Lantus giving me grief [Archive]

Gary_W

02-11-2008, 02:01 AM

Hi all,

These days, I'm down to 14u of Lantus before bed. I've experimented briefly with adjusting the dose to sort out the little niggles that now exist but life is really busy at the moment and I just don't have the time for the basal tests etc. at the moment.

Current problem is that if I go to bed <7.0 then I will wake up hypo, in other words the Lantus drops me around 3.5 in the night (63 US numbers). This is really annoying, as until recently I could go to bed as a 5.0 and wake up the same. In fact, if I was 6.0 or above I'd actually do a correction shot before bed! Not any more. I always test before bed. I'm usually around a 5 - 6, so I'll have a little milk and maybe a biscuit to acount for the Lantus dip.

Last night, I was 7.5 before bed so didn't bother with the food. I put in the 14u. Our youngest daughter woke up screaming an hour or so later. I sorted her out and then realised I didn't feel so good. I tested and was 2.2 (40). 30g of carbs in the form of orange juice took me as far as a 7, and I woke up as a 6.0 this morning. This is getting scary. Only thing I can think of is that the injection nicked a blood vessel (I bled very slightly) but surely that couldn't have caused this??? I wonder how often I go low in the night and don't wake up but my liver bails me out?

I feel absolutely dire this morning and frankly just don't need this. A couple of weeks ago I did flirt with splitting the dose (I went with 8u at night and 4u in the morning) but it caused raging highs in the morning. I cannot reliably change to a 6pm daily injection as I'm often either still working (various places) or on the road. Using less than 14u a day doesn't give me the cover (haven't done accurate basal tests but I can see the old numbers creep up).

Any suggestions / confirmation that even smallish doses of Lantus can drop you in the night like this? I'd consider going with the Levemir but everything I've read suggests it is even less flat than the Lantus. I really don't want to be eating before bed as even small amounts of extra food cause me to gain weight which I don't want to do.

Gary

ant hill

02-11-2008, 02:31 AM

Hello Gary :), I am also on Lantus and coping well with it but then there are people like yourself who have hassles with it.
I don't like asking this question as can often offends, How much do you weigh? I have read the perscription notes and they said that dose is around 0.4U*Kg Now this is an esterment of what your dose maybe at but don't go and adjust your dose on that fact as it may be not you. Have you done a complete flat spit dose like 8 and 8?
And as for Levemir is very similar 0.4U*Kg. ;)

Gary_W

02-11-2008, 02:48 AM

Hi Peter,

Thanks for the reply. I currently weigh just under 90Kg.

If I used the 0.4 u per kilo, I'd be injecting 35u of Lantus. As my TDD including covering 200 - 250g of carbs each day is only around 38u (14u of Lantus and 8 + 6 + 10 of Apidra) then these formulas don't work for me.

I haven't tried an 50/50 split, but taking the night-time dose down as far as 8u meant I went high in the morning...

Gary

ant hill

02-11-2008, 03:16 AM

Hi Peter,

Thanks for the reply. I currently weigh just under 90Kg.
You lucky sod!!! as I am about 118Kg. :(

If I used the 0.4 u per kilo, I'd be injecting 35u of Lantus. As my TDD including covering 200 - 250g of carbs each day is only around 38u (14u of Lantus and 8 + 6 + 10 of Apidra) then these formulas don't work for me.
I am glad that you understand that this is too much for you. :) So I would do the 50/50 split and see how goes as I see from most people has been a sucsess. That may not include you but have a try also put up with this regime as basels can be better studied over 48 hours. ;)

I haven't tried an 50/50 split, but taking the night-time dose down as far as 8u meant I went high in the morning...

Meh, try it Gary, I have also find that activity can influance the BG too so whey that into the account too. :)

SharpTail

02-11-2008, 04:49 AM

Gary...Keep an open mind about adjusting your Lantus dose. You may still consider splitting the dose about 12 hours apart. When I split my dose because the Lantus was running out in 18-20 hours rather than lasting 24, I initially tried a 50/50 split. I was having a drop in BS level through the night and could not get things to work well. After talking to a Diabetes educator at our hospital, she suggested an uneven split, for example around 60/40. After some fine tuning I currently take 26 U in the morning and 20 in the evening and this has given me almost perfect level blood sugars through the night. The other thing I found (and I can't explain why)was that my total dosage with the split dose was greater than what I had with the single dose. To get the right split for you will take some experimentation, but there should be some combination that will work well.
Pat

Stuboy

02-11-2008, 05:08 AM

im adjusting my lantus at the moment too, I downed it from 16u at night and morning to just 12. and today i've gone down again to 11.

It's worth trying a split dose, when i first started on lantus i found it wasn't lasting the full 24 horus and taking two doses 12 horus apart gives a nice flat profile (for me). and it means you can adjust in the morning for evening highs or low and adjust in the evening for morning highs or lows.

Give it a go and maybe drop the lantus one unit at a time three days apart untill you get it right.

By the sounds of it you're on about the same doses as me, i weigh 10.5st and my ratio is roughly (haven't got it quite right yet but it's getting very close) 12g:1u.

Good luck and keep us posted!

xMenace

02-11-2008, 05:12 AM

Sounds like a pump candidate. Check out that NHS thingy ;)

Stuboy

02-11-2008, 05:21 AM

well.. they can't deny the pump for UK patients on the basis of cost anymore... but you do have to "meet the criteria".

Well worth asking the question though!

SueM

02-11-2008, 05:31 AM

If the Lantus is causing problems at night have you thought of changing it over to the morning?
Or splitting the dose as others have mentioned?

shabbie

02-11-2008, 05:45 AM

hi gary,
i'm not a lantus expert as i used to take levemir.

i had problems witrh levemir not covering 24 hours (it was more like 18 hours)
when i tried to split the dose i ended up with highs in the gaps that levemir wasnt covered (i made loads of projections on excel spreadsheets to calculate the patterns ~ this saved loads of time and aggravation!)

i took my levemir at night, i only took enough to keep me level overnight, and would cover the gaps with the novorapid during the evening when it had run its course.

the pump has helped me to resolve a lot of the issues i had on mdi.

Real4

02-11-2008, 06:09 AM

Last night, I was 7.5 before bed so didn't bother with the food. I put in the 14u. Our youngest daughter woke up screaming an hour or so later. I sorted her out and then realised I didn't feel so good. I tested and was 2.2 (40). 30g of carbs in the form of orange juice took me as far as a 7, and I woke up as a 6.0 this morning.
If your description of what happened is accurate, this is NOT a Lantus issue. There is a delay of about 2 hours before Lantus begins to work, and any "peak" with Lantus would be about 4 to 6 hours after taking it. So, if you are low an hour after injecting Lantus, there is another cause, not the Lantus.

TenderVittleS

02-11-2008, 06:09 AM

I would just gradually reduce the amount of your nightime Lantus dose about 2 units. That way you don't wake up low.

Gary_W

02-11-2008, 06:09 AM

Thanks for the replies, folks.

I have condidered all kinds of splits and morning doses etc. The two biggest problems I have are a highly irregular life and also lack of time to test and fiddle.

I work from home, and today I'm actually at home catching up on paperwork. Last week I was on the other side of the world for a week (working) and had a horrendous journey back :mad: I drive lots in the UK and will leave the house anywhere between 4.30am and 11am depending on the day. I get home anywhere between 3pm and 9pm. For this reason, a morning dose of Lantus at a regular time is a little bit on the tricky side as I'll be in a car somewhere. The only time of day where I'm consistantly home is late evening. I know that persuading my brain to remember an 8am dose each day will be tricky depending upon where I am / what I'm doing. I suppose I could make sure I've got Lantus with me and whack in the second dose at lunchtime... The time varies each day, but I guess it'll be close enough? I do always eat lunch so I suppose it's a constant and I could get into the Lantus habit. I always do thighs with Lantus so I guess I'll have to figure out a way of subtley dropping my trousers in public...

As far as the time goes, I'm well aware that any changes I make to Lantus take a couple of days + to fully settle down. I just don't have any down time at the moment as this is my busiest time of year. Come April I'll have plenty of time to fiddle with this stuff, and my original plan was to string it out until then. Unfortunately what happened last night is kind of scaring me. I feel OK now, but it really wiped me out this morning. It was just one of those hypos that leaves you drained. Mostly, I'm right as rain inside 15 mins but occasionally they really stay with me afterwards.

XMenace - I am taking an afternoon later this month to speak with the local authority about a pump. There is the possibility of a trial in the spring which would suit my timescale just fine. It would be unfair to have a go at the moment as throwing the time at it that it deserves cannot happen at the moment. I must say that the concept of pumping is seeming a little more attractive as the days go on. It's such a pain as I had this thing absolutely nailed for a few months. No drops in the night, almost completely predictable. Really cheeses me off when it re-writes the rules when you start to beat it at its own game...

Gary

Gary_W

02-11-2008, 06:20 AM

If your description of what happened is accurate, this is NOT a Lantus issue. There is a delay of about 2 hours before Lantus begins to work, and any "peak" with Lantus would be about 4 to 6 hours after taking it. So, if you are low an hour after injecting Lantus, there is another cause, not the Lantus.

This is why I was so worried; if I could understand where the hypo came from then I wouldn't be so concerned. My evening meal yesterday was at around 5pm and I injected 8u of Apidra. I've profiled Apidra in me, and it is 85% gone at hour 3. By hour 4 there is none left worth shouting about.

Looking in my meter, I blood tested at 11.05pm and was 7.2 (130). I injected the Lantus around Midnight. The hypo happened at 1.20 according to my meter and the reading was 2.2. I tested again 12 mins later and had reached 3.2. I went back to sleep a short while later as I felt OK. I was woken up again at 4.15 (kids) and my BG was 7.0. I was 6.3 when I got up at 7.45am

No excercise, nothing else. I agree that Lantus shouldn't do this. But it did unless anyone can suggest something else? I've been T1 for 12 or 13 years now, so I'm not honeymooning.

Gary

Gary_W

02-11-2008, 06:21 AM

I would just gradually reduce the amount of your nightime Lantus dose about 2 units. That way you don't wake up low.

I did try 12u recently. I didn't wake up low, but just those 2u caused me to be way too high in the morning and (even with a decent amount of Apidra) I really spiked with breakfast.

Jan B

02-11-2008, 06:41 AM

Gary,

Your story sounds very much like mine & that's why I'm back on the pump. I hope you can get one. If not, hopefully you can get that Lantus dose perfected.

My last straw before going to the pump, was a morning where my husband thought I was being obstinate, and he just left town. Turns out I was LOST in my own house -- couldn't figure out how to come out of the bathroom; couldn't figure out how to find any clothes to put on, and ended up with a big bruise on my forehead and never figured out how that happened. The scariest thing is I kept telling my husband I was fine (from the bathroom) . . . and he believed it (thought I was sick to my stomach or something). When I finally escaped the bathroom, I called him and asked him where I was and where he was, he started pleading with me to check my bg.

No matter where I am or what I'm doing, I have a bottle of insulin and a syringe, so traveling doesn't sound like a very good reason to not be able to give a shot! Then, I always injected in the stomach through clothes when I needed to.

I hope you get this settled soon Gary.

dbc

02-11-2008, 07:04 AM

I know that persuading my brain to remember an 8am dose each day will be tricky depending upon where I am / what I'm doing.

Try your cellphone - the daily repeat alarm is the ONLY way I remember to take my second Lantus dose at 7:00pm everyday :D !

Alice

02-11-2008, 08:13 AM

It's funny how different we all are! I tend to forget nighttime doses...or I'll lie down "for just a minute" and hate to get up to take a bedtime dose of Lantus.

Along with the night lows, the "remembering" factor was the main reason I started taking Lantus in the mornings years ago. From my first prescription, I questioned why they told everyone to take a night...but assume it's because the want people to "sleep" through that 4 hour warm up period.

That's the last thing I would want to do with a 24-hour insulin starting up...so I take it in the morning. I did the split dose for a while, but found my "good amount" of a single dose finally.

It took a lot of patience. I was probably too slow in making changes in the beginning and wasted a lot of time.

With your schedule you may really find a pump easier...I like my MDI life now...but I have a pretty easy time with the MDI's.

Stuboy

02-11-2008, 08:59 AM

Gary...
What pen are you using for your lantus? Is it the blue Autopen24?

You say you tried 14 and you wake up low, and 12 but wake up high... sounds like you might need 13u!

Ask for the green 1u dose autopen24 in your next prescription slip.
I can't use the 2u pen because i often need the "odd" numbers. Im on 11 at the moment.

It will give you greater flexibility in adjusting your Lantus dose.

Eddy

02-11-2008, 09:15 AM

FWIW: I'm 181 cm and 75-80 kg, on 30U Lantus.

I'm down to 14u of Lantus before bed.

Is this at a consistent time of day? If not, that may present problems.

Current problem is that if I go to bed <7.0 then I will wake up hypo, in other words the Lantus drops me around 3.5 in the night (63 US numbers).

I have something similar. At the 22-hour mark, Lantus begins to "fade", and my sugar creeps up. Yet around the 1.5-hour mark, Lantus begins stacking. My total drop attributable to Lantus stacking usually is about 2.0, although I've also observed closer to 3.0 before.

Only thing I can think of is that the injection nicked a blood vessel (I bled very slightly) but surely that couldn't have caused this???

I've read that hitting muscle causes faster absorption. I once hit 1.9 one evening, then struggled for several hours to get my BG up. The next day, my BG was constantly creeping higher. It seemed as if the Lantus had indeed kicked in too quickly at first, leaving me deprived the next day.

I also have a screwball schedule. To handle my Lantus stacking, I inject at 17:30, then harness the stacking as a [partial] dinnertime "bolus". To deal with the Lantus "fade", I use a unit or two of extra Humulin-N at lunchtime, usually circa 12:30 to 13:00. (Humulin-N finishes within 5 hours in me.)

Note that, if you split your Lantus dose, I'd do so more gradually than what you tried. Skipping more than 40% until the following morning is rather severe. I'd not shift more than 15% at a time.

Hope this somehow helps...

Eddy

02-11-2008, 09:23 AM

If your description of what happened is accurate, this is NOT a Lantus issue. There is a delay of about 2 hours before Lantus begins to work, and any "peak" with Lantus would be about 4 to 6 hours after taking it. So, if you are low an hour after injecting Lantus, there is another cause, not the Lantus.

I disagree. I've consistently observed Lantus-stacking dips about 2.5 hours post-injection, regardless of bolus patterns and injection time.

And Humalog clears within 1.5 hr, Humulin-R within 2.0 hr, and Humulin-N within 5 hr... in me, at least.

I'm sure there are others in whom insulins kick in very quickly. Different people have different pharmacokinetics. The manufacturer-supplied activity graphs are well and good, but I doubt anyone would wager a month's pay that ten randomly-selected IDDMs would all react just like the pretty graphs.

Eddy

02-11-2008, 09:36 AM

I drive lots in the UK and will leave the house anywhere between 4.30am and 11am depending on the day. I get home anywhere between 3pm and 9pm.

Hmmm. Am I correct that BG < 4.0 is "legally hypo" in the UK? i.e., that anything causing a daytime hypo could mess with your work?

I know that persuading my brain to remember an 8am dose each day will be tricky depending upon where I am / what I'm doing. I suppose I could make sure I've got Lantus with me and whack in the second dose at lunchtime...

I carry my insulins with me. I have my mobile go off at 12:50 (afternoon NPH; usually lunch, too) and 17:30 (Lantus).

The time varies each day, but I guess it'll be close enough? I do always eat lunch so I suppose it's a constant and I could get into the Lantus habit. I always do thighs with Lantus so I guess I'll have to figure out a way of subtley dropping my trousers in public...

How much does the time vary? If lunch is your constant, that might be a better time for Lantus... particularly if you could harness that stacking and use it to your advantage.

FWIW, I inject both Lantus and boluses abdominally. However, injecting in the car can trigger leakage... if I inject on the road, I get out and walk around.

Finally, what sort of needle/pen do you use? I use 8mm needle, and generally inject centrally [on my abdomen] where I have more fat.

Gary_W

02-11-2008, 12:58 PM

Thanks for the further replies, folks.

Eddy - Can you tell me a bit more about the stacking? Are you meaning excess Lantus left after the 24h going onto next days dose? If so, I don't think that's an issue as I typically have to do a little correction shot mid evening to bring down the BG due to the Lantus running out. Only lately I haven't done that; I've gone with the slight high and then not bothered eating before bed.

Yes, anything below 4.0 is legally hypo over here. I always test before I get in a car and regularly on a journey. I've never yet had a hypo I couldn't treat myself and I always have glucose tabs / juice etc on me. I need to as my work involves going to see relative strangers at places that can be 100 miles in any direction and back again, so hypos during the day are a pain. If they happen, I know they're happening but obviously they delay me whilst I deal with them.

Lunchtime can vary between 11.45 and 3pm....

As to sites, I've always found my arms to be the quickest, abdomen next and legs the slowest. My rear end was always too unpredictable to bother with, so I don't inject there anymore. I've always done the Lantus in the legs and the rapid will go either in the arms or abdo depending.

JanB - That sounds like a fun day.....

Gary

marcia87

02-11-2008, 02:19 PM

My doctor said I could inject Lantus through my clothes. I just started Lantus -- 10m at 9:00 pm. The bs drops after about an hour but after breakfast is back to over 250 again, so we'll have to do some adjusting.

Marcia

aqualimestar

02-11-2008, 03:55 PM

Oh Lantus can be so irritating! When I am off my pump I have to switch back to Lantus, which is what I am doing right now. I split my doses, with one third of the dose being at night and 2/3 in the morning. When I tried to do 50/50 split I would get up in the middle of the night with insanely low blood sugars and eat half the house! I have a friend who tried Lantus once and went so low she passed out... Needless to say that was her first and last Lantus shot!
I do pretty well with the 2/3 am and 2/3 pm split... Try and work something out with your endo bc it can be really difficult to find the perfect dosage and time! It took us a few weeks of daily adjustments before we came to the 2/3 & 1/3 split... and even now I have to take less Novalog with my lunch or else I will crash around 4pm

Eddy

02-11-2008, 05:24 PM

Can you tell me a bit more about the stacking? Are you meaning excess Lantus left after the 24h going onto next days dose? If so, I don't think that's an issue as I typically have to do a little correction shot mid evening to bring down the BG due to the Lantus running out.

Yes, I'm referring to excess being left. I, too, need a correction around 22h... which I handle pre-emptively with a little extra NPH at lunch. Although the Lantus is weaker starting around 22h, it doesn't seem to run out until 27h... so I end up with a BG rise-and-fall around Lantus injection time.

I could well be wrong, as I've never had blood checked for insulin concentrations. However, the rise/fall move with Lantus time, regardless of sleep or bolus times/patterns. I've thus concluded that it's Lantus-related.

IMNSHO, this makes sense: How could Lantus activity be a step function, dropping from "near 100%" to "0%" during a very narrow time window?

jen_slc

02-11-2008, 07:41 PM

Hi Gary,

What a familiar story! I too am struggling with the "perfect" Lantus dose. I used to be on one single dose of 26u in the evening and was dropping significantly every single night. Didn't know it at the time though! I'd stuff my face before going to bed without taking any insulin (not realizing this was a bad thing!), only to periodically wake up in the middle of the night seriously low. It happened so often that I became very scared and didn't want to go to sleep at night for fear of... waking up dead, so to speak.

Then I split my dose into 2: 13u in AM & PM. Still experienced hypos. After much much much much much trial and error, I ended up at 8u AM & 7u PM, so no wonder I was hypoing so much; but in recent months I've had to reduce to 6u AM & PM. I'm still fine-tuning the basal, but it's difficult. One unit, even half a unit, can wreak havoc!

Also, I don't trust the pens; I use a vial and syringe, particularly because I sometimes have to play with half units. And here's a guideline my endo gave me: for every 40 mg/dl drop overnight, cut back the Lantus by 1 unit. But of course, everyone will react differently.

It's hard - you have to balance the drop overnight with other effects the rest of the day. For you, your BGs start to rise as Lantus runs out. For me, even with splitting, I have sort of a dusk phenomenon to deal with, and the more I cut Lantus back, the higher I go in the afternoons. You may end up choosing the lesser of two evils... I'd rather not drop so much overnight and be a little higher in the afternoons - at least then I can try to cover that rise with my Apidra lunch dose.

But I understand - basal testing gets old. I've been doing it once a week for a while now and it's tiresome! I would definitely consider a split dose if you can though.

Nikky

02-11-2008, 08:44 PM

Gary,
I assume you are using a pen for your Lantus. This may sound real stupid, but still worth asking.
Do you change the needle before each injection with Lantus? Take it off directly after the injection? Leave the pen without a needle untill next injection?
Not just for saving your skin - but as you probably already know, Lantus is quite sensitive.

Metermaid

02-12-2008, 12:08 AM

I did try 12u recently. I didn't wake up low, but just those 2u caused me to be way too high in the morning and (even with a decent amount of Apidra) I really spiked with breakfast.
I am having the exact same problem with my night time lows...I have been a T1 for 10 yrs, and all of a sudden this starts!! So frustrating! I am splitting my Lantus currently...8 in am 6 at dinner....I find that I have to go to bed with a high bg of at least 240 in order not to go low!!! Crazy. I have to figure this out too..Good Luck!

Gary_W

02-12-2008, 02:28 PM

Thanks for the further replies, folks. All good reading as ever :)

A little update. I decided not to make any changes last night, and purposely went to bed with a fairly high BG; I usually drift upwards a little in the evening (I believe this is due to the Lantus running out) and would traditionally do a little correction shot mid evening if necessary.

Anyway, I let the numbers drift up and I was 10.0 before bed (180). I whacked in the usual 14 of Lantus and this morning I was 5.8 (104). That was at 5.50am, only around 5 1/2 hours after I injected the Lantus. That's a pretty severe drop IMO and I can't really go on like that.

I'll drop it to 8 tonight and pop some more in tomorrow. I'm working from home again tomorrow so easily do-able. Not so many weeks ago, a slight drop in the night-time Lantus meant raging high BG in the morning. It will be interesting (!) to see what it decides to do this time.

Interestingly enough, my morning BGs were nice, but I had an unexpected creep up to a 10.0 again at lunchtime. No carbs, it just went there... Delayed DP??? Anyway, it was my only opportunity to eat so I put in correction plus counted carbs. Spiked to a 14.4 (which makes me feel pretty rough these days as I haven't trodden in these waters for a while), stayed in double figures for 3 hours. Then went from a 9.3 to a 3.3 inside the last hour. At that point, the Apidra had been working for 4 hours and there's not usually a great deal of it left. I just do not get what is going on at the moment.

Gary

Eddy

02-12-2008, 02:59 PM

I was 10.0 before bed (180). I whacked in the usual 14 of Lantus and this morning I was 5.8 (104). That was at 5.50am, only around 5 1/2 hours after I injected the Lantus. That's a pretty severe drop IMO and I can't really go on like that.

Wow. You have good reason to be frustrated.

Interestingly enough, my morning BGs were nice, but I had an unexpected creep up to a 10.0 again at lunchtime. No carbs, it just went there... Delayed DP???

I don't know whether to think the Lantus is running too quickly, or that something else might be in play...

Anyway, it was my only opportunity to eat so I put in correction plus counted carbs. Spiked to a 14.4 (which makes me feel pretty rough these days as I haven't trodden in these waters for a while), stayed in double figures for 3 hours. Then went from a 9.3 to a 3.3 inside the last hour. At that point, the Apidra had been working for 4 hours and there's not usually a great deal of it left. I just do not get what is going on at the moment.

Definitely perplexing.

I'm no expert on liver dumps, but I believe that the liver "wants to be paid back right away"... i.e., I've heard that one should sugar up after shooting glucagon. Could the spike/drop have been a liver dump?

FWIW, I've noticed that:

1. High BG makes Humalog delay for an extra hour, then hit hard. I wonder if your 14.4 excursion made the Apidra sit around for a while?

2. Walking, warm showers, and niacin all seriously compound the drop.

I agree with you about cutting back on the Lantus. A 4.2 drop overnight just is not right. I imagine (and an endocrinologist I am not) that such wildness could confuse and destabilize your body.

Gary_W

02-14-2008, 05:28 AM

A little update for everyone...

I've started to split the dose. Now doing 8u before bed and 6u with breakfast.

I'm only 2 days in, and due to the wonders of Lantus taking a few days to make its mind up about things I can't really comment on the long-term suitability of the split yet. What I do know so far is that the 4.0 drop over night has turned into a 1.5 drop which is a little friendlier. Because I've been going to bed high (ish) to prevent night hypos, I'm waking up higher than I'd like and I'm spiking horribly all morning even with fairly moderate carbs. I'll worry about that in a few days once things settle and I can see the effect / know how to tweak next...

Thanks once more for all the great info. Sad that I always come here rather than phoning the clinic...

As a brief aside, I've lost about 5lbs in weight over the last 5 days according to my bathroom scales. Not 100% accurate I know, but I'm aware of what I usually weigh and suddenly it's gone down. Either I'm dehydrated or something weird is going on. Feeling like death warmed up anyway due to busy days and children currently waking up several times in the night (ear infections, antibiotics, poor little things aren't up to much :( )

Gary

SharpTail

02-14-2008, 08:20 AM

Gary...Good the hear that things are getting better. A consideration you might make with your split doses is to have the higher portion in the morning. That might eliminate the drop you have overnight, since the previous morning dose will be wearing off sometime in the early morning. With the higher dose in the evening you will have that one working full speed all through the night.

Regarding your weight loss, I went through a period a while back when my blood sugars were not in good control for about 2 months. I lost weight during that time and I suspect it may have been due to my body metabolizing fats, since it could not access the glucose in my system very well.
Pat

Eddy

02-14-2008, 09:44 AM

Feeling like death warmed up anyway due to busy days and children currently waking up several times in the night (ear infections, antibiotics, poor little things aren't up to much :( )

Those factors right there probably are messing with your BG...

Gary_W

02-17-2008, 01:39 PM

A brief update...

For the last few days, I've been popping in 6u at night and 8u first thing in the AM.

The good news is that the night hypos have gone :) In fact, I need to raise the night-time basal a little as I am actually getting around a 1.5 (27) rise overnight.

The bad news is that I am getting horrendous spikes with breakfast and lunch. The numbers do come down to where you'd expect if you leave them, so it's not me doing the maths wrong for the bolus dose. It just seems like the Apidra is taking much longer to work now for those two meals which is deeply odd. Yesterday and today I spiked to around 13.5 (240 ish) at two hours after lunch; a couple of months ago, it would be rare for me to be above 7.5 at the two hour mark and there has been no change in my diet... Evening meal is fine, and comes down to the level I expect at the time I expect. I am guessing that it is the lack of active Lantus in the AM / early afternoon that is doing this as when I was squirting in the whole 14u at night I didn't spike this badly.

Rock and hard place really; if I inject much more at night, I go hypo. If I don't have the basal levels 'up there' during the morning I spike really badly. I cannot just add extra bolus insulin as the numbers do come right but take 4 hours to do so rather than just the two...

Stupid disease. Fix one thing and break another :mad: Any suggestions gratefully received; please forgive me if I'm being daft, but it's just got a bit on the tricky side lately after doing exactly what it was told for a decent period of time. The concept of a pump is starting to look rather more attractive.

Gary

Emm

02-17-2008, 02:21 PM

Gary, I suspect the meal spikes are simply because you got used to Lantus doing half the work for you. Now that your Lantus is more settled your meal insulin has to do more work.
If you drop back into the lower-normal range within a few hours of eating then your doses are ok, but the spikes are still not nice... can you have a little less carb? Less carb = less spike. Also means less insulin which means you're less likely to have highs / lows from miscalculation.

When do you take your meal insulin? During/ after / before a meal? If you're eating anything with a decent amount of carb it's handy to take the insulin at least 10 - 20 minutes before you eat (If your BG isn't low of course!). Give it a head start and avoid the peaks :)

Gary_W

02-17-2008, 02:31 PM

Hi Emm,

Thanks for the reply and the advice.

The weird thing is that my basals used to be spot on; if I didn't eat, my BG didn't rise or fall, so as far as I can see the basal didn't used to be doing a great deal of the work for me, although the reduced morning basal certainly seems to be having that kind of effect... That's why I'm confused about it.

I do inject almost immediately before eating. This has always been good practice with me and Apidra as the stuff has (until now) got into me so viciously quickly that a 20 min pre-bolus was a good recipe for a bad hypo during the meal / immediately after as the insulin would beat the meal. This is one thing to re-think.

As to reducing the carb content, I can do. But I've had spikes in double from a fairly simple wholemeal sandwich with around 40g of carbs... I'm used to eating a big plate of mashed potato with relative impunity so this is not sitting well with me...

Gary

jen_slc

02-18-2008, 11:17 AM

Gary_W

02-18-2008, 02:52 PM

Hi Gary,

For whatever reason, your basal requirements have changed. It's frustrating, I know! I'm going through the same thing... why this should happen after 16+ of the disease, I don't know. One year, you have a perfect routine, and the next, it changes on you, for no discernable reason.

And it's not surprising that a change in your Lantus regime has messed up the rest of your day. I hate to say it, but now that your Lantus is sorted out, you may need to start over with your meal boluses and start testing those in order to get back to a good, predictable routine again.

Great fun, isn't it?

Again today, I had a lingering high all morning and afternoon that eventually went. I don't think the basal is bringing it down that last little bit as 14u per day of Lantus for a 196lb man is not excessive! It just seems like the bolus stuff is on a go-slow at the moment. Works fine in the evening, but all day it just drags and drags...

I am just hoping that this is yet another bug / passing phase / stress. I guess I could up each bolus dose (change my ratios) but then I'll have to bring the basal down a little to avoid hypo.

Time for basal testing would be nice, but the days are long at the moment. Just called it a day after 16 odd hours of work which makes it tricky to do accurate adjustments and fiddle with the doses.

russ621

02-18-2008, 03:04 PM

Gary_W

02-18-2008, 04:31 PM

Hi Gary,

I'm on Lantus too, have been since it was first released in sept 2001. And I'm having very similar problems to you. Early morning hypo's. My ownly surgestion at the moment, is a glass of milk at bedtime with a biscuit. For me that keeps the early morning hypo's at bay, do you have a bedtime snack ?
I take 28 units at night (currently under review)
These pumps seem to be the way to go forward.
If you find a answer I'd be really interested to know

Russell

Hi Russell,

Until fairly recently, I could go to bed with a BG of 5.0 and be confident I would wake up with the same number. No snack involved.

Until I throttled back the night-time Lantus last week, I was starting to drop 4.0 or more in the night. As far as I'm concerned, going to bed as a 9.0 or eating up to 40g of carbs before bed is not something I really want to do. I put weight on very easily and avoid eating between meals if I can.

Since cutting the evening Lantus back, the night-time hypos are gone. I've just tested and I'm 5.4 right before bed. I won't snack tonight and I'm fairly confident again that I'll wake up as a decent number. I just know I'm going to struggle with the highs most of the day now :mad:

Good luck with yours; have you got time to do basal testing, as if you have it's really useful in finding out what is going on.

Gary

Gary_W

02-20-2008, 05:36 AM

A little update.

I'm having slightly better luck. Settled on 7u Lantus before bed and 7u in the morning. My waking BG now tends to come in within 1.0 of my bedtime number.

I've had to completely change my bolus ratios for breakfast and lunch. Was on 1u to 10g, and still am for the evening meal. But for breakfast and lunch I'm having better luck with 1 to 7.5g which is quite a significant change. I just went down to this a few days ago thinking 'I'll hit breakfast hard, eat less and then top up with a snack at hour 2'. At hour 2, I was down to a decent level (hoorah!), but it actually rose slightly by itself before lunch. So I'll keep at this ratio for the mo and see where it goes.

Seems to want a far more aggressive bolus dose at the moment for reasons beyond by understanding. It'll be OK until it changes its mind again next week and I end up shaking like a nervous dog :mad:

Eddy

02-20-2008, 09:47 AM

I'm having slightly better luck. Settled on 7u Lantus before bed and 7u in the morning. My waking BG now tends to come in within 1.0 of my bedtime number.

Not bad. :) It sounds like you might still cut back a _little_ before bed. Not sure about the morning. But I'd not make any changes for at least a few days.

I've had to completely change my bolus ratios for breakfast and lunch. Was on 1u to 10g, and still am for the evening meal.

That sounds like you had some insulin resistance...

But for breakfast and lunch I'm having better luck with 1 to 7.5g which is quite a significant change.

...and it might now be more pronounced?

I just went down to this a few days ago thinking 'I'll hit breakfast hard, eat less and then top up with a snack at hour 2'. At hour 2, I was down to a decent level (hoorah!), but it actually rose slightly by itself before lunch. So I'll keep at this ratio for the mo and see where it goes.

Hmmmm. I'd expect any basal-fade rises to occur in the evening, when the Lantus is least concentrated. However, I'd let things stabilize for a few days before messing with basal again.

Seems to want a far more aggressive bolus dose at the moment for reasons beyond by understanding. It'll be OK until it changes its mind again next week and I end up shaking like a nervous dog :mad:

It sounds like you're making good progress. :) At least you're not having the wicked overnight drops!