Lantus- Insulin Reactions Asymtomatic?

[DealCorn]

I was recently switched to Lantus from Humalin N. One thing I notice is that contrary to Humalin N (or NPH before that), insulin reactions are asymtomatic. I take a single dose of Lantus in the evening and its onset is such that it is most powerful while I am asleep. I move directly from sleep to a insulin reaction without waking up. With Humalin N (or NPH before that) I would always wake up, rush to the kitchen for a snack, and thereby avoid an insulin reaction.

This is disturbing and I will discuss it with the endo making the switch in due course, but I have a question. Am I atypical in that my insulin reactions are asymtomatic using Lantus? If this is normal, Lantus seems to me to be a dangerous product.

[MarkMunday]

DealCorn,

Welcom to the forum.

I switched from Humlin N to Lantus about 6 months ago. I didn't notice any difference in the nature of insulin reactions. I get as much warning of hypos coming on as I did with Humulin N. In fact, I now start feeling hypo a lot sooner than I used to. But that is because fewer hypos have resulted in a return of hypoglycemic awareness.

I haven't heard complaints like yours about Lantus. Could your hypo awareness have deteriorated about the time that you switched to Lantus beceause of an increase in the number of hypoglycemic episodes? In which case, you may want to review the Lantus dosage. Lantus shouldn't make you go hypo at night.

Test your basal rate by skipping a meal and testing every hour. If your bsl goes down with each successive test, your Lantus dose is too high and needs to be reduced.

I found that it took a long time for the Lantus action to settle down. But I am now reaping the benefits of a peakless and very consisten basal insulin. You will need to be patient.

Cheers,

Mark

Cheers,

Mark

:)

[Shalyndria]

Welcome to the Forums, DealCorn :)

I've never personally used Lantus, but I have seen studies about it which suggest that it is no better or worse than NPH with regards to asymptomatic hypoglycemia. I have a document (paper unfortunately, not online) that says that if a patient is given a starting dose of 20-25% less Lantus than previously taken NPH (twice daily) the chance of nocturnal hypoglycemia is reduced. Most episodes (I read a study showing approx. 60% of participants) of nocturnal hypoglycemia are asymptomatic (BG levels <2.6mmol/47mg), very common and last >4 hours. An A1c held consistently <6.0% can also cause hypoglycemic awareness by inhibiting the autonomic responses of epinephrine and norepinephrine.

Based on the clinical knowledge that for most people, Lantus is peakless and disregarding any possible chemical interaction, I would agree with Mark and suggest that you test your overnight basal dosage. It is definitely a prudent place to start to determine whether it's the dosage or a chemical reaction of the Lantus. Many people here have found better success in splitting their Lantus dose, and based on the results that you may get from testing during the night, this may be an option that will help you.

Let us know how it all turns out for you.
Shy

[docta-docta]

Lantus doesn't have the peaks quite like Humalin-I has. Your body can recognize rapid decreases in blood glucose, which could explain your Humalin detection ability. Lantus, on the other hand, does not suddenly become "more active" -- it's roughly constant action -- but does have minor peaks (especially when you're just starting to learn the proper dosing) -- so perhaps it "sneaks up" on you, and your body isn't able to recognize the sudden drop.

Some people find it's better to take their Lantus in the morning. Others split the dose and modify the doses as appropriate.

My personal experience is that I have to split my dose. If I go just one unit too high on my nighttime dose, I'll end up waking up hypo during the night.

Also, you'll find that if your glucose numbers are in more "control", your ability to recognize lows will also improve!