within an hour. Any help please? Not asking cast iron advice, just an idea.
Click to expand...
Sorry to hear that you are poorly @PattiEvans , and now that you have the additional problem of a broken pump. I hope that you get repatriated soon and feel heaps better.

My pump would be replaced within 24 hours within Europe. Can they get a new one to you?

For when you are home and feel well again:
When my pump broke (I drowned it when I went swimming) I had no idea of my daily dose as it was all on my pump. I now have a sticky label on my pens stating the Levemir dose and carb ratios on my Novorapid pen. I now that these will change over time but as it would not be used for more than 24 hours at any time those doses are a good starting point.
I have recently replaced my pens, which are only used as a back up, as mine were 17 years old, and the DSN suggested that our pens should be replaced every 5 years!!! (I think that is based on daily use -Mine get used once in a blue moon) still made sure that I got half unit pens.

I hope that you are home soon.
 
Have you contacted the pump company? I was told that Ypsomed will get a new pump to you within 24 hours if you're in Europe.
 
Good morning. After a terrible night I was surprised to wake at 10.1 with a pretty flat line. This morning I've done another 4u Levemir and 2u Apidra whilst eating only a 10g carb cookie for breakfast. BG has risen in the intervening 2.5 hours to 11.9. I'm giving it another half hour to see the trend then probably will do some more Apidra.

To explain, I didn't come entirely unprepared. We were due to be away only 8 days. So I packed 4 little reservoirs of Apidra to fit the Ypsopump (should last a total of 24 days), 6 cannula (18 days), a cartridge of Levemir, one of Apidra and necessary pens. I have the usual letter, recently acquired, from the DSN for airport shenanigans, a typed sheet I did detailing the most recent basal settings on the Omnipod plus hourly I:C ratios. Not to mention all my meds/Cavillon/pre injection swabs etc. Unfortunately that sheet was not much use for basal because I started on CamAps less than 6 weeks before we came and it doesn't have a set basal profile. Fortunately I did eventually remember the online .pdf report at Helli's prompting.

Leaving aside the period in IC when they took over (badly), it's been good. Until here in my room, clad only in a hospital gown with nowhere to tuck the pump and bearing in mind I was still groggy, I dropped the pump onto the bathroom floor. The first time the display dimmed, but I was still able to use it. The Ypsopump requires the display to perform a very complicated procedure to refill or change the cannula. The second time I dropped it the display disappeared altogether. Bye bye to any ability to change it. Tho it worked for a further 3 days until it needed changing

I've rung Ypsomed who are happy to replace it, dependent on pump insurance, who I have spoken to and I believe are happy to cover it. However, the problem lies with where to send any replacement as my repatriation is frustratingly unclear.
 
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