Lantus help...

susanna · #1 (**permalink**) 05-08-2008, 08:07 AM

Hi Everyone

I have been reading this forum for awhile but not posted much. I have learned so much from you guys already and thought someone would have some advice for me. So I was diagnosed with type 1 in Jan of this year and I'm currently on Lantus and Humalog. My first A1c was 12.3

at dxd and is now 7.2! Next time I'm hoping it will be in the 6 range but I'm happy with the huge improvment!

Anyways.. I'm still trying to adjust my lantus. Lately my numbers are great throughout the day with very few lows BUT my morning numbers are now higher then I'd like (7-9) when before my morning nbrs were really good (around 5) but I was going low between meals. I know this could be DP but is there any suggestions for keeping my morning nbrs down and NOT going low during the day?? I'm thinking I may need to get a half unit pen but not sure if that would even work. Or maybe I'll just have to accept the slightly higher morning nbrs since I'd rather that then always having to eat throughout the day. I currently take 1 shot of Lantus at night (around 16 units).

Thanks for any help or advice in advance!!!

Chappo · #2 (**permalink**) 05-08-2008, 08:12 AM

Firstly congratulations on your huge A1c reduction! You should be very very very happy with that!

I know Lantus effects people in different ways. I never had any form of DP (low or high) with Lantus, and I am soon to move onto the pump - 6 days to go!

I would suggest a test at perhaps 3 or 4am each morning, and a pre-emptive bolus may be in order.

If this doesn't work, try moving your Lantus injection to the morning and see how it goes.

shiftzor · #3 (**permalink**) 05-08-2008, 08:54 AM

It sounds like you need to increase your Lantus (Basal), you should be able to achieve a reasonable morning without going too high. What basal/bolus ratio are you working with? 55-60% basal and remaining bolus working well for me. Maybe you need to reduce your bolus and increase your basal to improve your morning numbers and reduce the hypos. I would advise that first you get your basal sorted by basal testing. Basal testing involves testing when you wake up and skipping breakfast/lunch (testing every hour). As long as you remain within range the entire time without any major fluctuations then your basal rate is correct. If you become low/high stop the test and adjust.

Once you have your basal sorted you can begin to adjust your bolus by testing pre-meal and then 2 and a half hours after meal, testing 4 hours after a meal can be a good indicator for fatty foods and fine tuning. I believe you can also do bolus testing where you only eat breakfast and then skip lunch, watching for fluctuations (repeating for each meal). DP is fun and is experienced by many people; I always take the most amount of insulin per carb in the morning.

There is no right and wrong answer for this game we play so you will have discover the rules for yourself. Good luck!

Scratch · #4 (**permalink**) 05-08-2008, 09:02 AM

Another possibility that should be checked for is that you might be going hypo overnight while sleeping, then the liver kicks in and you rebound upwards.

For many people, basal insulin needs are at the lowest between falling asleep and until 2 or 3 in the morning. It would be a very good idea to set some alarms to check what is happening between midnight and 3 AM, it may even be that you actually need to lower your Lantus dose. The only way to find out is to collect the evidence. Speculation without evidence remains speculation.

shiftzor · #5 (**permalink**) 05-08-2008, 09:21 AM

Quote:

Originally Posted by Scratch

Another possibility that should be checked for is that you might be going hypo overnight while sleeping, then the liver kicks in and you rebound upwards.

For many people, basal insulin needs are at the lowest between falling asleep and until 2 or 3 in the morning. It would be a very good idea to set some alarms to check what is happening between midnight and 3 AM, it may even be that you actually need to lower your Lantus dose. The only way to find out is to collect the evidence. Speculation without evidence remains speculation.

Ye that’s a good point, hopefully a basal test would highlight that as you might begin to drop again late morning. Try waking up at 3/4am one day and do a BG check, that would be the only way to find out for sure if this is a factor. I think someone (more knowledgeable than me) should write a quick guide to basal testing so many people ask the question and make it a sticky. Even just a general FAQ for type 1 related questions would be good, with links to websites maybe. It’s applicable to MDI as much as it is for pumpers.

susanna · #6 (**permalink**) 05-08-2008, 09:29 AM

Thanks for all your responses already!

I don't think I was properly told how to do basal testing, I'll have to speak with my diabetes educator when I see her next week.

I'm pretty sure I'm not going low at night as they thought at first I was and I did wake up to test for a few nights and I was fine. In fact I don't think I have ever gone low at night.. usually only during the day. The strange thing is that my insulin needs in the morning are actually less then at night..based on my i:c ratio.. so I'm a bit confused! what a crazy disease this is!

Thanks for all the advice.. I think a good basal test is what I need to really figure this out!

grace girl · #7 (**permalink**) 05-08-2008, 09:34 AM

Get a copy of Using Insulin by John Walsh. It's available on Amazon. It will give you clear instructions on every aspect of using insulin, including basal testing. It's worth having on hand!

shiftzor · #8 (**permalink**) 05-08-2008, 09:38 AM

Quote:

Originally Posted by susanna

Thanks for all your responses already!

I don't think I was properly told how to do basal testing, I'll have to speak with my diabetes educator when I see her next week.

I'm pretty sure I'm not going low at night as they thought at first I was and I did wake up to test for a few nights and I was fine. In fact I don't think I have ever gone low at night.. usually only during the day. The strange thing is that my insulin needs in the morning are actually less then at night..based on my i:c ratio.. so I'm a bit confused! what a crazy disease this is!

Thanks for all the advice.. I think a good basal test is what I need to really figure this out!

That’s not strange at all, DP is the reason for this and it’s your body that’s crazy not your dead pancreas. If we all required the same insulin day in day out life would be so much easier.

Somogyi effect VS. Dawn Phenomenon

susanna · #9 (**permalink**) 05-08-2008, 09:44 AM

shiftzor- I thought with DP it means your BG is higher in the morning so you usually need more insulin in the morning? am I wrong thinking that? apparently I need less insulin in the morning...

susanna · #10 (**permalink**) 05-08-2008, 09:46 AM

Thanks grace girl I think I will pick up a copy of using insulin!

shiftzor · #11 (**permalink**) 05-08-2008, 09:57 AM

Quote:

Originally Posted by susanna

shiftzor- I thought with DP it means your BG is higher in the morning so you usually need more insulin in the morning? am I wrong thinking that? apparently I need less insulin in the morning...

Sorry I just reread what u said. What is your I:C (insulin:carb ratio) in the morning/lunch/dinner? But you really should get basal sorted first before you worry about bolus, otherwise it will be very hard to get things right. I have the book Gracegirl is talking about its very good. Just remember everyone is different, so what works for you may not work for other people

so if you need less/more in the morning don't be afraid to do it. Diabetes is not an exact science.