Lantus and Humalog

[kukana]

I have a question about the two insulins. He takes Lantus(20 units) at 5 am and then takes Humalog at 530 for carbs ratio for breakfast. It seems when he takes Lantus on his days off and goes back to bed, his sugar drop 40+. So when he takes his Humalog for carbs for breakfast. Both insulins are dropping him at the same time because he takes his sugar at 830 and his sugar is usually between 35-50. Am I wrong? What I have read about Lantus it reaches a peak in 1 to 2 hours. And then the Humalog has already hit its peak and will still lower bg for a total of 4 hours. No one can seem to answer my questions.

We went to the new doctor yesterday and it was good. But I am still lost in this. I talk to the CDE and she said fax the sugars in one month. I said what happens if I need help, and he has low sugars and she said treat them.
They want us to go to the education class, but we can't get in until the end of March.

I am desperate.

[lorilei]

i think i need a little clarification...on his days off, he gets up and takes his lantus...he then goes back to bed before eating? gets up and checks his BG at 8:30. At that time it is low, b/w 30-50?. He then takes his humalog before eating his breakfast...am i reading this wrong? just want to make sure that he isn't taking his humalog and then going back to bed before eating...and then not surprisingly waking up low??

[G1nZeng]

I saw your other post about your husband's condition and if "he" is not willing to learn or try anything new on his own there is nothing you can do about it. It seems like he's in denial or something. Your husband needs to ask these questions as diabetes is different for everyone.

[BlueSky]

.... What I have read about Lantus it reaches a peak in 1 to 2 hours. ....

No, Lantus peaks at 8-12 hours and is still active after 24 hours. In the graph, Lantus is the dotted line at the bottom (insulin glargine):



Humalog (lispro) action, on the other hand looks like this :

[kukana]

In the book I have been reading, it states that Lantus starts working in 1 to 2 hours, (I guess peaks was the wrong word to use)
On his days off for example yesterday
5am bg-71 takes Lantus, take a couple of Glucose tablets,bg 95 at 545
545-8am goes back to bed
8am bg 49, eats 2 glucose tabs and 15 min later bg 69, takes 2 more and tests-bg 91 Takes humalog(4 units) 43 g of carbs, ratio 1-10.Eats breakfast

But when he works
5am takes lantus bg 129
530 takes humalog 43 g of carbs, ( 4 units) ratio 1-12(activity more active)
Takes sugar at 830 bg is usually 35-50 (hypo unawareness)

That is why I am asking is both insulins are working at the same time to lower sugars

Can't test before 830, job is too busy to test. Slows down at 830.

As for the denial, he is working with me now. He does everything I ask. And now is starting to test, on his own without me saying something, and is watching what he eats. We actually have made progress. Lot of progress. Actually yesterday when he was 49, he took care of it him self, with out me telling him.

[Subby]

In the book I have been reading, it states that Lantus starts working in 1 to 2 hours, (I guess peaks was the wrong word to use)

Definitely the wrong word - not to tell you off, but starting to work and peak are very different events Look at the graph Blusky kindly provided up above to get an idea of how much the Lantus is working as various points. You can see that at 2 hours it's probably just starting to gear up, really.

On his days off for example yesterday
5am bg-71 takes Lantus, take a couple of Glucose tablets,bg 95 at 545
545-8am goes back to bed
8am bg 49, eats 2 glucose tabs and 15 min later bg 69, takes 2 more and tests-bg 91 Takes humalog(4 units) 43 g of carbs, ratio 1-10.Eats breakfast

But when he works
5am takes lantus bg 129
530 takes humalog 43 g of carbs, ( 4 units) ratio 1-12(activity more active)
Takes sugar at 830 bg is usually 35-50 (hypo unawareness)

That is why I am asking is both insulins are working at the same time to lower sugars

I think I get where you are coming from about the two insulins causing dropping. Rather than answer your question, (which I find very hard - it's a convoluted approach you are taking) I'll try and put it another way.

First let my paraphrase your 2 presented scenarios

DAY OFF:
5am (Takes Lantus) Wakes a little low Takes hypo fix to normal
Goes back to bed>>>
8am Wakes again - very low, hypo fix x2 required

WORKING DAY
5am (Takes Lantus) wakes with normal enough BG
5:30 (Takes Bolus) Eats breakfast
8:30 Expects Low, always takes hypo fix

Putting aside all sorts of other questions, what that says to me: it's possibly too much basal full stop. Until basal coverage is improved, hard to decide on what the bolus is really doing. Considering this "expected low" after breakfast, bolus is possibly too aggressive, too, although as you say the basal may compound the bolus, for sure. These are just possibilities. To get to the bottom you need to basal test, see below.

Differences in the two scenarios may call for changes in dosaging. For example, going back to bed on the day off might mean that basal requirements are lowered, meaning that a "working day" basal is too high and will be causing these lows. So, on days off, a lower basal dosage and/or a different time to take the basal (for example, on getting up may more appropriately replicate a working day's pattern). These are just food for thought, not advice for the actual situation.

I wish I could help more than that but I don't think that's the role here - to give specific medical advice - the comments are made generally for you to consider in that light rather than the idea of doubling up being the direction to come from. (Yes, I suspect there is a doubling up effect to a degree - but you need to try and fix basal separately).

Best way to cut through the confusion and get somewhere - basal test. In this instance, testing overnight to see what the basal is doing, then testing through the morning without breakfast and bolus, to see what happens. Ask about basal testing if you're not clear how it might work for you to clear this up.

As a general rule, you shouldn't usually need to take glucose tabs and the like at certain times off the day. Instead options with dosaging amounts and times should be modified to better suit the body. That being said, people do sometimes need to use strategic snacks at times - but usually long acting snacks to tide over a long period. Eating something more sustaining on waking may be another approach to minimise these lows.

As for the denial, he is working with me now. He does everything I ask. And now is starting to test, on his own without me saying something, and is watching what he eats. We actually have made progress. Lot of progress. Actually yesterday when he was 49, he took care of it him self, with out me telling him.

That - is truly awesome. Keep up the good work, you are on the way to a new destination, from the sounds of it.

[SharpTail]

It really sounds like the dosage of lantus and/or humalog may be just too high. The lantus should not work to lower BS, but to just maintain it at an even level. Also, you may have already explained it, but 5:30 am sounds like an unusual time to take the Lantus especially when he then goes back to bed. If he is now on a split dose later in the morning may be a better option. I split my Lantus and take it at 10:00 am and 10:00 pm. For the morning period the am dose of Lantus from the day before may be starting to fade at 6:00 or so and therefore reduce the possiblility of low blood sugars.
Pat

[sable_032592]

does he take any humalog before he goes to bed or in the evening? perhaps he's doing exercise before bed or in the evening? is he taking any other meds? some meds can bring the blood sugar down as a side effect...

[Mich]

Hi Kukana,

I was getting ready to post a long drawn-out explanation, but Subby beat me to it. He gave you all good information. I also think the lantus sounds a bit too high.

Lantus should keep blood sugar level at 80-100 when a diabetic doesn't eat. Some people split the Lantus dose, one every 12 hours, so that they cover the full 24 hours and don't have any ups and downs. (Like during the 2 hour beginning period.) Ask your CDE or Doc about adjusting the dose. On a day off, test it for a half day at a time to see if hubby stays level with no food.

All of us have different insulin to carb ratios. We could all eat the same piece of toast, and each of us would need a slightly different dose to take care of it. For me, it's 1 unit to 9 carbs. I started at one unit to 10 carbs, but had to adjust it downward when I began pumping. Some people use more insulin than that and some use much more, or even less. Discuss this too with your Doc.

Work days and non-work days might well be different in both basal and bolus insulin, especially if he is physically active in his job. Testing is the only way to know.

I'm glad to hear that hubby is catching on and paying attention. He'll understand more and more as time goes on. (HI Hubby.)

You're doing a good job, worried wife

Mich