Lantus Question

[Jenn L]

I am wondering how Lantus works with a persons natural spikes in their bg's. If you have a tendancy to spike in the morning, does it help smooth it out, or do you need to bolus for the high?

[poper77]

Lantus is a long acting insulin. It is suppose to work more evenly and not have peaks like nph. Most take it 1 or 2 times a day. When I was on it, I was in one of the small percent of people that it did cause peaks after taking it. I am not sure if I answered your question....

[jen_slc]

It's hard to say because Lantus may/may not have a small peak in your body.

For me, no, Lantus does not smooth out my natural spikes, no way! even though I know it does peak a little bit in my body within the first 12 hours. My noticeable spikes tend to happen in the morning after I get up and late afternoon/early evening (sort of a dusk phenomenon, if you will). I force myself to eat breakfast and take a larger bolus for it in order to deal with my morning spike. If I didn't eat, I'd still have to bolus. And I'm currently considering a shot of Regular insulin at lunchtime to deal with my dusk spike because my Apidra runs out too quickly from lunchtime... I never noticed this dusk problem while on Humalog or Novolog.

So... it will vary for all of us. It's not a perfect insulin, but you use what you have at your disposal as best you can!

[cheryl]

Like anything else unless you do the same things at the same time everday and this is including activity and live like a robot, Lantus will not be perfect.....but it does keep you level....it doesn't have those life threatening peaks like nph did but it does peak on me....in the middle of the night no matter how low i go with it but I keep my lantus to where it covers that rise cause i cann't wrap my head around it anymore, I just live with it, but it does work a lot better then nph......

Cheryl

[grace girl]

I can only give my own experience: my bs spikes after I get up in the morning...I take lantus 2x daily. The spike isn't as large since I split the lantus into two shots, but it's still there. The endo had me play around with raising the pm dose to see if it would help, but I ended up going hypo during the night.
I use a lower carb ratio for breakfast, and though my numbers aren't exactly what I want two hours after, they are usually right on target by the next meal.
I know some people on lantus take a shot of humalog in the am to deal with the rise in bs...I just haven't personally found it to be neccesary.

[BlueSky]

A shortcoming of Lantus, IMO, is that it doesn't cope with the early morning DP surge. The only way to flatten out the DP is to inject another insulin. After switching to Lantus, I had big problems with high BG in the morning. You can do two things to deal with it. One is to use NPH instead of Lantus before bed, and inject Lantus in the morning. The NPH peaks when the DP kicks in. Another option is to inject some Regular as soon as you wake in the morning, and eat a very low carb breakfast. I used to do both. But, since I started exercising regularly, I have found that I don't need the NPH at night anymore.

[KrisinNM]

I have DP. BS can be 64 @ 4:30am when I get up and 210 by 6:30 when I am ready for breakfast.
I take 2 doses fo Lantus, 1 in the morning and one in the evening.
I am VERY insulin sensitive and the tiny spike that Lantus has can send me hypo. By figuring when this spike happens for me (about 10 hours after injection) I have been able to sort of control my DP by taking my evening dose of Lantus at 8:30.

[msrkBen]

I am wondering how Lantus works with a persons natural spikes in their bg's. If you have a tendancy to spike in the morning, does it help smooth it out, or do you need to bolus for the high?

I started using Lantus once a day. I took Lantus at night before bed and woke up with very low blood sugars. I switched it to the morning and it's been working out a lot better. I take 35 units in the morning and it last until the next morning.

That's the thing about Lantus you're suppose to take it once and it's suppose to last until the next day. That was the whole purpose of Lantus. If you take it more that once a day and since you can't mix it with fast acting I'm not sure what the purpose is because your back to taking more than two shots a day.

I remember back in the day when people were taking up to two shots a day and these days it's out of control people taking 6 shots a day, give me a break. There's a big problem and it's not about staying in control because back in the day everybody I knew were in control. It's either a bad physician thing or insulin is getting worse instead of better.

[BlueSky]

.... That's the thing about Lantus you're suppose to take it once and it's suppose to last until the next day. That was the whole purpose of Lantus. .....
The duration of Lantus is very dose dependent. The more you use, the longer it lasts. I inject only 12 units a day. And I couldn't possibly get away with one 12 unit shot a day. It runs out of steam after about 18 hours. So I have to take two shots.

Having said that, I agree that intensive MDI seems to have gotten out of hand, with people injecting before meals and again a couple of hours later. The advent of quick acting insulin and greater tolerance for high-carb eating has been a mixed blessing.

[msrkBen]

The duration of Lantus is very dose dependent. The more you use, the longer it lasts. I inject only 12 units a day. And I couldn't possibly get away with one 12 unit shot a day. It runs out of steam after about 18 hours. So I have to take two shots.

I understand, so can't you take 24 units at night or in the morning which would be one shot a day instead of two?

[grace girl]

The duration of Lantus is very dose dependent. The more you use, the longer it lasts. I inject only 12 units a day. And I couldn't possibly get away with one 12 unit shot a day. It runs out of steam after about 18 hours. So I have to take two shots.

Having said that, I agree that intensive MDI seems to have gotten out of hand, with people injecting before meals and again a couple of hours later. The advent of quick acting insulin and greater tolerance for high-carb eating has been a mixed blessing.


It was designed to be a 24 hour insulin, but for many people it only actually lasts anywhere from 18-22 hours. Many endo's and the company themselves are also recognizing this fact. Taking more doesn't stop it from running out, it just increases hypo risk while it's active. I determined that it was lasting only 20 hours for me after much testing....I also took it in a single dose at night, and also during the day. Same problem, just different times. Splitting the dose into two shots means that I actually have 24 hour basal coverage...which is the goal.
If it lasts 24 hours for you, I congratulate you. You're one of the few I know of that it actually does.

[msrkBen]

It was designed to be a 24 hour insulin, but for many people it only actually lasts anywhere from 18-22 hours. Many endo's and the company themselves are also recognizing this fact. Taking more doesn't stop it from running out, it just increases hypo risk while it's active. I determined that it was lasting only 20 hours for me after much testing....I also took it in a single dose at night, and also during the day. Same problem, just different times. Splitting the dose into two shots means that I actually have 24 hour basal coverage...which is the goal.
If it lasts 24 hours for you, I congratulate you. You're one of the few I know of that it actually does.

Yes it's been working great, well except for the lows when I was taking it at night. At first I had the hypo's and one of the problems was taking it at night but before that I was taking to much so then I lowered it to 35 and that was the magic number.

I guess my point is what's the use if you’re taking it twice a day? The reason I'm asking is because they made the insulin so you can not mix it like NPH, so now you're taking more shots per day.

As I said before the whole new insulin discovery has went wacko. To me the Lantus is useless for an individual if he/she can't take it once a day because that leads to more shots. If you could mix it with short acting then that's a different story.

Also I would like to ask Lantus why didn't they create the insulin so people can mix it with short acting, wouldn't that make more sense? I just don't get it. Give me animal insulin any day, it worked so much better. I didn't know anybody who was taking more than two shots a day back many years ago. Since human insulin, I read this once person was taking up to 8 shots a day this was one that really threw me for a loop. I said 6 up above but last year I was reading on the web and this person said 8 shots a day - unbelievable.

[DanG]

I understand, so can't you take 24 units at night or in the morning which would be one shot a day instead of two?

When I started lantus about 2 years ago, I think... it was when the availability of lente insulin completely stopped... maybe it was 3 years ago...

Anyhow, when I started lantus, I was told to take it at night - 22 units.
No problem for a long time.

Then I started reading here, and tried split dose about 3 months back and had the parmedics over one morning. Needless to say, I stopped the split dose. Now I have started doing lantus in the morning, attempting to play on the 18 hours, and attempting to beat the early morning low caused in the night time lantus action - no caloric input to defeat the basal action.

I like taking lantus in the morning. I have not done the basal testing to see when the basal dies completely in my system, but judging from how the morning lantus is working over the past coupld of weeks, I like it. No really low readings in the morning - which is nice. So, lantus seems to be doing about 18 to 20 hours in me, I guess.

I switched to morning lantus because I had dropped to 14 units at night just to stop the ultra low in the morning. Now I am up to 20 in the morning and if there is a drop during the day, I am awake and can handle the low, unlike the early morning lows while I was asleep.

I am with you, msrkBen - I wish the animal insulin was here again. But, we all gotta make money, and some of us (not me...) are the drug company and want money that wasn't being made with animal insulins. Why? - I wonder. I agree with your distaste for 8 shots per day - I do 4 shots per day using lantus and humalog, and reuse of syringes - another badboy tactic.:eek:

[BlueSky]

I understand, so can't you take 24 units at night or in the morning which would be one shot a day instead of two?
I use 12 units of Lantus a day, total. That is 6 units in the morning and 6 units in the evening. 12 units in the evening (no morning shot) means that I go high before bed because the Lantus has run out. Similarly, a single 12 unit shot in the morning results in high waking BS levels. Lantus doesn't last the full 24 hours, probably because the dose is smaller than the manufacturers had in mind.

When clinical trials were done on Lantus, much larger doses were used, presumably because subjects ate more carbs and were somewhat insulin resistant. It created the perception that Lantus lasts 24 hours. But this does not apply to people who are more insulin sensitive.

The same principle applies to other insulins. For example, a suicide attempt that involved injecting over 600 units of Novolog, meant that a glucose drip had to be used for 5 days to support the BG level. Clearly this would not have been the case if the insulin action had been over after 5 hours, as advertised.

Having said all that, splitting large insulin doses is a good idea anyway. It reduces absorption/action variability, which is about 25% with Lantus.

[msrkBen]

I like taking lantus in the morning. I have not done the basal testing to see when the basal dies completely in my system, but judging from how the morning lantus is working over the past coupld of weeks, I like it. No really low readings in the morning - which is nice. So, lantus seems to be doing about 18 to 20 hours in me, I guess.

I switched to morning lantus because I had dropped to 14 units at night just to stop the ultra low in the morning. Now I am up to 20 in the morning and if there is a drop during the day, I am awake and can handle the low, unlike the early morning lows while I was asleep.

I am with you, msrkBen - I wish the animal insulin was here again. But, we all gotta make money, and some of us (not me...) are the drug company and want money that wasn't being made with animal insulins. Why? - I wonder. I agree with your distaste for 8 shots per day - I do 4 shots per day using lantus and humalog, and reuse of syringes - another badboy tactic.:eek:

Yes I know what you're saying those morning lows just about sent me to the hospital. Switching to the morning shot worked for me.

I use to be on 4 shots but I'm using the inhaler now. I'm down to one shot of lantus, so far so good. I know you can still buy animal insulin overseas, just goes to show everybody how the drug companies and government are screwing with us.

[lilituc]

I think I'm the only person that had Lantus last more than 24 hours - it was something like 26-27 hours.

Oh, and I used to take 10-13 injections a day. Now that I'm on the pump, it's easier to see why - my average number of daily boluses is 11, so I'm eating on average 11 times a day. I don't see why there'd be any problem with it.

[fedup]

I was getting lows on oral meds and 10 Lantus before bed.. but getting highs after eating.. so Dr lowered the lantus to 8 in the am with 4u of Humalog before breakfast and before dinner.. and cut out oral meds except for Actos .. now all of my morning fastings at in the 200's!! and the humalog before breakfast isnt doing much.. still in the 200 after eating a 30 carb breakfast.. since I am new to insulin I have to keep checking with Dr ever 4 weeks.. but this is crazy! I was doing better on oral meds and lantus
I have taken BS before bed and its always lower than it is in the morning... one night before bed it was 114 when I woke up it was 161 SIGH.......

[Scarlett]

well-it was good knowing you msrkBen
isn't Big Brother watching you now?

when ISN'T the government involved is a shorter answer

I split Lantus 17U am and 15U pm and have been for approx. 2 yrs.-I also take NovoLog (short acting) as needed-funny...I don't seem to need as much Novo as I used to need when I was carbophobic-I stopped being afraid to eat carbs and I'm doing much better...lost 25 lbs. and it hasn't come back (hubby would have a joke for that one!!! and no...it's not behind me either) I weigh 130-135 and I'm 5'5"-so I'm average.

Endo started me at 25/25-I moved it down after day #2 when I couldn't raise my BS to above 35 the first 2 nights

Love my Lantus:D

[tori~]

I take 40 units of Lantus now, before bedtime...they had to go up on it because of blood thinners, but I do have to watch how low my sugar is before I go to sleep...I find if it is under 150 I'll be introuble come morning... so I eat a cookie or something to bring it up if it's that low... and I'm fine come morning...my high's are normaly b/dinner which I cover with humalog.... and that carrys me to BT...
but when I first started taking it I had low's through the night... have some one poke ya the first week... you'll figure out what's needed before long.. I've tried splitting the dose but it didn't do well for me...
Good Luck,
tori~