Question on Lantus?

[Shanemak]

Hello, I forgot I registered for this forum, and found it again during a Google search. Anyway I'm on a realy low dose of lantus, and for the life of me, I can't figure out how to balance my dosing out. During the daytime, when I'm most active, I really only need Novolog to cover for meals, but at bedtime, I need insulin working. My BG often goes on the high side at night, mostly due to the fact that I work until 8:30 at night and eat dinner late. But at midnight I take 1 unit of lantus, and my BG goes high around 5 am, then when I wake up it's also pretty high, but it goes terribly low during the daytime, especially around 7 p.m. So I really cannot take anymore lantus, an I can't get away with no coverage during sleep. Any advice?

[jtausch]

only 1unit, well lantus is supposedly a long acting insuluin. I take levemir and take 14 units at night and cover my meals if need be with novolog. I would get with your DR and and ask him to see if you need more lantus I think you do but I am not a dr just my opinion

[Shanemak]

only 1unit, well lantus is supposedly a long acting insuluin. I take levemir and take 14 units at night and cover my meals if need be with novolog. I would get with your DR and and ask him to see if you need more lantus I think you do but I am not a dr just my opinion

Well if I take more lantus, it will go drastically low during the day. Right now I have to eat every few hours just to keep it normal. What I need is insulin working at night. Maybe NPH would be helpful?

I spoke to my doc and she said to change the time I take lantus from 12 to 9. It only changed the time of night I wake up with high blood sugar. (By high I'm talking like 150-170)

[Subby]

Hey Shanemak. Can you fill us in a bit, what do you tend to do for food and novalog amounts during the day? You certainly have extremely low basal requirements... are you considered a classic type 1? The dose suggests you might have your pancreas still kicking in some insulin - which is a good thing!

As for the Lantus, well, if you are finding the tail end gets you, maybe Levemir is something to consider. It officially has a shorter action than Lantus, and often people speak how Levemir doesn't last the whole 24 hours and by evening they are going high. Perhaps Lev and you are a match made in heaven ;)

[Shanemak]

Hey Shanemak. Can you fill us in a bit, what do you tend to do for food and novalog amounts during the day? You certainly have extremely low basal requirements... are you considered a classic type 1? The dose suggests you might have your pancreas still kicking in some insulin - which is a good thing!

Well I take 1 unit of Novolog per 16 grams of carbs. When I am at work and active, it's 1 per 17. My pancreas is still producing insulin normally, it's just it's blocked by a layer of mucus as the reason I have diabetes is I also have Cystic Fibrosis.

As for the Lantus, well, if you are finding the tail end gets you, maybe Levemir is something to consider. It officially has a shorter action than Lantus, and often people speak how Levemir doesn't last the whole 24 hours and by evening they are going high. Perhaps Lev and you are a match made in heaven ;)


Possibly, I'll look into that. But for a trial, I plan to take my lantus at 11 a.m., opposed to midnight. Since it usually goes low at 7, and if I taked it earlier, that's 17 hours after I take it, so if I take it at 11, it'll work best at 3 or 4 in the morning when I'm sleeping, and that's when I really need it. Thanks for your suggestion Subby!

[SammyIamToday]

I had the problem going low like that, but after redoing my bolus ratios with my endo (went from 1:15g to 1:20-25g), I stopped going low every day.

Although it does sound like your situation is different, but that might be helpful.

[sable_032592]

i take 46 units of lantus when i get up and another 46 units 12 to 14 hours later... everyone is different so don't go according to other peoples' doses...

but lantus isn't for everyone, so talk to your doctor...

[JJM335]

Well if I take more lantus, it will go drastically low during the day. Right now I have to eat every few hours just to keep it normal. What I need is insulin working at night. Maybe NPH would be helpful?


Hi Shane:

You might find that Levermir would suit you better than Lantus. Levemir (like Lantus) is an analog long acting insulin but with a shorter duration of action. For T1's who use Levemir the recommended regime is 2 shots per day, but in your case, one shot at night might do the trick as most of the activity will be used up by late afternoon.

Because Levemir is an analog insulin, it is more predictable than NPH. Most of us who used N were glad to see the back of it.

Joel

[Shanemak]

Hi Shane:

You might find that Levermir would suit you better than Lantus. Levemir (like Lantus) is an analog long acting insulin but with a shorter duration of action. For T1's who use Levemir the recommended regime is 2 shots per day, but in your case, one shot at night might do the trick as most of the activity will be used up by late afternoon.

Because Levemir is an analog insulin, it is more predictable than NPH. Most of us who used N were glad to see the back of it.

Joel

Do they make Levemir in a pen device? On Aug 11th, I have a dr.'s appointment, and I will talk to an endocrinologist.I'll be sure to bring that up. These past few days, I haven't been taking any Lantus because I'm sick and tired of putting up with lows during the day. I can deal with a few hypers, but lows are really a drag.

Actually the weird thing is my blood sugar was lower (146) in the morning when I didn't take lantus, opposed to the upper 150s when I did. Boggles my mind.

[Shanemak]

i take 46 units of lantus when i get up and another 46 units 12 to 14 hours later... everyone is different so don't go according to other peoples' doses...

but lantus isn't for everyone, so talk to your doctor...

Yea this guy at my work takes 100 units of Lantus a night. He also takes diabetes pills and novolog, but then he doesn't take care of his diabetes, I seen him in the breakroom drinking a regular soda and eating cotton candy!

[Grunch]

You could also just eat some carbs around 6 pm every day and probably take something like nph at midnight to lower those 5 am bgs.

NPH has a peak around 6 hours after injection and the effect will end before your normal lows so I think it would be perfect for you.

[sable_032592]

Yea this guy at my work takes 100 units of Lantus a night. He also takes diabetes pills and novolog, but then he doesn't take care of his diabetes, I seen him in the breakroom drinking a regular soda and eating cotton candy!

yikes! i only take 46u at night... i am on metformin as well, but my endo says i'm insulin resistant... the only time i drink regualr soda is when i have a low... how can you not want to take care of your body though... it's the only one you got and most people are fighting to stay alive and this guy is throwing his life away? i realize we could all be dead tomorrow but then again, we could all live for another 50 - 60 years (depending on our age)... shame... this guy at your work is going to be in a lot pain...

i think my high lantus (46 and 46) dose is for me to have a steady dose of insulin in my system because i barely eat because i'm never hunger and usually deal with nausea in some form, alternating with throwing up and/or diarrhea, so i don't give myself too much humalog (anywhere from 4 to 15 units per shot)...

[Subby]

OK, so this guy might be feeding his insulin and body dreadfully... but at the same time, a high insulin use may not be down to that. I think that relationship between a high dose and "he's not doing the right thing" needs to be discarded.

It's quite possible he is a type 2 who typically can need much higher doses of insulin as a matter of course in combating insulin resistance. We just don't know. Eating these things is most likely exacerbating his situation, which is at the end of the day a sad thing. I hope something changes for him.

I am a type 1 with insulin resistance (without significant weight problems) and I use up to 100 units a day insulin, I "should" be using about 40 units. I only eat about 100 to 130g of carbs a day, typically. Even before food I use between 60 to 70 units for basal and basal corrections. I am very careful with spiking and control, I stay active, I do all I can. But my insulin use remains high, that is a relatively hidden issue with my body. Go figure.

[dbaratta]

I am a type 1 with insulin resistance (without significant weight problems) and I use up to 100 units a day insulin, I "should" be using about 40 units. I only eat about 100 to 130g of carbs a day, typically. Even before food I use between 60 to 70 units for basal and basal corrections. I am very careful with spiking and control, I stay active, I do all I can. But my insulin use remains high, that is a relatively hidden issue with my body. Go figure.

I had no idea that type 1 could be insulin resistant. UGH so many varibles. Very interesting.

[Shanemak]

Well I have been doing pretty good, that is until a few days ago. My blood sugars have really been goig high the last few days, and the only thing I can attribute it to would be because I started taking lactaid enzymes with my meals to see if it improves my dairy digestion. I haven't been taking any lantus at all, just 3 shots of novolog to cover for meals, but tonight I took 1 unit of lantus. Does anybody think that my hypers are account of the lactaid pills?

[Subby]

An answer would only ever be an educated (or not) guess, given a more standard case of diabetes - here it's really hard to have an idea, given your rather different cause of diabetes... How does the mucus issue work? Does it come and go? I have no idea. What are your real insulin needs? I have no idea.

But there is something definite I can say. Listen to yourself, invest in what you think, and try acting upon your suspicions to see if you can get a verification. For example, stop the lactoid enzymes and see if your readings return back to more normal levels. This is the only way I know to successfully navigate BG problems. Problem solve and experiment. Being educated or having a theory is fine and may help with tactics to try. But practical outcome is the reality.

Also, with this dairy issue, I don't know how much you are eating, but have you considered just cutting back a bit? I have mild/moderate lactose intolerance, and I find that just keeping portions small, and it really helps to pick either lactose free or skinny (yes, there are often warnings aired about skim or skinny being "packed" with sugar etc, I don't see it on the products I get and I don't get a BG problem either). I don't offer these as solutions to your problem, but I am saying there may be other avenues to go, if the lactiod enzymes are spiking you problematically.

[Shanemak]

An answer would only ever be an educated (or not) guess, given a more standard case of diabetes - here it's really hard to have an idea, given your rather different cause of diabetes... How does the mucus issue work? Does it come and go? I have no idea. What are your real insulin needs? I have no idea.

My diabetes doesn't come and go, I'm stuck with it. But I was only diagnosed with it in 8th grade or so. I had CF all my life, and after awhile, the insulin released by my pancreas was unable to penetrate the wall of mucus that was erected. If I would be able to stop my mucus production, I would most likely be cured of diabetes, but unforutnately, people with CF have a gene that constantly produces mucus. Sometimes it's very little, which is my case at present, and when I catch a cold, it's alot, and my blood sugar numbers escalate. When I am basically healthy, I only need 1 unit of Novolg per 16 grams of carbs per meal. When I have a cold, I require up to 7 units of Lantus to boot.

But there is something definite I can say. Listen to yourself, invest in what you think, and try acting upon your suspicions to see if you can get a verification. For example, stop the lactoid enzymes and see if your readings return back to more normal levels. This is the only way I know to successfully navigate BG problems. Problem solve and experiment. Being educated or having a theory is fine and may help with tactics to try. But practical outcome is the reality

Also, with this dairy issue, I don't know how much you are eating, but have you considered just cutting back a bit? I have mild/moderate lactose intolerance, and I find that just keeping portions small, and it really helps to pick either lactose free or skinny (yes, there are often warnings aired about skim or skinny being "packed" with sugar etc, I don't see it on the products I get and I don't get a BG problem either). I don't offer these as solutions to your problem, but I am saying there may be other avenues to go, if the lactiod enzymes are spiking you problematically.

I'm kinda stuck between a rock and a hard place here. With me having CF, I am unable to absorb the nutrients from all of the food I consume, so I must eat more just to maintain my weight. But with diabtes, you're kinda limited on what you may eat. So eating alot is a necessary evil I must endure, if I must take up to 20 units of novolog to cover, be it as it may. Cutting back isn't an option here. But thanks for your advice Subby, and I suppose I will find my answer like everything else in my life; through trial and error; there's no easy answer.