[DjInsulin]

I'm not sure if this normal but my night time fasting readings will drop up to 100 points or more on most nights with just lantus. I usually bolus in the mornings and evenings but tend to avoid it at night because of waking up low. I"m not sure if i'm just over medicated or have problems with lantus. I was pulled off NPH because of massive drops and extended hypo's. i'm on a 1-15 carb ratio using humalog and 50 corrective. i tend to eat somewhat low carb usually not more than 30 carbs per meal sometimes less.

[fairyblood]

The propose of a basal is to keep you at the same level BG when you are fasting. You defiantly need to drop you basal and you may even think about splitting you dose so that you can take a little less at night then in the day. If you are dropping that much at night that is a very dangers level of insulin for you especially at night when you might not wake up when you are low. Please work at decreasing the amount that you are taking. I would also consider doing a basal check when you get a chance so you can figure out what is happening. They are a lot of work and a bit of a pain but it is well worth it when you have a basal that is closer to what you need. If you need the help and have a good endo don't be ashamed to get some help with your numbers it sometimes helps to have another set of eyes.

[Subby]

Originally Posted by DjInsulin

I'm not sure if this normal but my night time fasting readings will drop up to 100 points or more on most nights with just lantus. I usually bolus in the mornings and evenings but tend to avoid it at night because of waking up low. I"m not sure if i'm just over medicated or have problems with lantus. I was pulled off NPH because of massive drops and extended hypo's. i'm on a 1-15 carb ratio using humalog and 50 corrective. i tend to eat somewhat low carb usually not more than 30 carbs per meal sometimes less.

From what you've written, it sounds like your primary problem is that you are taking too much Lantus. What is your dosage? How did you arrive at that number? When do you take it during the day?

I think the move from NPH to Lantus is probably a good idea. But I am curious that you/they didn't lower your dosage on that to address the drops and hypos. Did you lower it, and what was the result? Was something else happening?

[DjInsulin]

Just got back from the endo. I just switched to a new Dr. last month and they knocked back my lantus dosage. Their treating me like a new patient and starting me on a reduced dose of lantus 25 units and carb counting 1-15 for the humalog. I'll be doing my basal fasting test tomorrow morning to see how well that works. This will be my first basal test ever for a basal insulin.

For a brief history of me i started off on 42 units of nph in the mornings and 20 at night. This regime worked like gold for almost 7 years. So good in fact that i rarely used humalog during that time. My A1c would always be in the high 6's. About 2 years ago i started getting huge drops at dinner time on just the NPH. My endo at the time then suggested i move to lantus and put me on a dose of 36 units and using a sliding scale for the humalog. The scale did not work for me at all i would frequently crash on it. Though the more i learn about lantus the more i have a feeling i've been taking too much basal insulin and this has caused the humalog to work too good. To the point that i drop drop drop drop drop till i eat something. This did not work so well for me as i would frequently wake up in the 40's and 20's. It got to a point where i was scared to go to sleep scared to go out and do much of anything without having a few juice boxes and some candy with me. Bare in mind i live alone so i have to be extra cautious with the hypos.

Wish me luck!

[DjInsulin]

Also to add to this i think this whole mess started because of lows a few years ago and me over correcting. My a1c's went up to 8 and my doc at the times suggestion to fix the problem. More lantus! Which in turn caused me to keep over correcting so i'm starting to feel like maybe something as simple as never doing a fasting test with the lantus has kinda lead to this whole mess or made the humalog work a bit stronger than i would like.

Another thing is if my b.s. was say 200 and i ate 30 grams of carb with no correction i take 3 units of humalog. this in two hours would have me continue to drop past the magic 120 number until i was hypo.

[Subby]

Yes, everything you say suggests too much basal being a long term problem. I find that basal will magnify discrepancies in boluses: too much basal, and I will seem to get more action from a bolus, too little basal, and a bolus will often not seem to work as well. What is more the previous doc's approach sounded brittle and slap dash. So yes, your comments make sense to me.

It can be upsetting and frustrating to have such systemic long term issues being caused by such fixable things, another member here was (half) jokingly offering a hockey stick to someone to hit their doctor with, I'd be passing it along to you for your old doctor. But - rest assured you are not alone in going through that kind of thing and now you can look forward to things being better now you are on a better track.

Speaking of which, it's good you are systematically reducing your dose. Get your new team/doctor to agree that the best dose is the one that works and therefore establish that you are capable of finding and changing it yourself. it's good you are doing a fasting test in the morning. You should consider doing further basal testing, that's the best and in some ways only way you are going to get information about:

1. what dose you should be using, what time of day to take it
2. What daily background fluctuations in your system are occuring that give you "trouble" spots such as recurring hypos.

In other words, you will somewhat be able to profile your basal requirements (which may be flat or may have fluctuations). Either way, knowledge is power and could allow you to know what is going on and adjust insulin, food, lifestyle, accordingly. Here's a good read for basal testing for MDI.

Basal Testing for MDI - Diabetes Daily Forum

If you continue to find there are frustrating limitations to your insulin therapy you should look into getting a pump if possible. They can afford a huge amount of tweaking and control over basal (and bolus) compared to long acting insulin.

[DjInsulin]

Thanks for the advice. My new Endo said almost verbatim everything you have said. That i was probably taking too much basal and that i need to do a few basal test and check to see if it drops a little or a lot and vice versa. I'm actually pretty excited to try this out as my diabetic friends have always wondered how i got by not using much humalog at all. In all honesty up till a month ago i've been deathly afraid of the humalog because of having such bad hypo's and rapid drops.

Thanks for the advice! I've already sent another friend to this bored to help with their issues. It's good to know i'm not alone in the overmedicated group.

[DjInsulin]

Update.

One day into the new lower dose of lantus and much as everyone said the Humalog is now working like it's supposed too!!!!!!!

It's amazing to see my bloodsugar only shift up to 200 and then drop back down slowly not like an out of control freight train. It will probably take me a good week or 2 to get the hang of it. But my life long fear of humalog is fading as each hour goes by. I feel better and the control is so much easier esp when things don't drift up and down by 100+ at a time.

Thanks again everyone!

[BlueSky]

As you bring the Lantus down, you will find that you need to increase the Humalog. Basal insulin can be expected to be 40%-60% of the total daily dose, depending on your activity level and how you eat.