Overnight drop

[relyt]

So the other day I went to bed at 11 pm, and my blood sugar was about 180-200. I use Lantus and I knew it will bring the blood sugar down overnight. But to my suprise I woke up at 7 am under 60. Lately my Lantus has been dropping more than usually overnight, but throughout the day my numbers have been goo so I dont think it is a Lantus problem. Has anyone else had strange drops overnight after going to bed high.

[DanG]

Has anyone else had strange drops overnight after going to bed high.

I quit taking lantus at night.
I have been doing lantus in the morning for 2 years and am done with the lantus drop thru the night - I did not like the lantus drops at night - waaay to problematic. So, I read here about people that split lantus and take half in the morning and half at night. Within 2 days of beginning that split-lantus experiment, I had the paramedics here trying to revive me. So, that was the end of split lantus and the beginning of morning lantus.

To my thinking, I am doing no activity nor carb intake while I sleep, so why any insulin? I let the 18-20 hour lifespan of lantus run thru midnight to 2AM and then fly without insulin until I wake up and take lantus again. This routine has been working fine for me - waking at 70-120 consistently. I could lower the lantus as I need to go to bed at 150 or so otherwise I wake up with a bit of a dragging lantus hypo - lantus hypo is noticeably different than a humalog low - but with no running insulin as at other times during the day, the morning lantus low is not bad at all since that low is at the end of the lantus cycle and just fizzles out with no real ill effect.

[keeranx]

When I used to take lantus it had a tendency to spike for me in the early morning hours (even though it was supposed to be a steady 24 hour insulin). Your doctor might suggest splitting your lantus dose into two 12hour shots to avoid any spiking...this was what my nurse was suggesting but I just switched to an insulin pump. You should definitely ask your doctor soon as it could be dangerous...I often woke up with severe lows.

[JJM335]

To my thinking, I am doing no activity nor carb intake while I sleep, so why any insulin? I let the 18-20 hour lifespan of lantus run thru midnight to 2AM and then fly without insulin until I wake up and take lantus again. This routine has been working fine for me - waking at 70-120 consistently. I could lower the lantus as I need to go to bed at 150 or so otherwise I wake up with a bit of a dragging lantus hypo - lantus hypo is noticeably different than a humalog low - but with no running insulin as at other times during the day, the morning lantus low is not bad at all since that low is at the end of the lantus cycle and just fizzles out with no real ill effect.

Although Lantus is by no means as flat as is sometimes advertized, in fact if you look at the data, it is fairly clear that a single shot of Lantus will still show some release from the injection site up to as long as 72 hours. If you take Lantus daily (either once or twice) the shots will start to stack up on each other giving a "flattish" sort of release curve. Many posters here and on other boards have noted that it "doesn't last 24 hours"; what this really means is that 18-20 hours after a single shot the amount of insulin released falls below the minimum basal requirement.

Even when you are asleep your metabolism continues, albeit more slowly, so you certainly need some basal insulin - you cannot get away with none at all. However, many people need much less basal whilst asleep. What you may have serendipitously hit upon is a regime whereby taking a single shot of Lantus in the morning gives you a release curve that nicely matches your basal requirements (i.e. less at night when you need less).

Joel

[networkguy]

Ive had the same issue. Ive been taking 34 units at bedtime, and I wake up at 5am with 35-70 often enough to cause concern. Just starting last night I took 12u and then 22u this morning. Will try this for a few days and make adjustments. Ive tried the morning routine only, but then I spike at night, so I need *something*. Its just a matter of finding the right combo.

[xMenace]

There's a lot going on here.

Basal needs are not flat. Pumpers will prove this wrong. peaks and troughs have nothing to do with activity. It's all hormone based. Take a look at my profile below. These doses keep me flat 24/7 365.

Lantus is not flat. You should try to place the peak at peak need. Very difficult if ot impossible for most.

Lantus will not last 24 hours for most people unless they take larger than needed doses. JJM335's plan of using this early lapse to his advantage is brilliant: let it run out in the night when he goes low anyway.

My basals (yellow) and need (blue). Apply Lantus to this with no thought and you'll have to keep 911 on speed-dial!
http://www.diabetesforums.com/forum/attachments/diabetes/2337d1185295996-basal-questions-xbasals.jpg

[Lizzie G]

Although Lantus is by no means as flat as is sometimes advertized, in fact if you look at the data, it is fairly clear that a single shot of Lantus will still show some release from the injection site up to as long as 72 hours. If you take Lantus daily (either once or twice) the shots will start to stack up on each other giving a "flattish" sort of release curve. Many posters here and on other boards have noted that it "doesn't last 24 hours"; what this really means is that 18-20 hours after a single shot the amount of insulin released falls below the minimum basal requirement.

Even when you are asleep your metabolism continues, albeit more slowly, so you certainly need some basal insulin - you cannot get away with none at all. However, many people need much less basal whilst asleep. What you may have serendipitously hit upon is a regime whereby taking a single shot of Lantus in the morning gives you a release curve that nicely matches your basal requirements (i.e. less at night when you need less).

Joel

Re the 72 hours I completely agree; last year when I was on lantus and doing a lot of open water training I needed to reduce my lantus a couple of days before in order to cope on the long swims. also, when i started pumping, 3 days in i needed to up my basals quite dramatically (having had to reduce them quite significantly at the beginning).

It sounds odd that you were dropping so much on lantus overnight and were ok during the day. if you were to look at a curve for the body's basal insulin requirement most people peak dramatically in the early hours....perhaps you are taking too much lantus and the reason why you are ok in the day is because you are un-knowingly compensating by taking less insulin per gram of carbs than you might be taking if your basals were correct. it might be worth looking into - at the moment what is your TDD and what proportion is basal versus bolus? if more than 50% is your basal insulin this could indicate that your lantus dose could be too high.

[DanG]

if you were to look at a curve for the body's basal insulin requirement most people peak dramatically in the early hours....

I have not seen a curve that shows this with an explanation.
Perhaps there is one online?
If someone has link showing typical curve - please provide a link.
Thanks.
Sounds like an interesting search - here I go.

[JJM335]

It sounds odd that you were dropping so much on lantus overnight and were ok during the day. if you were to look at a curve for the body's basal insulin requirement most people peak dramatically in the early hours....perhaps you are taking too much lantus and the reason why you are ok in the day is because you are un-knowingly compensating by taking less insulin per gram of carbs than you might be taking if your basals were correct. it might be worth looking into - at the moment what is your TDD and what proportion is basal versus bolus? if more than 50% is your basal insulin this could indicate that your lantus dose could be too high.

Hi Lizzie:

If you look up your thread "Basal programmes - what is yours?" in the Pumping forum, I have posted my basals. As you can see, I have two low spots, one between 00:00 and 04:30 and the second between 15:30 and 17:00. I was under the impression that low basal insulin requirements overnight (as opposed to peaking dramatically in the early hours) were most common. I spent weeks trying to tweak down my Lantus to the lowest possible dose to try and prevent hypos, so much so that my basal dose on the pump (20.85 U on my "standard" basal programme) is almost exactly the same as my typical Lantus dose used to be ( 21 U - split).

On the pump this comes out to about 38% of TDD.

[JJM335]

JJM335's plan of using this early lapse to his advantage is brilliant: let it run out in the night when he goes low anyway.

My basals (yellow) and need (blue). Apply Lantus to this with no thought and you'll have to keep 911 on speed-dial!
http://www.diabetesforums.com/forum/attachments/diabetes/2337d1185295996-basal-questions-xbasals.jpg

Deus:

Unfortunately, my "brilliant plan" worked so "well" for me I went onto a pump.

In your chart, how do you distinguish between basals (yellow) and needs (blue)? I can see how you can plot your basal program, but how do you independently measure your needs?

Joel

[retired60]

I split mine with 15 u in the morning and 10u at night. This works excellent for me. No more lows to speak of.
Terry

[Lizzie G]

Hi Lizzie:

If you look up your thread "Basal programmes - what is yours?" in the Pumping forum, I have posted my basals. As you can see, I have two low spots, one between 00:00 and 04:30 and the second between 15:30 and 17:00. I was under the impression that low basal insulin requirements overnight (as opposed to peaking dramatically in the early hours) were most common. I spent weeks trying to tweak down my Lantus to the lowest possible dose to try and prevent hypos, so much so that my basal dose on the pump (20.85 U on my "standard" basal programme) is almost exactly the same as my typical Lantus dose used to be ( 21 U - split).

On the pump this comes out to about 38% of TDD.

Hey Joel

I suppose my last post wasnt brilliantly phrased, it being often the early dawn hours where one needs more insulin (DP), so it would generally be more common to have a slightly elevated BG in the morning.....the factor I also didnt consider in my previous post is age; how can I say it without being ageist (LOL im going to get myself in trouble!!!), but i know you are a bit older than me and i also read that as you get older the levels of hormones causing the DP decrease and it is far more common to go low overnight)...anyhow, i guess my last post just contained too many generalities that are based on a certain experience

Liz