[Metermaid]

Hi all, This is my problem: I take Lantus 8u am...7u dinnertime.
Humalog for meals coverage...I have severe lows that hit me 2-4 times a week, but always between 4am and 6am. I have come to the conclusion that Diabetes is for people who are good with math.....I am 'math challenged'.
Last night, I went to bed with a hs bg of 230, did not correct it, because: I WILL GO LOW...I ate an apple instead. At 4am I awaken with a 48 bg...I take 3 glucose tablets and go back to sleep...then at 6:30am...I am awakened barely and now bg is 23 !!! I wake hubby and take 3 more glucose tablets and 4 oz of apple juice...and feel like a real loser for not being able to fgure this out!!!
Any input would be highly appreciated!
Rita

[RyanN]

I have a similar problem at night with Lantus.
I'll take 12 units before sleeping, and my sugars always go down 100 - 120 pts overnight. So, I gotta bring up the sugars
to the high 200's at HS just to relax so I don't have to worry.
I hate worrying about going low at night, because I get stressed and can't sleep soundly, then wake up and am on edge for the day--like a bad cycle. Though I'm pretty good at catching lows, there is always that little voice in the dark as you lie in bed trying to sleep saying you might go low and never wake up. Though it is just a stupid worry, it is enough to keep me awake until I am sure my sugars aren't plummeting
for some unknown reason.

[Gary_W]

Hi Metermaid,

I've had similar problems with Lantus lows at night and (after asking for help here) I've discovered that I'm far from the only one!

Lantus, though it claims to be a peakless insulin, DOES peak. The charts seem to say it peaks at 4-6 hours, though this will vary with the individual.

If you are regularly dropping in the night like this, it is too much lantus; no maths needed. You humalog is completely gone from your system in 5 hours tops, so provided you are eating before 7pm, that is not going to be sending you low towards midnight. It can only be the Lantus with the evening meal. Your choices are to either cut it back or to alter the time when you inject it.

I've cut back my evening Lantus, and the good news is the night hypos are gone. I can go to bed with more or less the same BG that I wake up with. Bad news is that the change in Lantus has fouled up all of my ratios and my 2 hour post prandials are shot to bits, so I've fixed one thing and broken another. My total Lantus dose is the same, I've just split it to stop the night hypos.

Good luck

Gary

[ant hill]

Originally Posted by Metermaid

Hi all, This is my problem: I take Lantus 8u am...7u dinnertime.
Humalog for meals coverage...I have severe lows that hit me 2-4 times a week, but always between 4am and 6am. I have come to the conclusion that Diabetes is for people who are good with math.....I am 'math challenged'.

Hello Metermaid , Good nic name that you have.
I see that you're are on a serious low doses and any deviation either up or down would be big force on your well being. at the moment you are discovering lows during the night which is dangerous.

Last night, I went to bed with a hs bg of 230, did not correct it, because: I WILL GO LOW...I ate an apple instead. At 4am I awaken with a 48 bg...I take 3 glucose tablets and go back to sleep...then at 6:30am...I am awakened barely and now bg is 23 !!! I wake hubby and take 3 more glucose tablets and 4 oz of apple juice...and feel like a real loser for not being able to fgure this out!!!
Any input would be highly appreciated!
Rita

So now I would look at dropping 1U of your Lantus at after dinner and keep your morning doses as that you're are awake and using the energy and so using the insulin to help with your activity. If that's too low for you you may have to look at half unit doses say 6 1/2U or 6.5U and of course that means having to use a normal throwaway syringes. Anyway try 6U and see how you go and if you are still awake at 2AM have a test and you will probably enjoying the good sleep LOL

[Stuboy]

I would agree... it sounds like you need to start dropping your lantus 1unit at a time after dinner until you no longer have the lows.
I've been told that when adjusting like that, you should change the dose... and continue with that dose for three days, then change again if required... i find it works really well for me.
Although, if you're going to bed high AND eating and STILL going low, perhaps dropping 2 units would help... and dont eat before you sleep otherwise you wont know if the lantus is at the right dose.

You need to do some basal testing.

[xMenace]

One thing to consider is combining your doses and taking it all first thing in the morning. This may give you a much lighter effect through the night and into the morning. That would be totally wrong for most of us, but it may help you. Do you have morning rises from your Dawn Phenomenon?

I agree about cutting back. The upper limit for Lantus should be what keeps you normal as possible through the night. This will mean defficiencies throughout the day, so do some basal testing and find when you need to suppliment and how.

[Alice]

I am beginning to think that many of us (myself in the past) have all ended up taking too much Lantus...usually based on a doctor's quest to a lower A1C (and our own quest).

Every time I had the "lows" problem at night, it was a sign to cut back. I find I need to fluctuate between 23 & 24 units...where I used to fluctuate between 25 & 27 units.

It's ok to step back and reassess. When you start seeing high fasting numbers, you'll know you need an increase. In my case, I had to find a happy medium...I make sure I eat 15-20 carbs before bed without a bolus. This usually keeps me pretty even.

It has taken me many years to figure this out on my own. The doctors mean well, but they don't know you body chemistry, PMS stubborness, etc.

[Jan B]

Something I always fought against was the advice to eat a snack of protein and fat (peanut butter or cheese and crackers) before bedtime. Once I finally tried that, it worked very well. That way the sugar breaks down more slowly, giving you more coverage and protection.

[1type2go]

Originally Posted by Jan B

Something I always fought against was the advice to eat a snack of protein and fat (peanut butter or cheese and crackers) before bedtime. Once I finally tried that, it worked very well. That way the sugar breaks down more slowly, giving you more coverage and protection.

I was just going to say that .
lower GI Carbs will help but you are still eating before bed ,

I too have been having lows at night and I thought it was the humalog at supper 5 - 6:pm lasting to long and peaking to late

[quote] do some basal testing and find when you need to supplement and how.

I am, just now trying to figure out my Basel requirements ,and I am still unclear

Donovan

[grace girl]

Been there...
My advice would be to do some basal testing, for starters. Get a clear idea of what's going on. That will tell you if you need to lower the dose. You may not, it may simply be that you need to change the time of the evening shot so that the peak is done by the time you go to sleep.
I have really come to despise the term "peakless insulin" where lantus is concerned. I've been fighting with it's peaks for several years now.
With basal testing and some adjustments you can make the peaks work for you and not against you. I'm still working on it, but it's getting better!

[Stuboy]

If possible you want to avoid "having" to eat before bed time. Otherwise your Diabetes is controlling you, and your feeding the insulin, which isn't the way it should be.

[jen_slc]

I agree, sounds like your Lantus needs to be adjusted. I used to experience HUGE drops like that overnight too. It was very scary. These days I cut back my Lantus dose for every 40 mg/dl that I drop. This guideline came from my endo - I don't think it is personalized, I *think* this could be applied to anybody, but don't take my word for it. Just keep in mind that if you're dropping 150-200 points overnight, you may need to cut back quite a few units.

As an example, when I experienced 200-300 point drops, my Lantus dose eventually ended up at ~50% of what I was originally taking.

[Gary_W]

Originally Posted by jen_slc

As an example, when I experienced 200-300 point drops, my Lantus dose eventually ended up at ~50% of what I was originally taking.

Holy cow! My night-time Lantus drops of late have been 4.5 or 5 (which is worst case 90) and I felt agrieved at that. Still do.

You win!

[Metermaid]

Originally Posted by grace girl

I have really come to despise the term "peakless insulin" where lantus is concerned. I've been fighting with it's peaks for several years now.
With basal testing and some adjustments you can make the peaks work for you and not against you. I'm still working on it, but it's getting better!

When do you take your Lantus...do you split also? I just learned from you all, that Lantus has peaks!! Now I have to figure when it peaks for me?? Another math problem... I am wondering if I shouldn't take another kind of basal insulin?

[BlueSky]

I don't know whether Lantus peaks or not, and I don't think it really matters that much. If you split the dose you will get reasonably even action over the course of the day. What is more of an issue to my mind is the fact that our bodies' requirement for basal insulin action varies substantially during the 24 hour cycle. Most of us need much more basal insulin during the morning hours than we do in the afternoon and at night. I find that if I set my Lantus dose at a level that keeps me even during the morning, I will go low in the afternoon and/or at night. This is because the flat action of Lantus is adequate in the morning but excessive in the afternoon and overnight. It sounds like the same could be happening with you, Metermaid.

This is how I dealt with it. Reducing the lantus so that the afternoon and night BG was steady made sense as it stopped the lows. But I needed extra coverage in the morning. I provide that by minimising breakfast carbs and covering the meal with Actrapid (it is like Humulin R). I give myself a big dose of it when I get up, part of which conteracts the Dawn Phenomenon blood glucose surge. The net effect is that blood glucose is reasonably steady during the whole 24 hour cycle.

For me, Lantus on its own is not adequate to satisfy basal needs. Some extra coverage in the morning is essential. You could also try using NPH in a similar fashion. The big advantage of working with Lantus, IMO, is that it is like building on level foundations.