Lantus, 24 hours or what?

[Bountyman]

When I left the hospital Dx'd with T1 the hospital doctor prescribed Lantus, 15 units at bedtime. Two weeks later I had my first visit with my PA and brought him my testing numbers and he upped my dosage to 20 units. A month later he upped me again to 22 units and to adjust that to 25 a week later. My next visit two weeks later showed the 25 unit dosage to be correct for my (then) diet and excersize.

I looked up as much information as I could on Lantus and came to the conclusion that Lantus was a very non high/low-peaking background insulin. Rather you took 10, 25, 40, 60, 80 units per day the release was steady (in volume) no matter how much you took. More to my point:

Luke, in another thread, says his doctor prescribes 10 units of Lantus at bedtime...and 18 units of Lantus in the morning. I'm having trouble wrapping my mind around this logic as I was under the impression each injection lasts 24 hours. Injecting 10 units at night, then injecting another 18 units in the morning wouldn't work in the same way a fast-acting insulin like Humalog and Novalog works, would it? Wouldn't the injections start overlapping? I haven't quite learned the right type of math yet to figure out the overlap algorithm!

In essence, as I look at this, to me it's like the doctor is saying that the 10 units Luke is injecting needs a power boost of 18 units in the morning...when it seems that 18 units at night should produce the same results. I'm pretty sure that Lantus doesn't act like a gas pedal.

Not that I'm trying to second-guess the doctor...I'm just trying to understand this. Anybody?

[TommyC1]

For me Lantus seems to last the full 24 hours so I take one 25u dose before bed. I consider myself fortunate.
Others seem to find that Lantus does not last the full 24 so they split their dose in two. If that was me I might take 12 or 13 u twelve hours apart or I might take 10 in the AM and 15 at night or visa versa depending on how my sugars ran.
I think if it comes to that folks ought to do some in depth basal testing to see how it works for them. Dunno as I'd let some Dr. pull a dosage out of his butt like some seem to.

[Luke]

Mine is actually 10 at night and 8 in the morning.

I have found that many doctors do this, to help your lantus "last longer" throughout the 24 hour period.

We found that when I was first taking all of my Lantus at night, my readings would get higher in the evening time, but at the same time, I was crashing around 3-4AM.

Since we have started double dosing, I am no longer crashing at 3-4AM, and I am not spiking around or after dinner time.

It is one extra shot per day that I have to take, but I can tell that it is working.

[poodlebone]

For me, Lantus seemed to last around 18 hours and it did show peaks in action. I would go low overnight and was waking up with some very low numbers. By dinner time I would be high. Switching to two injections spread the coverage out to last all day.

[Joeprep4820]

Lantus acts for 24 hours theoretically. For me, I found it to finish up after 22 hours or so, so I split my doses evenly - one in the morning, one at night. I no longer use Lantus but rather the pump, but was a Lantus user for a good number of years.

[Bountyman]

So, now I'm thinking that the maker of Lantus designed it to release in a 24 hour period to be taken like a daily vitamin with breakfast. After all...every 24 hours IS mighty convenient. If it were rounded off to say, every 25 hours, if you did your first injection at bedtime, let's say at 10 o'clock, the progressional timeframe of injections would be insane.

I have no idea how one would figure out how to split up a 24 hour insulin. I'm not sure that it works the same as splitting a vitamin in two and taking half in the morning and half at dinner.

[Luke]

So, now I'm thinking that the maker of Lantus designed it to release in a 24 hour period to be taken like a daily vitamin with breakfast. After all...every 24 hours IS mighty convenient. If it were rounded off to say, every 25 hours, if you did your first injection at bedtime, let's say at 10 o'clock, the progressional timeframe of injections would be insane.

I have no idea how one would figure out how to split up a 24 hour insulin. I'm not sure that it works the same as splitting a vitamin in two and taking half in the morning and half at dinner.

I think, that as with anything that comes to diabetes, it is trial and error for each user. What works for me may not work for you, and what works for you may not work for me.

I may have to take more insulin or even less than some others. It all depends on how things are with them.

I think it goes back to trial and error.

[Joeprep4820]

I think, that as with anything that comes to diabetes, it is trial and error for each user. What works for me may not work for you, and what works for you may not work for me.

I may have to take more insulin or even less than some others. It all depends on how things are with them.

I think it goes back to trial and error.

That's the name of the game for Type I: trial and error.

[Grunch]

So, now I'm thinking that the maker of Lantus designed it to release in a 24 hour period to be taken like a daily vitamin with breakfast. After all...every 24 hours IS mighty convenient. If it were rounded off to say, every 25 hours, if you did your first injection at bedtime, let's say at 10 o'clock, the progressional timeframe of injections would be insane.

I have no idea how one would figure out how to split up a 24 hour insulin. I'm not sure that it works the same as splitting a vitamin in two and taking half in the morning and half at dinner.

It doesn't release evenly over 24 hours for anyone. For some people it's close to that so they can take just 1 shot. For others theres a significant peak a few hours after the shot or it may last more or less than 24hs. Splitting the dose helps reduce these problems.

[shiftzor]

If we play it by the book Using insulin it states that Lantus starts within 2 to 4 hours and finishes in 18 to 26 hours. Really you will have to work out how long it lasts for you. If you always spike when you basal test just before your Lantus injection it probably means you need to split your dose.

[Bountyman]

If we play it by the book Using insulin it states that Lantus starts within 2 to 4 hours and finishes in 18 to 26 hours. Really you will have to work out how long it lasts for you. If you always spike when you basal test just before your Lantus injection it probably means you need to split your dose.

I've never done that...test before my Lantus injection. I'm on Medicare and Medicare allows 3 tests per day. I do a FBG test when I wake up; a test 2 hours after breakfast (usually around noontime); and one more test 2 hours after lunch (usually about 3pm). What my blood sugar does between 3pm and around 8 o'clock the next morning...I have no idea. What I'll have to do is save up another $75 for a box of test strips to dick around with.

I figure if I don't eat for a couple weeks I can save enough to make that happen. :D

[Granny Shanny]

Pick up a ReliOn meter & 50 strips, all for about $30. That should give you a few days to see what's going on at least. It sure beats believing everything Medicare and the Lantus people say . . . find out for yourself.

I've never done that...test before my Lantus injection. I'm on Medicare and Medicare allows 3 tests per day. I do a FBG test when I wake up; a test 2 hours after breakfast (usually around noontime); and one more test 2 hours after lunch (usually about 3pm). What my blood sugar does between 3pm and around 8 o'clock the next morning...I have no idea. What I'll have to do is save up another $75 for a box of test strips to dick around with.

I figure if I don't eat for a couple weeks I can save enough to make that happen. :D

[Bountyman]

Pick up a ReliOn meter & 50 strips, all for about $30.

I'll search around town...see who sells that. Thank you.

[DanG]

Don't be afraid to try stuff away from the prescription of the doctor. Be careful in anything that you do, since insulin is a menace if you get too much.

I take lantus in the morning. I sleep real well, with probably zero insulin in my system. I recommend that, rather than split dose or evening dose. I was waking up at 3am lower than I knew when I took lantus at night. I have no idea what my basal profile is, but the morning lantus allows me to wake well within target.

I am practicing to be on medicare, I guess. I use only 2 or 3 test strips each day also. My test times are: occasionally I test in the morning to see that all things have been operating as planned; mid afternoon to see that morning breakfast and snacks did not lag in to lunch and lunch too large to manage; before bed to see if I need a bit of insulin to drag me down to a target level in the morning. I count on the residual lantus at bedtime to drag me down 50 to 70 points, so I aim for bs at bedtime to be 120 to 150. Sometimes I need to supplement with a few units of humalog at bed, if I enjoy too much dinner.

[Grunch]

I sleep real well, with probably zero insulin in my system.

That's certainly wrong. If you had zero insulin you'd probably die or at least wake up with extremely high blood sugars. And you said you expect to drop 50 to 70 points overnight so you apparently have even more insulin than needed during sleep.

[Bountyman]

I'm not sure why doctors recommend injecting Lantus at bedtime. And when IS bedtime, anyway? I usually take my "nightime" injection at 7 o'clock because that's when I lay down on my bed to watch Wheel of Fortune. I live in a trailer and watching Wheel of Fortune all the way from my computer desk isn't really an option. So, when they say "bedtime", are they thinking when I go to bed to go to sleep? Pfftt...I can't go to sleep until at least 1 o'clock in the morning. Been that way all my life. I get a little anxious about the shot, too. I'm needlephobic. I'd rather get it over with at 7 o'clock and not have to think about it or watch the clock while I'm enjoying my dark time (metaphorically speaking).

[Grunch]

You can take it any time you want as long as it's around the same time every day.

[Bountyman]

From my medications:

Lipitor: TAKE ONE TABLET DAILY
Lisinopril: TAKE ONE TABLET DAILY
Aspirin 81MG: TAKE ONE TABLET DAILY
Vitamin: Adults- One tablet daily with food
Lantus SoloStar: Inject 25 units subcutaneously at bedtime

Maybe they put that there so they don't have to explain that you can take your injection any time of the day you want as long as it's 24 hours after your last injection. Yeah, that's probably it. That's a lot to write on a prescription sticker.

My discharge papers from the hospital call for Lantus SC 15 units @ bedtime. That got put on the box my first vial came in and transferred to the box of Lantus SoloStar pens I now get. I'll ask my PA when I see him tomorrow what all this is about.

[Grunch]

Maybe they put that there so they don't have to explain that you can take your injection any time of the day you want as long as it's 24 hours after your last injection. Yeah, that's probably it.

If they tell people to take it any time people often forget to take it. It's not a problem with vitamins but can be a big problem with insulin. The "bedtime" instruction is meant to be idiot-proof. Works pretty well.

[TommyC1]

From my medications:

Lipitor: TAKE ONE TABLET DAILY
Lisinopril: TAKE ONE TABLET DAILY
Aspirin 81MG: TAKE ONE TABLET DAILY
Vitamin: Adults- One tablet daily with food
Lantus SoloStar: Inject 25 units subcutaneously at bedtime

Maybe they put that there so they don't have to explain that you can take your injection any time of the day you want as long as it's 24 hours after your last injection. Yeah, that's probably it. That's a lot to write on a prescription sticker.

My discharge papers from the hospital call for Lantus SC 15 units @ bedtime. That got put on the box my first vial came in and transferred to the box of Lantus SoloStar pens I now get. I'll ask my PA when I see him tomorrow what all this is about.


Search around here for "Basal testing"
Better yet get a copy of "Think Like a Pancreas" by Gary Schiener. I'm told "Using Insulin" by John Walsh is good too.

In a perfect world your basal insulin will hold your blood sugar steady, neither rising nor falling, so long as you aren't eating or doing heavy exercise.
Testing will tell you how close your basal insulin (Lantus) is coming and give you clues as to what sort of adjustments you might need.
There's a pretty good article by Gary Schiener here Getting Down to Basals :: Diabetes Self-Management (http://www.diabetesselfmanagement.com/Articles/Insulin/getting_down_to_basals/)

[sarahspins]

You can take it whenever you prefer.... really. Some of us liked to split the dose for more consistent results (I don't find it quite makes it to 24 hours for me... 16-18 is when it starts to stop working).

Basal testing can be VERY beneficial to those on MDI - I know for me, to have taken enough Lantus to get my fasting #'s nice and had that been the ONLY criteria for figuring dosage, I'd be scary low the rest of the day. What works for me when I am not pumping is to take a small amount of NPH at bedtime (and yes, I really do mean bedtime, not an a fixed time) to counteract my dawn phenomenon, and take a dose of lantus that keeps my #'s steady during the daytime - and I would split that into two doses. I didn't notice a huge change in varying the amounts of them, so I just split it 50/50.

[shiftzor]

Testing 3 times a day? That is crazy and suicidal. I test on average 8.9 times a day and I think the bare minimum is 6. Remember that your trend spotting the more results you have the easier it is to spot those trends and adjust doses.

I could rehash how to basal test but I think its covered more than enough on these forums ;).

[Real4]

I looked up as much information as I could on Lantus and came to the conclusion that Lantus was a very non high/low-peaking background insulin. Rather you took 10, 25, 40, 60, 80 units per day the release was steady (in volume) no matter how much you took. More to my point:

Luke, in another thread, says his doctor prescribes 10 units of Lantus at bedtime...and 18 units of Lantus in the morning. I'm having trouble wrapping my mind around this logic as I was under the impression each injection lasts 24 hours. Injecting 10 units at night, then injecting another 18 units in the morning wouldn't work in the same way a fast-acting insulin like Humalog and Novalog works, would it? Wouldn't the injections start overlapping? I haven't quite learned the right type of math yet to figure out the overlap algorithm!

In essence, as I look at this, to me it's like the doctor is saying that the 10 units Luke is injecting needs a power boost of 18 units in the morning...when it seems that 18 units at night should produce the same results. I'm pretty sure that Lantus doesn't act like a gas pedal.

I expect that most of what you read about Lantus is advertizing verbiage. Lantus is NOT smooth and steady for exactly 24 hours then stops. No drug can work that way. Lantus does have a peak, it's just not as pronounced as with the older forms of long-acting insulins.

By taking two injections (usually equal doses are best) you smooth out the peaks and valleys somewhat and get some other minor benefits.

In general, most medicines will work better given in multiple smaller doses. That is, better in a purely medicinal sense. It's easier and more convenient to take one shot or pill per day.
There's always a compromise.

BTW, I've been taking two injections of Lantus for years and 4 to 6 shots of short-acting for years, so I'm use to it.

[plattb1]

I take Lantus at 10:00 pm. That's because I never go to bed before then, am often up later, but always watch local TV news at 10:00 pm if I'm home. It just makes it easy for me to remember. That said, I've seen a lot of people split their doses for various reasons & know of several folks who take it in the morning instead. YMMV.

[shiftzor]

.....In general, most medicines will work better given in multiple smaller doses. That is, better in a purely medicinal sense. It's easier and more convenient to take one shot or pill per day.
There's always a compromise......

Its funny you should say that, I find insulins tend to hang around longer if the dose is higher and I believe there are medical studies that prove this. I found that Lantus was still active almost 48 hours after my last dose when I started pumping. The Lantus activity was not adequate enough to maintain my bg and had to be supplemented with the pump. Lantus longevity is certainly not an open and closed case.

[DanG]

That's certainly wrong. If you had zero insulin you'd probably die or at least wake up with extremely high blood sugars. And you said you expect to drop 50 to 70 points overnight so you apparently have even more insulin than needed during sleep.

I take lantus every morning. I doubt it lasts 24 hours, based on what others say. Hence, I think I might have 2 to 4 hours without insulin in the system. I have no idea what insulin is in my system, but I like the concept of living without insulin for a few hours - so my take on what is happening perhaps is all in my head - which is fine. Life is much a mindgame anyway.

[Bountyman]

No answers from seeing my PA today, he wasn't there, off for a week, family matters. Since I was there I thought I'd see the substitute guy anyway as I needed to hit him up for a couple free bottles of Patanase (hard to breathe through my nose some nights...too many broken noses). Got there 15 minutes before my appointment. Waited an hour and half before the nurse weighed me, took my temp, BP, and whatever that thing is they stick on your finger. She ushered me into the little waiting room saying "Rob will be right with you" where I sat for another hour before going balistic.

I started out the door when the nurse caught me and apologized for the long wait and I explained to her that 2½ hours was out of line and I'd better make myself scarce before I come unglued. She was nice enough to go back and tell the substitute guy that all I really needed was a couple Patanase and I'd be on my way...which he authorized and I was out of there.

I tried calling a cab to get home and kept getting a busy signal...so I walked all the way home. I'll tell ya'...by the time I got home I was so drained I hit the rack and went out like a light. I haven't walked that far since basic training in 1961. I will say this...as a cure, go for a 12 mile walk if you're ever a little irritable. If you're still irritable when you get back...you probably need some kind of psych' med's!

[ant hill]

I have splitted my insulin dose with Levermir. The said 24 hour insulin may vary from person to person. The 24 hour insulins do claim to last over a 24 hour period but to some may just last 18 hours.

To people like yourself who have recently diagnosed may find that insulins may work over the time that they say. But over time like me at 38 Years, The insulins become infective and testing is a good guide to control. My doses are 54U in the morning and 44U at night. Yes they're high doses and the meals are around 3 1/2:1 I:C Ratio and concidering Metaformin.

This is a progressive disease Bountyman and doctors are not clients to diabetes, Endocrinologists are. ;)

[Bountyman]

I have splitted my insulin dose with Levermir. The said 24 hour insulin may vary from person to person. The 24 hour insulins do claim to last over a 24 hour period but to some may just last 18 hours.

To people like yourself who have recently diagnosed may find that insulins may work over the time that they say. But over time like me at 38 Years, The insulins become infective and testing is a good guide to control. My doses are 54U in the morning and 44U at night. Yes they're high doses and the meals are around 3 1/2:1 I:C Ratio and concidering Metaformin.

This is a progressive disease Bountyman and doctors are not clients to diabetes, Endocrinologists are. ;)

When you say "progressive" is this typical of ALL insulin diabetics, or is this, like everything else I read on diabetes, on a case-to-case basis. Being a diabetic for 38 years your information on this disease is invaluable. I'll be 67 next month so I doubt I'm looking at another 38 years of this disease. I'm hoping of dying of a coronary during sex with some 21-year-old mattress-thrasher! :D

[ant hill]

so I doubt I'm looking at another 38 years of this disease. I'm hoping of dying of a coronary during sex with some 21-year-old mattress-thrasher! :D

LOL that's the way to go. :D:D:D

[HollyB]

The other thing is that even if the Lantus released perfectly steadily over 24 hours, that's not what everyone needs. That becomes really apparent when you start figuring basals on a pump - my son, for example, needs half the basal between about 10 pm and 2 pm that he does at other times. So if you have a tendency to run low at night, and high in the daytime (or vice-versa), two doses of Lantus might allow you to fine-tune to your basal needs a little better.

[SuzySushi]

For my 13 y.o. daughter, Lantus lasts something like 20 to 22 hours, not 24. Her dose is split with about 70% given at dinnertime and the remaining 30% given at breakfast. That way the doses are given approximately 12 hours apart. The theory is that the breakfast Lantus boosts her basal insulin coverage during the afternoon so that it won't wear off before or during dinner. She also takes NovoLog at each meal.