How to Change Lantus Injection Time(s)

[owlyn]

I currently take 28u Lantus in the morning. MY FBGs have been averaging around 150, and my regular doctor thinks I should switch over to taking it in the evening. His new theory (based on a recent seminar he attended) is that your FBS make up 75% of your A1C (my latest is 7.9, which is up from the low 7s where it usually is). Therefore, the more important thing to do is get your FBG under control with the long acting insulin, and then use rapid (in my case, Humalog) as you would normally with meals and so on.

This is the first I've heard the 75% thing, and it doesn't sound right to me, but this is what they preached at the seminar.

So, he thinks I should switch to the evening, which makes sense regardless of the 75% thing. If I want to switch to evenings (with dinner), how do I go about it? Or should I do a split? (prefer not to)

[xMenace]

I think this number reflects the fact that bolus ratios, coverage of meals, is fairly easy to achieve - diet, exercise, med doage and timing. Basal rates can be much tougher, and their impact is not short term like bolusing, it has a 24 hour effect. FBG is used because it is the test most untainted by bolusing. I agree that if this number is correct, it's a good indicator your basals are at least close.

I agree with their % rate for most diabetics. Flatliners are fairly easy to get right; they have few and minor fluctuations. However, add a big DP and it lowers the % rate as this adds a big spike not necessarily covered by the lantus or bolus, at least not well understood control. Usually it's built into the am bolus, but that forces the person to eat the same meal every day. Any deviation causes fluctutions. Then there are those with dusk phenomenons. This is another basal event usually covered by boluses. Again, deviation in diet causes problems.

In my experience, doctors and DE's either don't believe these things or don't uderstand them. They continue with 'in the ballpark' dosing. Pumping in these cases solves a lot of problems.

In your case, I think your morning Lantus is falling short of it's expected 24hr duration and has a need to ramp up, all during your highest time of need - DP. Moving it to the evening ensures you'll have active basal in the wee hours.

[DeusXM]

Best way to do it is over a prolonged period. Lantus lasts about 24 hours, so you've got 2 hours or so to play with. So you do it something like this.

Say you take your Lantus at 8am and you want to move it to 6pm - you'd do it like this:

Day 1 - take Lantus at 8am
Day 2 - take it at 10am
Day 3 - 12pm
Day 4 - 2pm
Day 5 - 4pm
Day 6 - 6pm

Although you are taking the Lantus progessively later each day, you probably will still have enough in your system to cover that extra 2 hours. You could also go the other way, but most people find getting up at 2am somewhat tricky :T

This also works very well for adjusting your basal timing when travelling abroad.

[owlyn]

Thanks, Xmenace. The DP thing is odd with me, because I sometimes hypo between 3 and 5 am, but I don't doubt that I do have some DP. The hypso tend to occur when I've done a full hour of exercise in the evening. The overnight hypos were the main reason I've been afarid to do the Lantus in the evening. I know a pump would probably help with all this, but I hate the idea of having something attached to me all the time.

[owlyn]

DeusXM,

Thanks. The progressive movement makes sense. What do you think about splitting it? Would that help any, or just mess things up more, given my occasional 3-5 am hypos (see previous post)?

[DeusXM]

I don't know about splitting it - I've never split my Lantus dose. If you're having 3am-5am hypos and you currently take your Lantus in the morning then I'd suggest that you probably are taking enough Lantus to last you during the day but your basal needs drop dramatically at night and so overall you end up with too much in your system. Theoretically then a split should help (take a great proportion during the day and less at night) but I'm going to have to leave this one to someone with experience of splitting their Lantus dose.

[grace girl]

I had a similar situation to you...was taking lantus in the am, it wasn't lasting the full 24 hours, but I also had some night time hypo issues. Taking it at night (for me) made the night time hypos worse. My endo had me split the dose, and it has solved both problems.
What I did was split the total dose in half and take it 12 hours apart...then went through some tweaking over about a month period of time to get it right. I was taking 24 units in the am, I'm now taking 16 units in the am and 4 units in the pm and I haven't had an overnight hypo in months and months. It takes some basal testing and some work to get it right, but for me it was WELL worth it.

[tanyatype1]

Hi Owlyn! This is interesting. Sometimes there's conflicting info which makes things confusing sometimes. I was just reading another thread titled AACE Clinical Conversion Series, and a poster replied that the bulk of the A1C was from post prandial BGS. But your doc has just learned that it's mostly made up from your FBS. Hmmm, I wonder which one is correct? (Obviously they're both very important!) Cheers!

[owlyn]

I had a similar situation to you...was taking lantus in the am, it wasn't lasting the full 24 hours, but I also had some night time hypo issues. Taking it at night (for me) made the night time hypos worse. My endo had me split the dose, and it has solved both problems.
What I did was split the total dose in half and take it 12 hours apart...then went through some tweaking over about a month period of time to get it right. I was taking 24 units in the am, I'm now taking 16 units in the am and 4 units in the pm and I haven't had an overnight hypo in months and months. It takes some basal testing and some work to get it right, but for me it was WELL worth it.

Thanks! It's nice to know that one's own unique situation isn't necessarily completely unique. Hmmmm, and you're taking less Lantus overall... What time in the PM do you take that shot? And what do you think of this idea (for a starting point):

If I calculate 28 units/24 hours = 1.7 units/hour (roughly, of course), with it tailing during the last 2-3 hours. So, this means I would need 2.5 hrs * 1.7 units = 4.25 units overnight. Sooooo.... I think I'll try taking 24 units in the morning, and 4 before bed (ugh- just what I need-one more thing before bed :thumpdown ) with my 30-45 gram snack and the 2 or 3 units of Humalog that goes with my snack. Does that sound reasonable?:dontknow: :confused:

[owlyn]

Hi Owlyn! This is interesting. Sometimes there's conflicting info which makes things confusing sometimes. I was just reading another thread titled AACE Clinical Conversion Series, and a poster replied that the bulk of the A1C was from post prandial BGS. But your doc has just learned that it's mostly made up from your FBS. Hmmm, I wonder which one is correct? (Obviously they're both very important!) Cheers!

Well, he didn't say what the seminar was about- just that lots of other topics were discussed besides diabetes, so I don't know how much credence to give to this information. I guess I'll have to call my endo, who will doubtless want me to come in for no real reason other than to bill the insurance company for a visit. It's not that he's not good- he is well respected (heads up the Endocrinology Department at a leading university), it's just that even with all that knowledge, it's still, "let's try this:..." I mean, I can come up with a "let's try this..." here on DF just as well, you know?

Anyway.... mathematically, it would seem that FBS should have more weight on its own, as it makes up about 30% of my day, but that means that 70% is made up of PP. Yet he said that FBS makes up 70% of the A1C. I guess it's possible because no one ever said that any of this was linear. I'm getting a headache.

[shockme]

i was told by my cde that if i wanted to change the time i shoot my lantus-i could do it in hour increments. one hour later the 1st day,and add an hour eac day. trish