[Gary_W]

Hi all,

These days, I'm down to 14u of Lantus before bed. I've experimented briefly with adjusting the dose to sort out the little niggles that now exist but life is really busy at the moment and I just don't have the time for the basal tests etc. at the moment.

Current problem is that if I go to bed <7.0 then I will wake up hypo, in other words the Lantus drops me around 3.5 in the night (63 US numbers). This is really annoying, as until recently I could go to bed as a 5.0 and wake up the same. In fact, if I was 6.0 or above I'd actually do a correction shot before bed! Not any more. I always test before bed. I'm usually around a 5 - 6, so I'll have a little milk and maybe a biscuit to acount for the Lantus dip.

Last night, I was 7.5 before bed so didn't bother with the food. I put in the 14u. Our youngest daughter woke up screaming an hour or so later. I sorted her out and then realised I didn't feel so good. I tested and was 2.2 (40). 30g of carbs in the form of orange juice took me as far as a 7, and I woke up as a 6.0 this morning. This is getting scary. Only thing I can think of is that the injection nicked a blood vessel (I bled very slightly) but surely that couldn't have caused this??? I wonder how often I go low in the night and don't wake up but my liver bails me out?

I feel absolutely dire this morning and frankly just don't need this. A couple of weeks ago I did flirt with splitting the dose (I went with 8u at night and 4u in the morning) but it caused raging highs in the morning. I cannot reliably change to a 6pm daily injection as I'm often either still working (various places) or on the road. Using less than 14u a day doesn't give me the cover (haven't done accurate basal tests but I can see the old numbers creep up).

Any suggestions / confirmation that even smallish doses of Lantus can drop you in the night like this? I'd consider going with the Levemir but everything I've read suggests it is even less flat than the Lantus. I really don't want to be eating before bed as even small amounts of extra food cause me to gain weight which I don't want to do.

Gary

[ant hill]

Hello Gary , I am also on Lantus and coping well with it but then there are people like yourself who have hassles with it.
I don't like asking this question as can often offends, How much do you weigh? I have read the perscription notes and they said that dose is around 0.4U*Kg Now this is an esterment of what your dose maybe at but don't go and adjust your dose on that fact as it may be not you. Have you done a complete flat spit dose like 8 and 8?
And as for Levemir is very similar 0.4U*Kg.

[Gary_W]

Hi Peter,

Thanks for the reply. I currently weigh just under 90Kg.

If I used the 0.4 u per kilo, I'd be injecting 35u of Lantus. As my TDD including covering 200 - 250g of carbs each day is only around 38u (14u of Lantus and 8 + 6 + 10 of Apidra) then these formulas don't work for me.

I haven't tried an 50/50 split, but taking the night-time dose down as far as 8u meant I went high in the morning...

Gary

[ant hill]

Originally Posted by Gary_W

Hi Peter,

Thanks for the reply. I currently weigh just under 90Kg.

You lucky sod!!! as I am about 118Kg.

If I used the 0.4 u per kilo, I'd be injecting 35u of Lantus. As my TDD including covering 200 - 250g of carbs each day is only around 38u (14u of Lantus and 8 + 6 + 10 of Apidra) then these formulas don't work for me.

I am glad that you understand that this is too much for you. So I would do the 50/50 split and see how goes as I see from most people has been a sucsess. That may not include you but have a try also put up with this regime as basels can be better studied over 48 hours.

I haven't tried an 50/50 split, but taking the night-time dose down as far as 8u meant I went high in the morning...

Meh, try it Gary, I have also find that activity can influance the BG too so whey that into the account too.

[SharpTail]

Gary...Keep an open mind about adjusting your Lantus dose. You may still consider splitting the dose about 12 hours apart. When I split my dose because the Lantus was running out in 18-20 hours rather than lasting 24, I initially tried a 50/50 split. I was having a drop in BS level through the night and could not get things to work well. After talking to a Diabetes educator at our hospital, she suggested an uneven split, for example around 60/40. After some fine tuning I currently take 26 U in the morning and 20 in the evening and this has given me almost perfect level blood sugars through the night. The other thing I found (and I can't explain why)was that my total dosage with the split dose was greater than what I had with the single dose. To get the right split for you will take some experimentation, but there should be some combination that will work well.
Pat

[Stuboy]

im adjusting my lantus at the moment too, I downed it from 16u at night and morning to just 12. and today i've gone down again to 11.

It's worth trying a split dose, when i first started on lantus i found it wasn't lasting the full 24 horus and taking two doses 12 horus apart gives a nice flat profile (for me). and it means you can adjust in the morning for evening highs or low and adjust in the evening for morning highs or lows.

Give it a go and maybe drop the lantus one unit at a time three days apart untill you get it right.

By the sounds of it you're on about the same doses as me, i weigh 10.5st and my ratio is roughly (haven't got it quite right yet but it's getting very close) 12g:1u.

Good luck and keep us posted!

[xMenace]

Sounds like a pump candidate. Check out that NHS thingy

[Stuboy]

well.. they can't deny the pump for UK patients on the basis of cost anymore... but you do have to "meet the criteria".

Well worth asking the question though!

[SueM]

If the Lantus is causing problems at night have you thought of changing it over to the morning?
Or splitting the dose as others have mentioned?

[shabbie]

hi gary,
i'm not a lantus expert as i used to take levemir.

i had problems witrh levemir not covering 24 hours (it was more like 18 hours)
when i tried to split the dose i ended up with highs in the gaps that levemir wasnt covered (i made loads of projections on excel spreadsheets to calculate the patterns ~ this saved loads of time and aggravation!)

i took my levemir at night, i only took enough to keep me level overnight, and would cover the gaps with the novorapid during the evening when it had run its course.

the pump has helped me to resolve a lot of the issues i had on mdi.

[Real4]

Originally Posted by Gary_W

Last night, I was 7.5 before bed so didn't bother with the food. I put in the 14u. Our youngest daughter woke up screaming an hour or so later. I sorted her out and then realised I didn't feel so good. I tested and was 2.2 (40). 30g of carbs in the form of orange juice took me as far as a 7, and I woke up as a 6.0 this morning.

If your description of what happened is accurate, this is NOT a Lantus issue. There is a delay of about 2 hours before Lantus begins to work, and any "peak" with Lantus would be about 4 to 6 hours after taking it. So, if you are low an hour after injecting Lantus, there is another cause, not the Lantus.

[TenderVittleS]

I would just gradually reduce the amount of your nightime Lantus dose about 2 units. That way you don't wake up low.

[Gary_W]

Thanks for the replies, folks.

I have condidered all kinds of splits and morning doses etc. The two biggest problems I have are a highly irregular life and also lack of time to test and fiddle.

I work from home, and today I'm actually at home catching up on paperwork. Last week I was on the other side of the world for a week (working) and had a horrendous journey back I drive lots in the UK and will leave the house anywhere between 4.30am and 11am depending on the day. I get home anywhere between 3pm and 9pm. For this reason, a morning dose of Lantus at a regular time is a little bit on the tricky side as I'll be in a car somewhere. The only time of day where I'm consistantly home is late evening. I know that persuading my brain to remember an 8am dose each day will be tricky depending upon where I am / what I'm doing. I suppose I could make sure I've got Lantus with me and whack in the second dose at lunchtime... The time varies each day, but I guess it'll be close enough? I do always eat lunch so I suppose it's a constant and I could get into the Lantus habit. I always do thighs with Lantus so I guess I'll have to figure out a way of subtley dropping my trousers in public...

As far as the time goes, I'm well aware that any changes I make to Lantus take a couple of days + to fully settle down. I just don't have any down time at the moment as this is my busiest time of year. Come April I'll have plenty of time to fiddle with this stuff, and my original plan was to string it out until then. Unfortunately what happened last night is kind of scaring me. I feel OK now, but it really wiped me out this morning. It was just one of those hypos that leaves you drained. Mostly, I'm right as rain inside 15 mins but occasionally they really stay with me afterwards.

XMenace - I am taking an afternoon later this month to speak with the local authority about a pump. There is the possibility of a trial in the spring which would suit my timescale just fine. It would be unfair to have a go at the moment as throwing the time at it that it deserves cannot happen at the moment. I must say that the concept of pumping is seeming a little more attractive as the days go on. It's such a pain as I had this thing absolutely nailed for a few months. No drops in the night, almost completely predictable. Really cheeses me off when it re-writes the rules when you start to beat it at its own game...

Gary

[Gary_W]

Originally Posted by Real4

If your description of what happened is accurate, this is NOT a Lantus issue. There is a delay of about 2 hours before Lantus begins to work, and any "peak" with Lantus would be about 4 to 6 hours after taking it. So, if you are low an hour after injecting Lantus, there is another cause, not the Lantus.

This is why I was so worried; if I could understand where the hypo came from then I wouldn't be so concerned. My evening meal yesterday was at around 5pm and I injected 8u of Apidra. I've profiled Apidra in me, and it is 85% gone at hour 3. By hour 4 there is none left worth shouting about.

Looking in my meter, I blood tested at 11.05pm and was 7.2 (130). I injected the Lantus around Midnight. The hypo happened at 1.20 according to my meter and the reading was 2.2. I tested again 12 mins later and had reached 3.2. I went back to sleep a short while later as I felt OK. I was woken up again at 4.15 (kids) and my BG was 7.0. I was 6.3 when I got up at 7.45am

No excercise, nothing else. I agree that Lantus shouldn't do this. But it did unless anyone can suggest something else? I've been T1 for 12 or 13 years now, so I'm not honeymooning.

Gary

[Gary_W]

Originally Posted by TenderVittleS

I would just gradually reduce the amount of your nightime Lantus dose about 2 units. That way you don't wake up low.

I did try 12u recently. I didn't wake up low, but just those 2u caused me to be way too high in the morning and (even with a decent amount of Apidra) I really spiked with breakfast.