[Eddy]

Originally Posted by sarah91

Having had the results from being on a sensor for 5 days the consultant came to the conclusion that Lantus is only lasting me til 3am.

[...]

The doc did not give me any solution to this problem but am going back to the hospital in 2 weeks to reassess how to overcome this problem.

Many people split their Lantus into two doses.

In me, Lantus "fades" a bit before 24 hr, but still has activity. I handle this by injecting Lantus at 17:30, and an extra 2U of NPH at lunchtime.

[sarah91]

Splitting my Lantus would probably do the job but I don't fancy waking up at 3am every morning to inject it!
Also if its only effective for 4 hours wouldn't I have to inject it 6 times a day???

[JJM335]

Originally Posted by sarah91

Also if its only effective for 4 hours wouldn't I have to inject it 6 times a day???

Sarah:

Lantus is touted as a "24 h insulin". If you look at the idealized activity curves put out by Aventis (and based on a single injection) you will see that it takes about 8 hours to reach maximum activity and then supposedly continues release at a flat level to 24 h. Their activity curves don't continue beyond 24 h, but it is reasonable to assume that release from the injection continues for many hours longer albeit at a reducing level.

If you take a single daily shot of Lantus, these curves start to stack on top of each other, so at say 2 or 3 hours after the shot, you are getting some insulin from the most recent AND the earlier shot. This is obviously complicated. Many T1s seem to find that Lantus "only lasts 22 or 23 h". This doesn't mean that release stops completely after that time, only that the coverage is inadequate around the time of injection when one shot is wearing off and the other hasn't got up to full speed yet.

Everyone seems to react a bit different, but is it possible in your case that the problem is NOT that the Lantus has stopped after only 4 h but that you are experiencing a "hole" at that time? You could imagine several explanations for this -perhaps in your body the Lantus takes longer to "get going" so at 3 am your old shot is wearing off and your latest one hasn't fully kicked in yet. You also don't say how much Lantus you are taking. Smaller doses seem to last less long.

The most common way to deal with "holes" seems to be to change the timing of your injection and/or to split the dose. If you take 2 shots at about 12 h apart, you will end up with two "holes" but they will be smaller, and you may still have enough basal insulin to stop your BG's climbing.

Why don't you try splitting and see if it works? This will take a bit of time as you are probably best to start by taking a couple of units in the morning and then taking 2 U off your evening dose. You will have to keep increasing the morning and reducing the evening until you end up with an even split.

An alternative is to ask your doctor to try Levemir. This Novo's basal insulin. It's a 12 h insulin for T1's so you will have to split your dose. Some people find it works better than Lantus.

Joel

[Stuboy]

Im shocked that it would only last 4 hours... i think you have to consider Joel's comment about the gap...

Also... consider your Lantus injection site, some parts of the body absorb the insulin slower than others, I inject into my stomach, if you inject into your bum then it will take longer to start acting that it would if you injected into your stomach.

[sarah91]

Thanks for your comments Joel and Stuboy. I'm going to the hospital next week and run it past the docs. I'm currently taking 18 units of Lantus at about 10.30pm - 11 pm.
From the results I got when wearing the sensor my sugar levels started to rise at about 3am and kept on rising until I injected my first shot of Novorapid at 8am. Could the 'hole' be 5 hours long?

I changed my injection sites just before Xmas so there should not be a problem there as I'm using the sides of my stomach and the more central part of my thighs.

Thanks for the advice guys. How do you know so much?

Sarah

[Stuboy]

We're all learning here, alot of people on here have been diabetic for most of their lives, they have the experience and have usually been there done that! lol.

[JJM335]

Originally Posted by sarah91

From the results I got when wearing the sensor my sugar levels started to rise at about 3am and kept on rising until I injected my first shot of Novorapid at 8am. Could the 'hole' be 5 hours long?

Sarah:

Like you say, it seems v. unlikely that the hole would last 5 h. However, a rising BG from 3 am onward doesn't necessarily mean the Lantus is running out after 3 am, only that you don't have enought to cover your basal needs. This could be because your basal requirements rise after 3 am and an amount of Lantus that is fine earlier now is no longer adequate.

Perhaps you have an early onset of Dawn Phenomenon (DP)? Many of us experience rises in BG around dawn or immediately upon waking (hormones are released that stimulate glucose release by the liver to prepare you for the activity of the day). In your case could this be kicking in at about 3 am?.

If you are unsure about this, there are a couple of good books that you can order from Amazon. "Think Like a Pancreas" by Gary Scheiner and "Using Insulin" by John Walsh. They aren't expensive (< £10) and will really give you new insight!!

Joel

[sarah91]

Thanks I'll look into these books. Dawn phenomenom is something that has been mentioned before by the diabetes team I see.
Will let you know how I get on.

Thanks again for the advice

Sarah

[Scratch]

Originally Posted by sarah91

Having just come away from the hospital I have found something very interesting about Lantus which may answer some of your queries regarding erratic blood sugar levels.

Having had the results from being on a sensor for 5 days the consultant came to the conclusion that Lantus is only lasting me til 3am. I was waking up with very high blood sugars and thought that it was due to night time hypos or the dawn phenomenom (excuse the spelling!) but it appears that my body is using up the Lantus I am injecting at 11pm in about 4 hours instead of the full 24 hours!

The doc did not give me any solution to this problem but am going back to the hospital in 2 weeks to reassess how to overcome this problem.

Hope this may answer a few problems that some of you have been having.

Sarah
xxx

This is a bit odd. Here's why it sounds odd to me.

Just for easy rounding purposes, let's say my Lantus shot is 15u at 9 PM, which based upon a flat uptake profile I should be seeing around .625 u/hr of Lantus being used in a 24 hour time period.

Now let's say that Lantus was not stretched out over 24 hours, but only 4 hours instead. If that Lantus is being used in my body and just for ease of number crunching, it still goes in with a flat uptake profile, that'd mean I'm seeing Lantus being used at a rate of 3.75 u/hr. That would be 3.1 u/hr more than my current basal needs and using my I/C ratio, it means I'd have to eat approximately 30 g of carb/hr to keep my blood sugar stable or it'll begin plummeting at a rate of 105 mg/dl or 6 mmol per hour.

I'd be looking at one nasty nasty hypo if that were the case.

Here are a list of possible scenarios then --

Your doctor is correct somehow with his hypothesis. I'd suggest his hypothesis could be falsified with a simple ketone test. When you wake up in the morning, use a urine testing strip for ketones. If your Lantus stopped working overnight, your body would begin burning fat for energy. Ketones present in your urine would be evidence in support of his hypothesis, although not absolute confirmation. Absence of ketones would falsify his hypothesis almost beyond doubt as it would show that you have Lantus in your system being used by the cells for energy.

The hypothesis that seems more likely plausible is that you've got DP and it's pretty strong.

[sarah91]

Thanks. I'll have to get some ketone test strips but I'll definitely give it a go.

I have been losing weight quite quickly, if the lantus does stop working this could be a reason why!

Thanks again for the advice

Sarah

[xanlexian]

For whatever it is worth, I inject Lantus twice in a 24hour period.


210 units at 2:00am -- 200 units at 2:00pm.


I've got a **LOT** of vials in the fridge. THANKFULLY, I get it all from the manufacturer. Again, THANKFUL that one of my doctors managed to set THAT arrangement up.

Lantus works for me, but I have to inject nearly a vat of the stuff.

Then there's the regular insulin that I have to inject every 90 minutes.

And no... I really don't sleep.

[sarah91]

Wow thats a lot of injecting!

[ant hill]

Originally Posted by DeusXM

The ones which us lot are particularly worried about are mood swings.

I generally hyperanger if I was low and disorientation is another affect that I put that down

to general diabetic life.

As I said before, my diabetes nurse thinks that Lantus has caused depression, or at

the very least, 'low mood' in a significant number of her patients.

OK, We all understand that we experience lows from a miscalculation of a bolus, Can this be

a more constant low? Not low enough to be "Out of it" But a sub low. Please, Tell me if you

do not follow me.

Originally Posted by Teresa

wow Joe, im really sorry to hear u had problems to that extent... that

must have been scary beyond belief! *hugs* All i know is Lantus is ok for me at the moment!

Glad u have found some insulin that works better for u!

Yeah I can second that. That must be awful.

Originally Posted by xanlexian

For whatever it is worth, I inject Lantus twice in a 24hour period.


210 units at 2:00am -- 200 units at 2:00pm.

GAHD!!! Gee and I thought I take large doses.

[Moreno]

I haven't really notice anything, i will ask my doctor thou.