Ok some feedback and advice needed

[Pitzi]

Been on the new Apidra/Lantus treatment since yesterday. I must say my BG's have stabilized compared to the old insulin I used. Just a matter of fine tuning dosages.

For instance the 20u of Lantus last nite was a tad too much, I was low most of the nite and had to eat stuff to keep me normal. I'll reduce it by 2 units tonite. Started off with 10u of Apidra this morning, and was pretty spot on. Same at lunch with 15u.

Now to the advice I need. I took the Lantus at 21:00 last nite. Now it's 15:30 the next day and I see my BG creeping up slowly but surely over the past hour or so (I had lunch at 11). Has anyone experimented by splitting the Lantus dose in half and taking it in the morning and evening? Or doesnt this make any sense?

Overall, I feel so much better! No more of that spiking immediately after meals, then going hypo 4 hours later, and then having to yo-yo all day with hypo's or going high. The constant hunger also seems to have disappeared :)

[lgvincent]

I was under the impression that there is a large number of people who have to split their Lantus dose. I'm not sure how many have to do this, though.

[jen_slc]

Now to the advice I need. I took the Lantus at 21:00 last nite. Now it's 15:30 the next day and I see my BG creeping up slowly but surely over the past hour or so (I had lunch at 11). Has anyone experimented by splitting the Lantus dose in half and taking it in the morning and evening? Or doesnt this make any sense?I split my Lantus 1:1 because my bg would start to creep up at about the 20-hr mark. It sounds like maybe it isn't lasting the full 24 hours for you either, but make sure you rule out other factors for the rise. Lantus has really been pushed as a full 24-hr insulin and up until a few months ago, there wasn't any data to show otherwise, just people's stories about bg creeping up at the 18-20 hour mark. At my appt back in March, my endo told me about a new study that had just come out demonstrating that Lantus really doesn't last 24 hours in quite a lot of people, so splitting is a good idea in these folks. It can be split 1/2 and 1/2 but depending on your body and requirements, can also be split unevenly between AM and PM doses.

[poodlebone]

For instance the 20u of Lantus last nite was a tad too much, I was low most of the nite and had to eat stuff to keep me normal. I'll reduce it by 2 units tonite. Started off with 10u of Apidra this morning, and was pretty spot on. Same at lunch with 15u.

Now to the advice I need. I took the Lantus at 21:00 last nite. Now it's 15:30 the next day and I see my BG creeping up slowly but surely over the past hour or so (I had lunch at 11). Has anyone experimented by splitting the Lantus dose in half and taking it in the morning and evening? Or doesnt this make any sense?



I had the same problem when I started on Lantus. I was waking up low in the early morning hours, and by dinner I was high. I split the dose 50/50, taking it 12 hours apart and that helped a lot. When I saw the CDE after going low/high she told me to split it. I had taken my full dose the night before and she said that I should only take half that night (the night of my appointment). She said to take the other half in the morning, and that I might wake up high the first morning but not to worry about it. I can't even remember if I woke up high or not.

[jeggeman31]

When I was on Lantus I also split my dose 1/2 and 1/2. I also would wake up low, and go to bed high.

[Ailsa]

It's probably too early for you to start rearranging your dose. Unlike other insulins Lantus takes a few days to settle down when you change the dose, so it might pay to wait a bit before you change anything.You could also try taking it at a different time of day if that suits you. I take mine 7am & it works for me.

[Pitzi]

Ok, so another update. been 4 days now (+ -)

decreased the Lantus from 20u at nite to 18 units. Seems that solved my running a bit low in the morning. But my Apidra needs are going up everyday more, not sure why? I started out with 10u per meal but it was fine for breakfast but too little to cover lunch/dinner.

Now I'm having another problem. If i say have lunch at 12:00 and get my apidra, it will stay stable (4.0-5.0) for the next 4 hours or so, then shoot up. Any ideas? Maybe my lantus should be increased again?

[DeusXM]

It sounds to me like you need to split your dose and re-evaluate your bolus requirements.

For most people, breakfast is the smallest meal of the day. Therefore it's the meal that (usually) requires the smallest bolus. I wouldn't be surprised if you needed double what you're taking for breakfast to cover your evening meal.

If you're injecting Lantus at night, then your bg rise at 4ish is probably because your Lantus is starting to burn out and not cover your natural liver function. Splitting your dose should help alleviate this.

[Pitzi]

It sounds to me like you need to split your dose and re-evaluate your bolus requirements.

For most people, breakfast is the smallest meal of the day. Therefore it's the meal that (usually) requires the smallest bolus. I wouldn't be surprised if you needed double what you're taking for breakfast to cover your evening meal.

If you're injecting Lantus at night, then your bg rise at 4ish is probably because your Lantus is starting to burn out and not cover your natural liver function. Splitting your dose should help alleviate this.Those are my thoughts as well. I'll give it a few more days of trial and error and then see if things come rite all well, else I'll split my lantus

[DeusXM]

What you really need to do is keep a food diary for a couple of days. Test you BG before each meal, make a note of it, and then record how many carbs are in the meal and how much insulin you took. Then do a test 2 hours later and record that BG too.

Then when you look back over the week you'll be able to see exactly how your BG's doing - if it's rising between the 2 hour test and the next meal then your Lantus dose is too low. And if your BG has returned to normal two hours after a meal, your Apidra dose is too low.

[Pitzi]

Guys I'm about to give up on this. contacted my endo, he said leave the Lantus as is but increase your Apidra which i did by 2 units at lunch. result is that 5 hours after lunch I'm sitting at 10mmol when 2 hours after lunch I was at 5.
Now I called him and he says he';s heard that Apidra does this, so wants to change me to Novorapid

What do I do now? :(

[Pitzi]

I'm gonna try to split/increase my Lantus from tonite, lets see what happens tomorrow. I think thats where the problem lies. what i cant understand is why the first 2 days this didnt happen?

[duck]

Guys I'm about to give up on this. contacted my endo, he said leave the Lantus as is but increase your Apidra which i did by 2 units at lunch. result is that 5 hours after lunch I'm sitting at 10mmol when 2 hours after lunch I was at 5.
Now I called him and he says he';s heard that Apidra does this, so wants to change me to Novorapid

What do I do now? :(

Wow, how does he figure that? Okay, let me chart these results out:

Lunch
+2 Hours: 5mmol
+5 Hours: 10 mmol

Seems to me that your Apidra worked just fine, but you may not be getting enough Lantus (as already suspected). Your Apidra stops working at about the 4 hour mark, and assuming you did not eat anything additional or eat anything that may take longer to digest (ie, pizza) or that you do not have a delayed gastric emptying rate, I concur that it's your Lantus dose that needs some tweaking. I also concur with the suggestion you may need to split the dose.

The best way to determine this is to test often...before meals, two hours after meals and four hours after meals. If you take longer than 6 hours between meals, maybe test at the 6 hour mark. We'll need to review the results of the blood tests and compare your results against the time you took your Lantus. If I remember right, the people who had to start splitting their doses seemed to think their Lantus stopped working between 18 and 20 hours after their shot...We need to figure out when yours is stopping as well.

Don't give up, you'll figure this out.

[Pitzi]

Wow, how does he figure that? Okay, let me chart these results out:

Lunch
+2 Hours: 5mmol
+5 Hours: 10 mmol

Seems to me that your Apidra worked just fine, but you may not be getting enough Lantus (as already suspected). Your Apidra stops working at about the 4 hour mark, and assuming you did not eat anything additional or eat anything that may take longer to digest (ie, pizza) or that you do not have a delayed gastric emptying rate, I concur that it's your Lantus dose that needs some tweaking. I also concur with the suggestion you may need to split the dose.

The best way to determine this is to test often...before meals, two hours after meals and four hours after meals. If you take longer than 6 hours between meals, maybe test at the 6 hour mark. We'll need to review the results of the blood tests and compare your results against the time you took your Lantus. If I remember right, the people who had to start splitting their doses seemed to think their Lantus stopped working between 18 and 20 hours after their shot...We need to figure out when yours is stopping as well.

Don't give up, you'll figure this out.Right let me explain better. I didnt eat anything between the 2hr test and the 10mmol one.

My digestion is a bit slow, always been like this. I cannot take more Lantus at nite, because then I wake up seriously low. I took my lantus at 21:00 last nite, 18 hours from that would be 17:00. I was 10mmol at 16:00.

My gut feeling says that the Lantus is to blame, it's somehow burning off quicker in my case hence I wake up low if I take more. i'm gonna slipt it 50/50 from tonite and increase it to 2 x 12 unit shots, lets see what happens tomorrow.

my endo is so useless that it ain't funny!

[Pitzi]

To add to what I said, it seems to start skyrocketing everyday at the same time from my BG notes. everyday from 15:30 it starts climbing. I normally have my lunch at 11, which means that as soon as the Apidra wears off it spikes because the basal has worn off.

And now the endo wants to tell me it's the Apidra's fault....

[DeusXM]

Bear in mind that any changes in your Lantus tend to take about 3 days or so before they fully work through - patience is the key here.

One thing you can do to fully eliminate the Lantus issue is to fast for an entire day. I know, that sounds daunting. But if you fast for 24 hours and just take your Lantus, you can see whether or not your basal dose matches your basal output. If you have hypos, then it's too high. If you run too high, then your Lantus dose is too low.

[corwin]

Why not just skip lunch once, if you go high as usuall it's the lantus if not it's the apidra. Then you know what needs to be fixed. Good luck.

[DeusXM]

Ah, didn't realise it could work like that. Good tip, corwin.

[rzrbks]

Pitzi,

About once every 4-6 weeks, I'll fast for 14-18 hours to check that my Lantus dose is correct. As long as I'm running between 85/4.7 and 125/6.9, I know that Lantus dose is correct so then I turn to Novolog/NovoRapid dose and tweak it just a bit.


This method is how I learned that I had to change my breakfast NovoRapid ratio from 1:15 to 1:5. With all my other meals and snacks, I just use the 1:15 and all is fine.

Part of the Charm of Diabetes is all the checks and adjustments you constantly get to do.

[grace girl]

I'm new to the Lantus, too, and I've experienced something similar. I have to say that it really does take at least 3 full days to know what a change in the Lantus is going to do. Also, I was running higher as the day wore on, but after seeing the dietician she pointed out that my eating habits seemed to be more to blame. (I'm one of those people who eats the least amount at breakfast, then the food amount seemed to increase at lunch, and again at dinner.)She had me simply make sure I was getting the same amount of carbs with each meal, and the problem has taken care of itself.
Hope this helps! I know what you're going through!

[Simons]

I guess Iam one of those fortunate people whose Lantus lasts 24 hours. I have been on Lantus for three years and thinks it does a good job for me. I use Novolog for my short acting insulin.
Simons

[Georgia]

Good luck with it, Pitzi :shakehand

I guess Iam one of those fortunate people whose Lantus lasts 24 hours.

:dito:

[Pitzi]

Ok people quick update. been splitting my Lantus from 20u every nite to 14u at nite and 10 units in the morning. Now i stay stable throughout the day (always between 4.5 and 6) including fasting in the morning.

No more high's at 16:00 like before. However I tend to spike again around 18:00. yesterday I was at 8mmol by dinnertime (18:30) and tonite I was 9.2mmol.

The Apidra does it's job well with the current dosage, i dont go high or low after meals and pretty much everything has stabilized. Now how to get rid of the evening spike? perhaps increase the morning lantus a bit (say 2 units?)

I'm sorry to be asking this, but this forums collective knowledge is way better than my Endo's who gives me totally nonsensical replies like "you must change to Novorapid" I eat lunch at 11am, and by 15:00 any fast acting insulin is done. I am not low or high during that period, nor for the next 3 hours. So it's logic that the Lantus dose needs tuning (proven by the fact that splitting my dose now made the afternoon spike history)

[duck]

What times are you taking your split Lantus? My immediate thought is maybe your body is doing a 'liver dump' around 1800 hours...my pump basal patterns are up and down all day, so this may be evidence that you have one spike in your basal needs per day. if it is a change in basal need, it may be 'easier' to handle the spike with an extra shot of Apridra, or we can try and tweak the Lantus. But the Lantus will be harder to hit one particular spike, than it would be with Apridra.

[Pitzi]

What times are you taking your split Lantus? My immediate thought is maybe your body is doing a 'liver dump' around 1800 hours...my pump basal patterns are up and down all day, so this may be evidence that you have one spike in your basal needs per day. if it is a change in basal need, it may be 'easier' to handle the spike with an extra shot of Apridra, or we can try and tweak the Lantus. But the Lantus will be harder to hit one particular spike, than it would be with Apridra.
I'm taking the Lantus at 19:00 and 07:00.

I also thought of a "spike" but how could I have a liver dump if I never go low? Since I split my Lantus I've never been even below 4.0mmol which is so great. Only thing i dont like is this 17:00-18:00 spike.

[duck]

I'm taking the Lantus at 19:00 and 07:00.

I also thought of a "spike" but how could I have a liver dump if I never go low? Since I split my Lantus I've never been even below 4.0mmol which is so great. Only thing i dont like is this 17:00-18:00 spike.

Liver dumps happen for a number of reasons, going low is only one of them. Kinda makes you want to :shot: , doesn't it?

lol

[Pitzi]

Liver dumps happen for a number of reasons, going low is only one of them. Kinda makes you want to :shot: , doesn't it?

lol
Eish didn't know that!

I'm gonna raise my morning Lantus a bit and lets see what happens. I'm just scared that I'll go low during the day whereas I'm perfect at the moment.

[Pitzi]

hey people, I finally managed to win the spike war.

merely changing my Lantus dose from 19:00 and 07:00 to 20:00 and 8:00 totally eliminated the spike. I have been stable all day today and perfect!

as to why a change of a mere hour when taking Lantus solved the problem, i honestly wouldn't know! It just seems to me that lantus doesnt last long in my body somehow. By changing the dose time it now covers perfectly.

[DeusXM]

It might be that coincidentally your natural liver fuction increased at the same time your Lantus action decreased. That's great news though, hope it lasts, and hope you're feeling a lot better.