[DanG]

There was a thread here in type 1 forums last week where someone (a new type 1) was sorta upset about lantus, so he stopped taking it and just went with the humalog/novalog.

How important is the lantus?
Is it vital for life? Or, can a person quit lantus and be careful to watch intake and humalog?

Also, while I have been type 1 for 33 years, I am learning new terminology here - like the term bolus, which I am gathering refers to the humalog intake? What is the meaning of the term bolus?

On lantus - I think I have read here that lantus really should not drop your bs overnight? I also see some people here at the forum take lantus before bed and also at breakfast. Why? What effect?

I need to be above 200 at bed when I take 20 lantus, or by morning I am scary low. I usually can function quite well at 40 when I wake up. 40 during the day would have me on my back on the ground. Anyhoo, it seems sorta contrary to what I have read there to be dropping that much at night on lantus. Am I correct on that?

I am new to humalog/lantus - only 2 years. And, I trust a bunch of varying experience here at the forum better than the doctor - and he knows that - I visit him maybe twice a year so he can get some insco money and write my scripts. I can remember 20 years back when I lived out west where no script was needed for diabetic meds. So, I didn't see the doc... ever. Now I need script, so I pay the doc and let them write the script.

Thanks for answers from you guys that know answers.
DanG

[JediSkipdogg]

Let's start with basic terms. Bolus and basal came from pumpers but can easily be turned into MDI (multiple daily injections.)

Basal is a base line insulin. It is long acting and either lasts 12-24 hours and must be taken enough to cover all hours in a day. It is required by your body to push the energy your body produces 24/7 into the cells. For people on shots this is the Levemir, NPH, Lantus types.

Bolus is your correction and food intake insulin. This you take if you are running high or you eat something. This would be regular, Humalog, Novolog, Novorapid types.

A body needs both otherwise one may run high. If a person is honeymooning, meaning their pancreas is still producing some insulin, they may be able to forgo the basal insulin and just give bolus insulin. Generall, basal is thought to be about 50% of your total daily insulin intake.

Lantus is generally a 24 hour insulin. Some notice though that it only works about 22 hours for them. Therefore they need to give it in two seperate doses because the body requires insulin in it 100% of the time or else it can't push the glucose energy into the cells. That then makes the blood acidic and causes DKA (diabetes ketoacidosis.)

You mention that you need to be high (200) at night to not wake up low in the morning. On Lantus one should not have the problem. SO I think you may need to descrease your Lantus dose by at least one unit and see what it does to you in the morning and throughout the day.

I think I got all your questions. Any more?

[grace girl]

I can add a few things about lantus. It isn't supposed to cause lows over night, nor is it supposed to peak. It's also supposed to be a 24 hour insulin.
It seems to work differently for everyone. As Jedi said, if you have to be at 200 to go to sleep, your taking too much Lantus. But like many of us on lantus, if you adjust the dose down to where you can go to sleep at a good number, you may not be getting enough lantus during the daytime.
Many people also find that it really doesn't last the full 24 hours for them. I had both problems, so I now take my total of 24 units in two injections, 12 hours apart, one in the morning and one at night.
I'll also add that for me, at least, it does have a peak, and it isn't slight. Even with the split dose (meaning much smaller doses each time) I have two times daily when I have to watch out for a low because of the peak.
You have to test a lot and learn just what it's doing for you, and what it's not, so you can make it work for you.
I personally think it's a good insulin, but it requires some effort to find out what you have to do it make it work for you, and not all doctors are up on doing anything that isn't totally by the book. That can make it take even longer to get it working right for you. It's taken me 6 months.
Stick around here and you'll learn all you ever wanted to know. If I hadn't found this place I would still be fighting overnight lows because of the lantus, myself.

[rzrbks]

Also, while I have been type 1 for 33 years, I am learning new terminology here - like the term bolus, which I am gathering refers to the humalog intake? What is the meaning of the term bolus?

Bolus is generally used in one of two ways.

1. You bolus for the amount of carbs you eat/drink at a given ratio, for example, I bolus at a 1:15 (generally) ratio---1 unit of insulin per each 15 grams of carbohydrates

2. You bolus to bring down high B/G readings: example, I had pizza and chheesecake for lunch, was a co-worker's birthday, I'll check at two hours after I finished eating, if I'm above 140/7.7 then I will inject (bolus) 1 unit which brings me down 50/2.7 in one hour. Correction bolusing id not something many CDEs, in my experience, will recommend. But most of us figure out the ration that works best for each of us.

I use 1:50, but I know other people here have different rations and even different rations depending on how high their B/G is.