Lost on Lantus!!!

[Metermaid]

Hi all, This is my problem: I take Lantus 8u am...7u dinnertime.
Humalog for meals coverage...I have severe lows that hit me 2-4 times a week, but always between 4am and 6am. I have come to the conclusion that Diabetes is for people who are good with math.....I am 'math challenged'.:stupido3:
Last night, I went to bed with a hs bg of 230, did not correct it, because: I WILL GO LOW...I ate an apple instead. At 4am I awaken with a 48 bg...I take 3 glucose tablets and go back to sleep...then at 6:30am...I am awakened barely:afraid: and now bg is 23:eek: !!! I wake hubby and take 3 more glucose tablets and 4 oz of apple juice...and feel like a real loser for not being able to fgure this out!!!:confused:
Any input would be highly appreciated!
Rita

[RyanN]

I have a similar problem at night with Lantus.
I'll take 12 units before sleeping, and my sugars always go down 100 - 120 pts overnight. So, I gotta bring up the sugars
to the high 200's at HS just to relax so I don't have to worry.
I hate worrying about going low at night, because I get stressed and can't sleep soundly, then wake up and am on edge for the day--like a bad cycle. Though I'm pretty good at catching lows, there is always that little voice in the dark as you lie in bed trying to sleep saying you might go low and never wake up. Though it is just a stupid worry, it is enough to keep me awake until I am sure my sugars aren't plummeting
for some unknown reason.

[Gary_W]

Hi Metermaid,

I've had similar problems with Lantus lows at night and (after asking for help here) I've discovered that I'm far from the only one!

Lantus, though it claims to be a peakless insulin, DOES peak. The charts seem to say it peaks at 4-6 hours, though this will vary with the individual.

If you are regularly dropping in the night like this, it is too much lantus; no maths needed. You humalog is completely gone from your system in 5 hours tops, so provided you are eating before 7pm, that is not going to be sending you low towards midnight. It can only be the Lantus with the evening meal. Your choices are to either cut it back or to alter the time when you inject it.

I've cut back my evening Lantus, and the good news is the night hypos are gone. I can go to bed with more or less the same BG that I wake up with. Bad news is that the change in Lantus has fouled up all of my ratios and my 2 hour post prandials are shot to bits, so I've fixed one thing and broken another. My total Lantus dose is the same, I've just split it to stop the night hypos.

Good luck

Gary

[ant hill]

Hi all, This is my problem: I take Lantus 8u am...7u dinnertime.
Humalog for meals coverage...I have severe lows that hit me 2-4 times a week, but always between 4am and 6am. I have come to the conclusion that Diabetes is for people who are good with math.....I am 'math challenged'.:stupido3:
Hello Metermaid :), Good nic name that you have. :D
I see that you're are on a serious low doses and any deviation either up or down would be big force on your well being. at the moment you are discovering lows during the night which is dangerous.

Last night, I went to bed with a hs bg of 230, did not correct it, because: I WILL GO LOW...I ate an apple instead. At 4am I awaken with a 48 bg...I take 3 glucose tablets and go back to sleep...then at 6:30am...I am awakened barely:afraid: and now bg is 23:eek: !!! I wake hubby and take 3 more glucose tablets and 4 oz of apple juice...and feel like a real loser for not being able to fgure this out!!!:confused:
Any input would be highly appreciated!
Rita

So now I would look at dropping 1U of your Lantus at after dinner and keep your morning doses as that you're are awake and using the energy and so using the insulin to help with your activity. If that's too low for you you may have to look at half unit doses say 6 1/2U or 6.5U and of course that means having to use a normal throwaway syringes. :( Anyway try 6U and see how you go and if you are still awake at 2AM have a test and you will probably enjoying the good sleep LOL :D

[Stuboy]

I would agree... it sounds like you need to start dropping your lantus 1unit at a time after dinner until you no longer have the lows.
I've been told that when adjusting like that, you should change the dose... and continue with that dose for three days, then change again if required... i find it works really well for me.
Although, if you're going to bed high AND eating and STILL going low, perhaps dropping 2 units would help... and dont eat before you sleep otherwise you wont know if the lantus is at the right dose.

You need to do some basal testing.

[xMenace]

One thing to consider is combining your doses and taking it all first thing in the morning. This may give you a much lighter effect through the night and into the morning. That would be totally wrong for most of us, but it may help you. Do you have morning rises from your Dawn Phenomenon?

I agree about cutting back. The upper limit for Lantus should be what keeps you normal as possible through the night. This will mean defficiencies throughout the day, so do some basal testing and find when you need to suppliment and how.

[Alice]

I am beginning to think that many of us (myself in the past) have all ended up taking too much Lantus...usually based on a doctor's quest to a lower A1C (and our own quest).

Every time I had the "lows" problem at night, it was a sign to cut back. I find I need to fluctuate between 23 & 24 units...where I used to fluctuate between 25 & 27 units.

It's ok to step back and reassess. When you start seeing high fasting numbers, you'll know you need an increase. In my case, I had to find a happy medium...I make sure I eat 15-20 carbs before bed without a bolus. This usually keeps me pretty even.

It has taken me many years to figure this out on my own. The doctors mean well, but they don't know you body chemistry, PMS stubborness, etc.

[Jan B]

Something I always fought against was the advice to eat a snack of protein and fat (peanut butter or cheese and crackers) before bedtime. Once I finally tried that, it worked very well. That way the sugar breaks down more slowly, giving you more coverage and protection.

[1type2go]

Something I always fought against was the advice to eat a snack of protein and fat (peanut butter or cheese and crackers) before bedtime. Once I finally tried that, it worked very well. That way the sugar breaks down more slowly, giving you more coverage and protection.


I was just going to say that .
lower GI Carbs will help but you are still eating before bed ,

I too have been having lows at night and I thought it was the humalog at supper 5 - 6:pm lasting to long and peaking to late :confused:

[Quote] do some basal testing and find when you need to supplement and how.

I am, just now trying to figure out my Basel requirements ,and I am still unclear

Donovan

[grace girl]

Been there...
My advice would be to do some basal testing, for starters. Get a clear idea of what's going on. That will tell you if you need to lower the dose. You may not, it may simply be that you need to change the time of the evening shot so that the peak is done by the time you go to sleep.
I have really come to despise the term "peakless insulin" where lantus is concerned. I've been fighting with it's peaks for several years now.
With basal testing and some adjustments you can make the peaks work for you and not against you. I'm still working on it, but it's getting better!

[Stuboy]

If possible you want to avoid "having" to eat before bed time. Otherwise your Diabetes is controlling you, and your feeding the insulin, which isn't the way it should be.

[jen_slc]

I agree, sounds like your Lantus needs to be adjusted. I used to experience HUGE drops like that overnight too. It was very scary. These days I cut back my Lantus dose for every 40 mg/dl that I drop. This guideline came from my endo - I don't think it is personalized, I *think* this could be applied to anybody, but don't take my word for it. Just keep in mind that if you're dropping 150-200 points overnight, you may need to cut back quite a few units.

As an example, when I experienced 200-300 point drops, my Lantus dose eventually ended up at ~50% of what I was originally taking.

[Gary_W]

As an example, when I experienced 200-300 point drops, my Lantus dose eventually ended up at ~50% of what I was originally taking.

Holy cow! My night-time Lantus drops of late have been 4.5 or 5 (which is worst case 90) and I felt agrieved at that. Still do.

You win! :eek: :D

[Metermaid]

I have really come to despise the term "peakless insulin" where lantus is concerned. I've been fighting with it's peaks for several years now.
With basal testing and some adjustments you can make the peaks work for you and not against you. I'm still working on it, but it's getting better!

When do you take your Lantus...do you split also? I just learned from you all, that Lantus has peaks!! Now I have to figure when it peaks for me?? Another math problem...:eek: I am wondering if I shouldn't take another kind of basal insulin?

[BlueSky]

I don't know whether Lantus peaks or not, and I don't think it really matters that much. If you split the dose you will get reasonably even action over the course of the day. What is more of an issue to my mind is the fact that our bodies' requirement for basal insulin action varies substantially during the 24 hour cycle. Most of us need much more basal insulin during the morning hours than we do in the afternoon and at night. I find that if I set my Lantus dose at a level that keeps me even during the morning, I will go low in the afternoon and/or at night. This is because the flat action of Lantus is adequate in the morning but excessive in the afternoon and overnight. It sounds like the same could be happening with you, Metermaid.

This is how I dealt with it. Reducing the lantus so that the afternoon and night BG was steady made sense as it stopped the lows. But I needed extra coverage in the morning. I provide that by minimising breakfast carbs and covering the meal with Actrapid (it is like Humulin R). I give myself a big dose of it when I get up, part of which conteracts the Dawn Phenomenon blood glucose surge. The net effect is that blood glucose is reasonably steady during the whole 24 hour cycle.

For me, Lantus on its own is not adequate to satisfy basal needs. Some extra coverage in the morning is essential. You could also try using NPH in a similar fashion. The big advantage of working with Lantus, IMO, is that it is like building on level foundations.

[Metermaid]

What is more of an issue to my mind is the fact that our bodies' requirement for basal insulin action varies substantially during the 24 hour cycle. Most of us need much more basal insulin during the morning hours than we do in the afternoon and at night. I find that if I set my Lantus dose at a level that keeps me even during the morning, I will go low in the afternoon and/or at night. This is because the flat action of Lantus is adequate in the morning but excessive in the afternoon and overnight. It sounds like the same could be happening with you, Metermaid.

For me, Lantus on its own is not adequate to satisfy basal needs. Some extra coverage in the morning is essential. You could also try using NPH in a similar fashion. The big advantage of working with Lantus, IMO, is that it is like building on level foundations.

Blue Sky,
Thanks for your input..yes, exactly right about the different basal needs throughout the 24 hr day... I was just wondering how you all handled that and I see your method is interesting and I had not considered that. I am going to get J.Walsh's book on Using Insulin to better equip myself before doing any major insulin changes.
:confused: Another question for you Blue Sky; is not the pump the answer to our dilemma? Is there a reason that you are not on the pump? I have had the MM 522 delivered and am in the process of reading through all the handouts/CDs/information before setting up my training session...I am also procrastinating because I have never really wanted to go on the pump....wanting the control myself with the MDIs. Being an RN, control comes with the territory...just wondering about you.
Thanks so very much for taking time to help out a fellow Diabetic! Rita

[grace girl]

When do you take your Lantus...do you split also? I just learned from you all, that Lantus has peaks!! Now I have to figure when it peaks for me?? Another math problem...:eek: I am wondering if I shouldn't take another kind of basal insulin?


Well, just to be clear, "peak" really isn't the right word. A peak would imply going up, peaking, then coming down. For me it's more like a rising plateau...my bs drops for 4-6 hours after the injections, then it flatlines.
I take it twice a day with the higher dose in the am and timed so that by reducing my humalog for breakfast I can, for the most part, control the peak.
I've struggled with over-night for years. I had been taking it at 9pm, and I've been back it up recently, trying to get the peak finished before I go to sleep.
When I took it in one dose I had 200-300 point drops overnight constantly. I cut the dose in half and still dropped over 150 pts a night, with a snack, yet I was high all day long because I didn't have enough basal during the day. It was a nightmare. Splitting has helped, but I'm not going to lie...my life revolves around math. I hate math. But since I like being alive, I deal with it.

[BlueSky]

..... Another question for you Blue Sky; is not the pump the answer to our dilemma? Is there a reason that you are not on the pump? ...
Yes, using the pump enables you to solve these problems by customising the basal rate. It was while I was trialing a pump that I figured out just what my basal insulin requirements are. They vary from .25 units per hour in the late afternoon, to .95 units per hour in the morning. Achieving this level of action with only Lantus is not possible. But where there is a will, there is a way ;) .

The pump worked very well, but I was not able to keep it for financial reasons - we don't get any financial support from the public health system or private insurance for pumps here. So I would have to pay the initial cost and running expenses myself. Maybe next year, or the year after that. I am doing reasonable well with MDI. I have found an unconventional way (using Regular in the morning) to match insulin action with the varying underlying requirement. It works very well, and I am in no hurry to stop using it.

If you don't want to or can't use a pump, you can still have good control. But you might have to take control of the situation and be unconventional. Don't expect too much help from medical professionals. They are, in my experience, naive and unimaginative. So, yeah, using the pump is certainly the easiest way to go ;)

[ant hill]

:confused: Another question for you Blue Sky; is not the pump the answer to our dilemma? Is there a reason that you are not on the pump? I have had the MM 522 delivered and am in the process of reading through all the handouts/CDs/information before setting up my training session...I am also procrastinating because I have never really wanted to go on the pump....wanting the control myself with the MDIs. Being an RN, control comes with the territory...just wondering about you.
Thanks so very much for taking time to help out a fellow Diabetic! Rita

Hello Rita Metermaid, Just had to say that LOL. :D I thought that by having a pump would confuse you more with maths I think but that's up to you and the Basel is very fine in the pump!! like you would have half unit doses on MDI as with a pump you could do quarter units!!!! Yeah it's that fine! and because that you're are on a very low dose the pump would be good as because that you can able to do fine doses. and it's good like when you are about to eat you cannot forget to bolus ether as it just a press of a button. :D
By the way, I am not a sales person to pumps. LOL :biggrin:

[Metermaid]

... and dont eat before you sleep otherwise you wont know if the lantus is at the right dose.

OOPS:stupid1: I just ate...and took one less unit of Lantus at dinnertime....that was a waste of an experiment....oh well, I will try it again tomorrow night.
Thanks, Rita

[Metermaid]

One thing to consider is combining your doses and taking it all first thing in the morning. This may give you a much lighter effect through the night and into the morning. That would be totally wrong for most of us, but it may help you. Do you have morning rises from your Dawn Phenomenon?
.

No, my am bg are fine after a night time low. Thanks for the input!!! Rita