a question about Lantus and night time..

[grace girl]

I'm having a hard time finding a pattern with my nightime snack and what my bs ends up being in the morning. I take my Lantus every night at 9. I generally go to bed around 11. I usually eat a 15 g carb snack. I've tried having it at 9, at 10....but my morning readings are so erratic! Sometimes it stays the same as it was when I checked before bedtime. Sometimes it's higher. Sometimes it drops as much as 120 points over night, which makes me leary of being too low when I go to sleep.
Can some of you who have been using lantus for a while tell me how it works for you? I keep thinking there's got to be a pattern somewhere so I could settle this down into something regular...but I haven't found it yet!

[Penny]

I'm having a hard time finding a pattern with my nightime snack and what my bs ends up being in the morning. I take my Lantus every night at 9. I generally go to bed around 11. I usually eat a 15 g carb snack. I've tried having it at 9, at 10....but my morning readings are so erratic! Sometimes it stays the same as it was when I checked before bedtime. Sometimes it's higher. Sometimes it drops as much as 120 points over night, which makes me leary of being too low when I go to sleep.
Can some of you who have been using lantus for a while tell me how it works for you? I keep thinking there's got to be a pattern somewhere so I could settle this down into something regular...but I haven't found it yet!

The only thing regular about my fasting readings is that they are always different. I have tried everything I can think of, a snack, splitting my lantus, more Lantus, less Lantus, etc. etc. I have fasting readings of from 60 to 180. But, throughout the day, they stay fairly steady, and I seldom go high. I'll keep trying, bu I quit worrying about it.

[grace girl]

I'm the same way, pretty steady during the day. They just keep telling me that I should be between 80-120 when I wake up, and it doesn't happen all that often.

[jen_slc]

In theory, if your Lantus dose is correct, your bg level should remain stable through the night - whatever bg level you go to bed with, you should also wake up with. If you are dropping 120 points through the night then it sounds like your Lantus is too high. I had this problem a couple of years ago and I was going low every night without knowing it. I would force myself to eat and go to bed high so it wouldn't happen but it did anyway.

Do you cover your bedtime snack with a fast-acting insulin? Your snack, and subsequent bolus, could have something to do with it. You could try testing your Lantus dose: take away the snack for a few nights, test before bed, try to test at 3am and then see where you end up in the morning. If you are stable through the night without a snack, then maybe the snack is the issue. Then you can try snacking again and seeing what it does.

[grace girl]

I don't bolus for the snack...only meals. They told me to have a snack at night to regulate nighttime blood sugars.
I've often wondered if I'm taking too much lantus, but today the endo wants me to up it two more units tonight....
The only time my bg stays the same over night is if I eat a snack about an hour before bed. It rises from the snack, then stays there...leaving me high in the morning. No snack usually leaves me low. I keep thinking there's got to be a happy medium somewhere...I just haven't found it yet.
I'm hoping that hearing some other people's experience might give me a clue as to where I'm missing it.

[jen_slc]

I don't bolus for the snack...only meals. They told me to have a snack at night to regulate nighttime blood sugars.
I've often wondered if I'm taking too much lantus, but today the endo wants me to up it two more units tonight....
The only time my bg stays the same over night is if I eat a snack about an hour before bed. It rises from the snack, then stays there...leaving me high in the morning. No snack usually leaves me low. I keep thinking there's got to be a happy medium somewhere...I just haven't found it yet.
I'm hoping that hearing some other people's experience might give me a clue as to where I'm missing it.hmm, well, I don't want to go against your doc's orders or anything but... do you like to eat a snack at bedtime or do you force yourself to eat to prevent yourself from going low? Again, theoretically, your bg should be stable through the night if your Lantus dose is correct. Stable meaning normal and stable, not high and stable. If your bg goes high because you eat, then it needs to be covered with insulin (and not Lantus, it should be some kind of fast-acting insulin). If your bg goes low through the night when you don't eat, your Lantus might be too much. From what you've said, and this is just my impression based on what you've told me, is that you might be feeding your Lantus to keep you from going low. Your happy medium could be no snack and less Lantus. Or it could be snack plus bolus of fast-acting and less Lantus. Either way, it doesn't sound like your Lantus is fine-tuned... I'm wondering why your doc wants to up your Lantus dose to cover the high you get from snacking? :hmmmm: A high from snacking should be covered with fast-acting.

[jillsp]

Can you switch your Lantus dose to in the morning? That might help. It sounds like without a snack, you go low, so maybe if you take your Lantus in the morning, then when it is starting to run out is when you will be waking up to take another injection. Just a suggestion.....

[grace girl]

He says he's basing raising the dose on averaging my bs over a weeks time.
I've thought more than once about taking it in the morning because of all of this. I'm thrilled with how it works during the day...it's just been this night thing.
As to the snack, I've eaten one at night since I was first diagnosed 6 years ago, and I'm used to. I would really have to stop and think about if I wanted it...it's about as common to me as taking shots are.

And in a way, I probably am feeding the insulin. I woke up at 60 twice now and didn't recognize it at all, and that bothers me. If I had to choose, I'd just get up higher every day than deal with morning lows. It's not the low itself that bothers me, but the not recognizing it.

[HelenM]

You say that sometimes BS stays the same as the night before. I wonder if there is something in common about those days.
Does the time of your evening meal vary? if it is later on some nights the meal (and the fast acting insulin) could perhaps be affecting your bedtime BS . The composition of that meal could also cause a difference. What type of meal have you eaten the the evening before the fall of 130. Have you been more active on some days than others? So many variables!

tell me how it works for you?
For me Lantus works very well. I take it at about 6pm (thats when I took it in hospital after diagnosis and haven't needed to change it) and have my evening meal at about 7.30pm-8pm. I find that the 2 hour post meal and bedtime tests indicate the trend and that if I eat later I don't always know if my BS is going up or down at bedtime. If the effect of the evening meal has 'finished' my BS will normally go down , normally not more than around 15 points. If I am still quite high at bedtime it will go down more. I usually wake with BS between 70 and 100.
I was told by one doctor to eat 15gm carbs at night if my BS was less than 130 and the other if less than 90. I've found through experimentation that the 90 (in fact 85) works for me. I hate it if I have to eat just to feed the insulin.
Examples picked at random to show variation ( last week evening between 75 and 97, morning between 74 and 93)
Eve. Morn
86 74
91 88
120 (after late dinner) 92
77 (10gm carb) 89
98 82
156!(later dinner Fajitas) 99


Two weeks ago I did wake up with a hypo (53) I had been out to a local fete and I didn't eat the main course so compensated with the dessert: a sticky tarte (fast sugars). My Bs was 101 at bedtime so I though I was OK, perhaps the lack of protein caused the problem, certainly the meal wasn't balanced.

[grace girl]

helenm: thank-you. I was curious as to the experience of others. I haven't known what to expect from the lantus at night. The endo just told me it should be below 150 when I go to sleep, and if it's 100 or below, eat a small snack. Because of the erratic experience I've had, too many nights I've eaten because I was afraid to spend the night tossing and turning wondering if I was going to go low. I don't seem to recognize lows too well upon waking, and it concerns me.
I'm at the tail end of a long process of fine-tuning all of my insulins...and from the numbers I've seen the last couple of days I decided not to up the lantus last night. I think it's good where it is...I've just got to get past this mental thing about going low at night and try not eating and see what happens.
I just basically wanted to know if other people are able to find a basic pattern with this stuff, or if it's normally erratic.
I was on Humalog Mix for 4 years before this...erratic is normal to me. I have a hard time really believing that any of it is going to do what they say it will do because of that. I'm learning!

[Jazz]

helenm: thank-you. I was curious as to the experience of others. I haven't known what to expect from the lantus at night. The endo just told me it should be below 150 when I go to sleep, and if it's 100 or below, eat a small snack. Because of the erratic experience I've had, too many nights I've eaten because I was afraid to spend the night tossing and turning wondering if I was going to go low. I don't seem to recognize lows too well upon waking, and it concerns me.
I'm at the tail end of a long process of fine-tuning all of my insulins...and from the numbers I've seen the last couple of days I decided not to up the lantus last night. I think it's good where it is...I've just got to get past this mental thing about going low at night and try not eating and see what happens.
I just basically wanted to know if other people are able to find a basic pattern with this stuff, or if it's normally erratic.
I was on Humalog Mix for 4 years before this...erratic is normal to me. I have a hard time really believing that any of it is going to do what they say it will do because of that. I'm learning!

I was put on 7 units of Levemir originally and it has been subsequently reduced to 4 units, due to hypos upon waking. I take Levemir at around 10:30pm each night and now I consistently wake up around 4 to 5mmol/s each morning. I have got into the pattern of eating a bedtime snack if my bedtime reading is around 7.9mmol/s or less - I personally would worry all night about going too low if I did not eat a snack when my reading is lower than around 7.9mmol/s. (The snack gets smaller, the closer my reading gets to 7.9mmol/s though)! I also find that even if for some reason I go to bed on a high BS reading (Eg 11 mmol/s) - I still find that my morning BS level is around 4 - 5 mmol/s - it must be a quirk of being a Type 1.5. Incidentally, when I went on holiday to Barbados recently, I had to take the Levemir at 6pm in the evening, due to the time zone factor and my morning BS readings were slightly higher - around 5 to 7 mmol/s, so the timing also affected my readings. Anyway, I hope that recounting my experience is helpful to you and good luck with the fine tuning.