Lantus Users

[vrocco1]

Hi folks, I'm pretty new to this forum, and have not posted much, but have been lurking for a while now. Seems to me that there is a good number of type ones on this forum. Hopefully someone can help me.

I just started using lantus and humalog in January. In just a couple of weeks I had great control (A1C was 6.5 3 months ago). However, recently I started experiencing a few odd hypos right before lunch and dinner (5 hours after the previous bolus). I was using 32 units of Lantus in the morning, and Humalog (based on BGL and carbs) before each meal and my evening snack.

Well, the better half was not happy about the hypos, so I discussed it with my internist during my visit this week. He suggested cutting the basal from 32 units to 25 units, which seemed like a huge difference to me. Then I thought about it, and realized that was only 1/3 of a unit per hour, which did not seem like much. However, my BGLs have been through the roof (fasting at 250 this morning) since then, and I have not gotten much sleep. I have not made much of an adjustment to my carb/humalog ratio, because I was already being fairly aggressive there (1 unit per 12-13 grms).

I guess what I am looking for is some input from other MDI users. Should I slowly increase the lantus, or should I adjust the bolus doses? :confused: I have to get some sleep! :top:

BTW... I'm a 44 yo man, been type one for about 23 years.

[DeusXM]

Given the original lateness of your hypos, I'd say you were right to adjust your Lantus dose rather than your bolus. However I think you've been advised to drop it by too much. If you're running that high on your new dose then I'd suggest bringing your Lantus back up to 29 or 30u, and then if that still causes hypos then drop it down a bit, to maybe 28u or 27u.

You're right that cumulatively, your dose drop isn't a massive change, but basal insulin adjustments seem to have far more dramatic effects than similar adjustments with bolus doses. Trust your own judgement - from what you've discussed in your post it sounds like you know what you're doing anyway.

[MarkMunday]

vrocco1,

DeusXM has given some good advice. I have a couple of additional comments, based on the numerous adjustments I have made to the timing and amount of Lantus shots.

Of all the basal insulins I have used, I find Lantus to be the most effective. But finding the right dose is really tricky. Changing the dose by more than a couple of units at a time causes confusing results. And after making the change, you have to let it settle down for a few days before judging whether it is working or not.

So I would suggest that you don't change the Lantus dose by more than 2 units at a time. And don't do it more than once a week. That way, your test-and-measure experimentation will lead you to the right Lantus dose. You also may find that, because you have reduced your basal level, you need a bit more Humalog before meals. So test your 1 hour and 2 hour post meal blood sugars.

You can test you Lantus dose by skipping a meal and the corresponding bolus shot. Your blood sugar needs to be in the target range to start with. And if your basal level is right, your blood sugar shouldn't move out of the target range after skipping the meal. Lunch and supper are thge best meals to skip. Skipping breakfast can produce confusing results because of the Dawn Phenomenon.

It is almost immpossible to find a level that puts your system into equilbrium. But you will be able to see if you have it in the right ballpark. I have pitched my basal level so that my blood sugar declines slowly in the absence of a meal/bolus. It means that I can eat the occasional between-meal snack without bolusing for it.

Once you have got your Lantus dose right, you are well placed to figure out your mealtime bolusing requirements. You may require more than 1 unit per 12-13 grams of carb.

I have found that my bolusing needs have increased steadily over the years. And it is not because of insulin resistance. I am convinced that it is the result of post-prandial release of hepatic glycogen. My beta cells stopped producing insulin many years ago. But elements of the counter-regulatory system have been deteriorating more slowly. My bolusing insulin to carb ratio is 1:3-5. If I understand the dynamics of all this correctly, Symlin should help as it inhibits the release of glycogen by the liver at mealtimes. And I am looking forward to it becoming available in this part of the world.

Cheers,

Mark

[vrocco1]

Thanks guys, I noticed that after I reduced the Lantus by 7 units, I did not really see a change for two days. I agree that you need to move slowly. I think I am going to move upwards slowly. I increased it by two units this morning, and I think I'll try that for a week to see how it works out. I live on a small farm, so the weekends are hard labor. Not a good time to judge the results I guess, because I had a few hypos today. The thing that worries me is the overnight high BSLs. I'm up all night running to the bathroom, and just don't get the sleep I need. I do bolus with a snack before bed, but I hesitate to increase that so I don't end up hypo over night.

I appreciate the input, I really did not know which way to go! Thanks again.

[MarkMunday]

Varying amounts of exercise play havoc with control. Fine tuning the insulin regimen is really difficult because the goalposts keep on moving. Sounds like a pump may suit you better. You would be able to program different basal rates for weekdays and weekends, taking into account the different levels of activity.

Keep up the good work and good luck with it.

Mark

[vrocco1]

Yeah I was thinking the same thing (about the pump). I woke up at 159 today instead of 250 like yesterday. That is exactly what it was when I went to bed, but I took 4 units of Humalog. I would have thought I'd end up hypo? Of course I ate like a lumberjack last night to make up for the day's activities. Very frustrating, but I'm going to give it a few days before I increase the lantus again. Once I get back to work, things will change.

I see you do 1 unit per 5 carbs?

[Simons]

I have been on lantus for several years now and have really l8ked it. Use Lantus and Novolog prior to meals. The past couple of weeks my bs' have been terrible I just can't seem to control them. Every couple of days I increase my lantus by two units. Have gone from 13 to 22 and don't know what else to do.
I have a history of terrible sugars occasionally for a week or few days at a time but than i revert back to where i originally was but this time is more difficult.
Any suggestions?
Simons

[MarkMunday]

Simons,

That is a massive increase. Could the vial have gone bad? I monitor results carefully when a cartridge is over a month old. Because once potency starts to deteriorate, it loses strength very quickly. I use only 8 units at a time. So a 3ml cartridge lasts 37 days. I see you are also on a small daily dose. If you keep it in the fridge, you can get more than the 28 day advertised useful life out of it. But sometimes it lasts longer than others and you have to be careful. Lantus is the only insulin I have had this problem with.

Mark

[Mick]

Let us not forget our trusty old "TDD Calculator" formula. This old physician's formula has been used for years to judge a T1 diabetic's Total Daily Dose of insulin, and is based on body weight. Of course, other things will effect YOUR dose, such as food intake, activity, sensitivity to insulin, and body fat percentage--BUT--it will generally get you at least in the ballpark. Here it is:

Take yourt weight in Kilograms--to get that, take pounds and multiply times .45. I'll use my weight for an example--I weight 140 lbs, so that would be 63 kg. Take that nunber and multiply times .6 For me, the result would be 38. That should be my TOTAL (basal and bolus) dose per day. Approximately half that should be basal and half bolus, so my Lantus dose should be about 19 units. In fact, it is 17 units, but I am an extremely thin and muscular person, so that would decrease my insulin need. My bolus doses should also total about 19 units per day--but they generally do not, again, for the reasons already given above. I use between 10 and, if I've totally pigged out for the day, maybe 15 units. But I don't eat very much, and I exercise a lot. So, at a muscular and lean 140 pounds, I take 17U Lantus and 10 or 12U Novolog, for a TDD of 27-29U, well below my expected 38U TDD, but for understandable and explainable reasons. I know where I SHOULD be, I have a place to begin my calculations, and I know why I fall below my expected dose. Of course, as we all understand, this is NOT a science--it's an art, with a bit of voodoo thrown in, and a lot of luck needed for decent results, and still consistancy is never dependable!

Michael
T1 since 1965

[vrocco1]

Michael,

I must be a totally average person in every way. I did your calculation and came up with 59.5 units. Right now I take 27 units of lantus, and about 10 units of humalog with each meal. Throw in another 3 for my evening snack, and I am at 60 units plus or minus a couple! Pretty cool!

[birds_eye]

Hey Mick, that TDD calculation is pretty cool in theory. But I'm like you, my TDD is 46u, but I'm currently on 20u Lantus and 4+4+6= 14u Humalog. So that leaves me 12u shy of my TDD. Also I'm very active though, and but I do eat alot, I think the exercise keeps my requirements low, and decreases insulin resistance.

Symlin should help as it inhibits the release of glycogen by the liver at mealtimes. And I am looking forward to it becoming available in this part of the world. quote MarkMunday

I just recieved my August Diabetes Forecast mag, and read about that Symlin drug, but would like to know Mark if you would consider taking another injection at mealtimes?

[MarkMunday]

I have often wondered about that TDD formula. I weigh 71 Kg. So, according to the formula, my TDD should be about 43 units. My actual TDD is 36 units. My basal and bolus insulin requirements should be about 23 units each. But my actual basal daily dosage is 12 units (8 Lantus and 4 NPH). And I use about 23 units of Novarapid daily (9 before breakfast, 8 before lunch and 7 before supper).

My body weight is in the middle of the normal range (BMI of 23). And I am not particularly active. But my actual TDD is 16% lower than it should be, based on my weight. And my actual basal is only 33% of my actual TDD. It was even lower (as a percentage) before I went on a low-carb diet. Go figure.

birds_eye, I don't relish the thought of another injection before meals. But if it gives me better control over post-prandial blood sugars, I will do what it takes. Breakfast is when I have the most difficulty. So I would definately inject Symlin beforehand. I am not so sure about lunch and supper.

Cheers,

Mark

[jdstein11]

Wow. According to the TDD formula, I weigh 195 lbs = 88 kg = 53 units / day. I've been on insulin for just over a month, and have hit that once. As a matter of fact, I average 78 units / day, but I eat a pretty high-carb diet, for now. By changing my breakfast cereal (Quaker Oatmeal Squares: 44 carb / serv. to Grape Nut Flakes: 24 carb / serv) I've noticed that I can reduce my morning shot from 34 to 18, which is the ONLY way I can get close to that formula.

I suppose eating less, exercising a bit more and lowering my carbs would help too, right? ;)

As for the Lantus, I've been instructed to only take it at night and have averaged 11 units. Do others take a lot more? I use Novolog before all meals, averaging about 20 per meal and 4 per snack.

[bashboza]

High, I have a really short experience with Lantus so I am far from being exper there but I have few comments.
1. On the Lantus on the paper comming with the box of cartridges I read that one should not store an already open cartridge in the fridge. Don't know how it affects insulin potency, but that's what I've read. They may have written it in order to protect users from the idea that by keeping it in a fridge it may be used more than a month after it was open.

2. The action profile of Lantus in my experience is quite different from what they promote over the net. That's kind of specific to me maybe, because all the insulins I've used and I am using work with me non standartly the rapid ones act slowly than they are designed and the basal ones work faster and for shorter time. My particular experience with Lantus today was in that direction also. Yesterday at 10p.m. I did 18 i.u. Lantus(my usual dose) and today at 10 a.m. I did 24 i.u. Lantus (something I do for the first time, experimenting with particular goal but that's a different subject). So today 2-3 hours after the 24 i.u. Lantus I got a continuos hypo that I fed with carbs for few hours. What I mean is that the today Lantus acted faster and shorter and thus stronger than the way they showed it on the action profile graphs. So your hypos might be something similar.

P.S.: Please excuse me for my poor english.

[vrocco1]

bashboza... I found that a hypo triggered by Lantus can last a long time...

I had an interesting experiement yesterday. I had to fast for 24 hours in order to prepare for a medical procedure. I took my moring Lantus at the usual time (6am). Then fasted until about 10am the next day. I was amazed at the results. My BGL stayed between 93 and 129 the entire 24 hours (It went way up after 7am the following day when the Lantus gave up). In any case, I had two very minor hypos during the day. One at 1PM and one at 8PM which I treated with a few ounces of gatorade.

Does this sound normal, or should I not even had those two hypos? To me it seemed that my dose must be pretty close to "right on".

That is my first fast in over 20 years of using insulin. I don't think I could have done that if I were still using Humulin N and R!

[ang]

maybe you're basal needs are different at different times of the day. with my pump i have four different rates throughout the day ranging from 1.25 to 1.8 units per hour. so with lantus you dose might meet your highest requirements, but is too much at certain times of the day which is when you're going low. forgive me, i've never used lantus, but how does one deal with this? do you adjust with rapid insulin? also, you can't forget the fact that the literature might say that insulin is active for x number of hours in the body, but it might be different for you personally. its unlikely, but i won't say impossible that they hypos are due to humalog at meal times (do you take humalog at breakfast?) have you started a new exericise regime and you're experiencing catch-up activity? but then again, you can't ignore the fact that sometimes this disease does whatever the "bleep" it wants! that's what i find most frustrating. just when you think you've got it under control it decides to throw you for a loop! good luck and hopefully you'll get it figured out.

[vrocco1]

ang,
You made a good point. The only way I can deal with it is by eating or adjusting bolus doses. I'm sure the Lantus curve is not a smooth as advertised, nor does it last exactly 24 hours. In any case, I was very impressed with the performance having never experimented like that before.

To complicate things even further, I have to deal with different basal rates on different days of the week also! So much fun....

[sirius]

I am 28 years old and diabetic officially from 25 December, 1998. I started to take new therapy from November 2004 (Humalog & Landus). Last HA1C was 7.7 (I haven’t made new testing from June). Before Landus I used (Actrapid and Insulatard) and the HA1C’s were 8.5 the best and 9.9 the worst. As you see Landus is better for me, but what happens it gives me a lot of hypos and very important: in the period from November 2004 to June 2005 gave me a present 6 kilos more (13.22 lbs). I used to be 127.86 lbs-58 kg and in June I was 141 lbs-64 kg and 170 cm high??!....which had never happened to me, except when I was diagnosed and I lost 17.63 lbs – 8 kilos. I was thinking….what is happening? I did not change my diet. I couldn’t do extra exercise because of the often hypos I had. Anyway, my work was and is my exercise….running from one place to another. I always wanted and enjoyed to do something, anything that makes me being involved and feeling useful, just not to sit on one place. I always felt I had too much energy, I have it and now, but it’s not harmonized. Sometimes I feel so much energy, I can work all day and I am feeling great (normal sugar blood). Sometimes, for example: if it is a calm day and I do not have too much work, I may have hypos. How can you explain this strange disease? Well to get back to the topic, what could I do to lose weight and take control of the low blood sugar? First, because I couldn’t do any gym, I went to a beauty saloon for two weeks (it was my first time, wasn’t necessary before) and lost 4.4 lbs. I changed the diet, started to eat less, to make measurements more often and now, I have 132 lbs. In all my diabetic history I had hypos, but this was something else, specially the last two months. Before the Landus usage, my highest sugar level was 380 mg/dL, now it increases up to 200 mg/dL the most. I started with 28 unit Landus in November (I take it at 23.30h. in the night) and now I take 18 Landus. Also I don’t know what is happening to me, hope it lasts longer – I also take less Humalog . I started with 8+10+10 and know I take 2+6+4. Sometimes I change the insulin units, depends on the blood sugar level. Specifically, when I had hypos after a meal only, I changed the Humalog units (usually two units down). If I had more than 2 hypos, I changed the Landus therapy (usually two units down).

[jdstein11]

If you're reading in the 200's, why are you reducing your doses of both Humalog and Lantus?

[vrocco1]

I can't argue about the weight gain, I think I put on 10-15 lbs in the last eight months. I never had that problem before. Like you, I am very active so I don't actually do exercise, it just happens. I agree with the previous poster about reducing your insulins. Do you count carbs to arrive at your dose of Humalog?

The so called sliding scale based on BGL level alone is a loosing battle, unless you eat the very same thing every day. By basing it on your BGL alone, you're treating what happened several hours ago. Not what is happening now.

[sirius]

When you have hypos, you either reduce the insulin or you eat more. If you have more weight, you should reduce insulin, I think.
Jdstain 11, I have 200 mg/dL BG (I HOPE I WROTE CORRECTLY THE ACRONYM FOR BLOOD SUGAR), sometimes after hypo or after stress. Actually I had yesterday 196 mg/dL before I go to sleep and in the morning I woke up with normal blood sugar 110 mg/dL. For example, the day before yesterday I had 130 mg/ dL (in the night) and in the morning 82 mg/dL. I may have these results due to the PMS. Usually 10 days before PMS I feel my metabolism is changing. The blood sugar goes little up, I feel like I have 5 kilos more…I think this is the case and now. And again I have to change the insulin units.
So, every time is different, despite the fact that I have the same program every night: I sleep around same time 1.30 or 2.00 h., I take Landus same time 2330 h. and I drink one glass of milk 30 min after the insulin injection.
Vrocco 1, I am trying to count carbs. Here is what my meals contain, my new diet: (2 Humalog) – Breakfast (0930 h) 100 ml. milk, low fat 1 % + 4 spoons of cereals or 2 (rusk) and I glass of milk; (6 Humalog) – Lunch (1430-1500 h.): I piece of meat-120 g, 200 g. green salad (something green-vegetables without carbs), vegetables with carbs, legume 60 g (rice, beans, potatos….), little olive oil, 30g bread; (4-6 Humalog) – Dinner (2030 h.): I piece of meat-80 g, 200 g. green salad (something green-vegetables without carbs), vegetables with carbs, legume 30 g (rice, beans, potatos….), little olive oil, 30g bread. I eat fruits if necessary during the lunch and dinner time. I don’t use snacks in between my meals. I am trying to drink more water. Actually and before this illness I never had big need to drink water, and now I don’t have it, but for the blood sugar I have to drink more. I have 2 coffees per day, one in the morning one in the afternoon. That’s it. I am not measuring grams or carbs, but I am trying to use the same carb units every meal as much as I can. The problem is when I am outside, working and running.
So, I eat every day at the same time, take insulin at the same time, try to use same carb units for every meal and still have hypos. Maybe I should pay more attention to the energy consumption. But again I may sit all day or have a calm day and still have hypos. I also write my results in a note book, but maybe I should open agenda and do a study, write not only the BG results, but also what I eat, what I do during the day. You know this needs time and money for the measurements (I do the measurements at home). I need to get better, because I would like to become mummy.
I would like to know what do you do when you have hypos ??? At first I was drinking 200 g. coca cola at once (that’s what I was told to do when I lived in Macedonia) and the BG was going from 55-250 mg/dL. Now, if I have hypo, I lay down or stop doing anything for 30 min, take one coca cola, take one straw and pull small amounts of coca cola until I feel that I am getting better. That way the sugar doesn’t go up to quickly. I am measuring the BG again to see if it is normal and stop to drink. After that I take one rusk. Or I take one or two small spoons of sugar and drink water. Sometimes the blood sugar stays normal until the next meal, sometimes it increases until 200 mg/dL. I need to get better, because I would like to become mummy.

[vrocco1]

Sirius, When you have a hypo, you should consume 15 grams of carbs (4oz of coke) and wait 15 minutes. Then test again. If you consume unmeasured amounts, you will definitely end up going high as you have been. It seems to me that your basal insulin is way too high. If you go to bed with a BSL of 190 and wake up at 100, you are at a huge risk for a hypo. Of course it may be that you are going to bed right after dinner, which could be another cause for that huge drop in BSL. You need to work with a doctor in order to get that basal dose correct before you do anything else.

[sirius]

Vrocco1, actually I take Landus 2330, take my milk at midnight and go to bed at 0130 until 0200 in the morning. The last two days I have highs during the day (10 days before PMS). I've paid attention to this :my blood sugar is higher in thee days before PMS. I thought that too, to decrease the landus units. In a period of one month I did that because I had a lot of hypos and decreased the Landus units from 22 to 18 (I started with 28, November 2004). Also the last two weeks it was necessary to decrease and the Humalog.
What do you think, is it better to stay on the same units of Landus (18) and increase the boluse insulin (Humalog), which I take during the day. Since I decreased the Landus to 18 units (before three days) I don't have hypos in the morning, but now I have highs during the day (two days now).
Of course I'll ask the doctor first. Anyway I would like to know what you think.Thanks

[vrocco1]

As I said in an earlier post, the way to know if your basal dose is correct is to fast for a period of time. If you have some big time lows, you're over doing it. You'll never get the bolus doses correct until the basal rate is right. Then you need to adjust your bolus dose based on what you're about to eat. To adjust the bolus dose, you need to know two numbers (work with your doctor) The first is, if I take one unit of (Humalog) insulin, how far will it lower my BGL? The second number you need to know is how many grams of carbs will one unit of humalog take care of? Again, only an experienced doctor or educator can help you with those numbers. To me, it sounds like you need some more help to get these answers.

[sirius]

Your answers are so much helpful, Vrocco1! I think in USA the endo’s and the diabetics are much more advanced in taking care of diabetes. I don’t remember mentioning, but anyway I’ll say it again in Macedonia (the country I am coming from) the diabetes care was so much worse then in Greece (where I live now). I suppose I should be lucky to take better quality insulin here in Greece(Landus & Humalog)!!! I was thinking and still thinking that diabetics are left on their selves to manage their health condition. “The diabetes patient is the best doctor himself” - I was hearing this all the time from my endo’s. Yes, I agree, but shouldn’t I have first somebody who is professional and who will help me by giving me the right directions first.
My conversations with my endo now are like this: talks only if I had lows or highs and then he says “well try to do this or that” or I say do you think I should increase or decrease the bolus or the basal….Answer: “well, try and see what happens and call me tomorrow”. So, when I get that kind of answers I say why should I call him?! I’ll try myself and see what happens! This is one of the reasons, why I am feeling unsecured and I have fears for my future pregnancy.
I should find some endo and at the same time specialist for pregnancy to whom I can count on. I found one and I was so disappointed. Here’s the story….
My endo recommended her to me. She is working in a state hospital and on the first meeting I waited her for 3 hours to take some directions and start with the new therapy (Prophane & Humalog) vice (Landus & Humalog). She was very arrogant and her answer for the delay was that I had to mention (which I did when I asked for her) that my endo, send me to her?!!! I said to myself ….” Maybe I am exaggerating and imagining things. She didn’t give me any telephone, but gave me a new diet and some table with BG’s results and insulin units that I should stick on according with my BG’s results. For example if it is < 60 mg/dL, 0 units insulin; 60-80 BG , 2 units insulin; 80-120, 4 insulin, 121-160, 6 u insulin, 161-200, 8 u insulin …….(My opinion is that the BG’s and the insulin work different for everyone. I am telling this because when I have 80 BG and I take 4 units insulin I will have hypo. So, this may not work and for me. This is because I don’t know my “numbers” (which vrocco1 mentioned).
We appointed the next meeting on 21 June. I couldn’t go because I had to be on work that day and out of country for hole month (Confederations Cup Germany). So because I didn’t know her telephone I called my endo first to contact her and tell her that I want to move the date for the meeting and to give me her telephone too. He gave me a telephone from the hospital on which I had to speak with two people to find her. Just to mention that I have a mobile from my endo and he is working in a state hospital too. He told me it will be better to communicate with this woman only when she is at work. So what happens when I am pregnant, have a big BG problem and she is out of work. Who will help me? At the end when I called her she was so ruthless and the first thing she told me was….” Why did I call my endo to contact her on her telephone”. I said: “because simply I don’t have your phone. I asked her when we can rearrange a meeting. She said I can’t see you in July, call me from August.” So, that’s why I haven’t start with my new therapy yet. I am thinking to change her. Maybe a private specialist can help me? They are usually more careful, but it costs. I am concerned.
Vrocco1, you are the first one to tell me about the “two numbers”. Not a soul has told me that before, specially a doctor. That’s why I decide it to join this forum, hoping that I’ll find at least a good support here and to learn more.
Who can help me about the “numbers”? or where should I search for that help? Can I help my self about it? How?

[vrocco1]

Sirius,

Here is an excellent reference for you:

http://www.huntsvillestarmarket.com/pdf/diabetes28days.pdf#search='28%20days%20to%20contro l%20for%20diabetes'

Copy and paste the link into your address entry. It is in PDF form, so you'll need the acrobat reader. It's called 28 Days to Diabetes Control. I think it might help you. It is a very non-technical and practical guide to self management. We can be our own best doctor as you said, but there are some things you need to know. The link I gave you is a place to start, not a cure-all.

I see your endo put you on a sliding scale based on BGL. That is only a place to start. I'm sure he wants to judge your insulin sensitivity before making a move to intensive control (I hope). In my opinion, the sliding scale will never get you under control enough to have a baby. The sliding scale (based on BGL) should be just a temporary measure.

[sirius]

Yesterday, I was feeling bad during one short film shooting, I couldn't leave the place for 15 min. I lost 15 min not knowing what is happening to me, and from the other side I said it might be the sun which didn't help the situation (TOO HOT!). The bag where I have my "first bs aid" (sugar, juice and my glucometer I had left it in the office).It was time for a lunch and I went to eat without measuring the bs. I took the same 6 units Humalog. Finally, I was back to office before dinner, measured the bs and saw on the glucometer 212. I measured it at 2030 h. My heart started to cry! I thought:" it was a hypo that I had before lunch, not the sun's fault". The fact of not being able to help myself activated the liver alarm. I had to drive around 50 km, so I put 2 more units (I usually take 4 Humalog) and had my standard dinner. Two hours after it was 110?! I took one fruit from fear of getting lows in the night. Took my milk and before that my Landus. I did not had hypo in the night, but I had it in the morning. My bs was 50 when I woke up. I didn’t want to get out from my bed. I am feeling so tired.
CONCLUSION: If I have normal bs before I go to bad with 18 Landus, I have hypo in the morning. If I have higher bs from 130-196 I will have normal bs in the morning.
I’ll decrease the Landus to 16, and work out on the bolus insulin after. (bolus dose based on what I eat). But, I don’t know the “numbers” which vrocco1 mentioned.
What do you do when you have hypos at work? What do you do when you have hypos before meals?

[Kenai]

Hi All, I have been on MDI with Lantus/Novolog since January and have had great difficulty managing the Lantus until I found some data on the web. The following is a link to a good article about Lantus activity variation from day to day. It's not as consistent as Aventis would like us to think.

http://www.medscape.com/viewarticle/479477

I also have found data from Hoechst Marion Roussel (1998 - pre FDA approval) about Lantus activity. This data shows the activity can have a significant peak 12-14 hours after injection, and again a smaller peak ~ 23.5 hrs after injection.

Once I understood the activity pattern, it was much easier to avoid hypos by having carbs on board at significant times and keeping peaks of the short acting from coinciding with the lantus activity peaks.

Hope this helps. Can't wait for Detemir to become available in the US.

[GregGolden]

I had this problem, my BGL's would hit a low around 930am, thats when the Lantus was peaking, so I just had to adjust my unit per carb ratio for just the morning.