[grace girl]

I know insulin needs change, but what I'm going through in the morning is about to drive me crazy. I used a carb ratio of 1:8.5 for MONTHS and it worked great. But since January I'm constantly adjusting it to keep from going low, and I don't get it. I tried 1:10 this morning and was 68 two hours after I ate!
Yet I tried 1:10 one day last week and went sky high!
I don't eat a lot of carbs for breakfast, usually no more than 25, and I generally eat the same things, so I don't think it's the food.

I know that part of what's going on is the lantus. I take a large am dose and if I don't eat I'll drop sometimes 50 points by 1:00, but it's perfect the rest of the day as far as basal tests go...it's just the same problem I've had with lantus all along...the first 4 hours just kick me in the butt.

All in all lately I find myself skipping breakfast more days than not just because I'm getting tired of dealing with this. If I don't eat I know exactly what my bs will do, whereas, like today, if I do eat who knows!
Maybe I should try only eating protein for breakfast and skip the humalog altogether. I'm really baffled by this.

[Cyborg]

Sounds like you are feeding the insulin. I suggest having a discussion with your doctor about cutting back on your morning lantus.

[LancetChick]

Some people are bothered by the peaks they get with Lantus (I'm not one of them.... I don't get peaks with Lantus) and find that Levemir works better. In the meantime, splitting your dose can smooth the peak out, and you don't have to divide it into doses 12 hrs apart if it isn't convenient. I split my Lantus because it doesn't last 24 hrs, but I need the full force of it in the morning because of DP, so I take it at noon and 8:30PM.

[BlueSky]

Originally Posted by grace girl

.... I know that part of what's going on is the lantus. I take a large am .... the first 4 hours just kick me in the butt..

It doesn't sound like food is the issue. Variability in Lantus absorption and action can be as high as 25%. And, if you are having a large dose in the morning, it could be what is causing your problem. The larger the shot, the greater the chances of getting unpredictable BG is. Try splitting the shot.

[grace girl]

I do split it. I just take a much larger dose in the am than in the pm.

[BlueSky]

How about splitting that morning dose. Give yourself two shots in different body parts, one after the other. It will make a difference if absorption is an issue.

Figuring out what works best is a process of elimination. As a matter of interest, Bernstein's view is that an insulin injection should never be greater than 7 units because variability makes the effect on blood glucose too unpredictable.

[Cyborg]

If it is an absorbtion problem, wouldn't that just make it worse? Sound like some morning to afternoon basal testing is in order.

[grace girl]

Originally Posted by Cyborg

If it is an absorbtion problem, wouldn't that just make it worse? Sound like some morning to afternoon basal testing is in order.

Well, here's the basal test results: (I did each of these several ttimes)

morning test: (from rising to lunch-time) bg drop of 50 points.(once it was 80)
afternoon: (lunch-time to supper time) no more than 20 point drop.
Evening test: (from dinner time til 9pm) no more than 2o point drop.

The first test would indicate that I need less lantus, the other two would indicate that it's dead on.

It's just the crazy way my body seems to deal with lantus. No matter how many units I take my bg drops slowly for 4 hours from the time of injection, then drops quite drastically in the 4rth hour. I only take 7 units at night and when i did the over-night basal tests I found it doing the same thing...it will drop 50-80 points if I haven't eaten anything. Yet dropping the dose to even 6 units had me waking up high every morning.
So, I've been having a small snack, which keeps the drop within a 30-40 point range, which I can live with.
It's just this morning thing....
My bs rises in the am after I get up usually around 30 points. If it weren't for that I'd go hypo after the am lantus shot even on the days I don't eat.

[Cyborg]

I still think you need to drop the morning Lantus a bit. Good luck working it out, I'm sure it's frustrating. The joys of MDI...

[Emm]

I have to agree about dropping the Lantus - even just a tiny reduction might be right for you. Also perhaps make your split more even? Unless there's a good reason for taking most of it in the AM?

How are your numbers overnight?