January 22, 2007
Daily Care, Insulin Analogs
Question from New York, USA:
I use an insulin pump, but my diabetes team encourages all of their pumpers to have a back-up plan in case of pump failures. I was given Levemir to use next time, with instructions to replace my pump basal on a unit-for-unit basis. However, I know some people use Levemir twice a day and others once a day. I would like to see if once a day would work for me, but I don’t know how to try this safely. I get six units of basal between 10 p.m. and 10 a.m., and eight units between 10 a.m. and 10 p.m. So, if my pump failed, I figured I would simply add up the basal I would get over the next 12 hours and give that amount. However, if I wanted to try and see if it worked once a day for me, I would have to inject 14 units all at once, I imagine. If I didn’t, then I would go high anyway from too little basal and if I did inject all 14 units at once, and it only worked 12 hours, then it would essentially be like having double the amount of basal I needed during those 12 hours. So, how do I determine if once or twice daily dosing is more appropriate for me? Lantus is not an option for me.
Answer:
When the drug was released, most of the studies were done on twice a day dosing. It is more conservative. Since this plan is only short term, you would probably want to use the most conservative regimen, which would be twice a day basal insulin. There is no other way but to try. Since you are on a pump, you would not necessarily be able to do this.
JTL
[Editor’s comment: Since it is your diabetes team that has given you the Levemir, you should ask them about your dosing. And, of course, if your pump fails at 2 a.m., you might wish to use short-acting insulin for several hours until you can give yourself Levemir. A lot depends on what time the pump fails and how long it takes your pump manufacturer to provide you with a replacement. I recently heard of someone whose pump failed at midnight and got the replacement at 2:30 a.m.!
BH]
