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Type 2 Question about Lantus


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Old 04-11-2017, 08:55 AM   #1
Lady221
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Question about Lantus

My Dr first said he wanted me to split my Lantus (30am/30pm) I was having very high fasting sugars in the mornings, sometimes 40 points higher overnight. Now he wants me to try 60 units at bedtime only. Can you take Lantus all at once? Does this make a difference? Thx

 
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Old 04-15-2017, 09:17 PM   #2
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Re: Question about Lantus

Lantus lasts roughly 24 hours, so yes, many people can take it just once a day. Other individuals find that it only lasts about 18 hours in their system, so prefer to split the dose to better cover the whole day.

I've been on Lantus for five years and have only taken it once a day the entire time. It works for me. However, I'm an elderly type 1 and need only approximately 8 units a day. (I've been trying it at 9 units the last couple of nights but haven't decided whether or not that is my new desired level.) I take mine at 6 PM so I have several hours still awake in case something goes amiss like mistakenly injecting fast acting instead of basal insulin.

Some people find that Lantus has a slight peak and for those people, taking it as a single dose in the evening might help a little with dawn phenomenon (the morning BG rise). I'm battling that problem myself (my BG stays pretty level through the night but rises about 45 points between the hours of 4 AM and 11 AM), but taking Lantus at night doesn't help me at all. What I've done the past couple of days is to set the alarm for 4 AM and take a couple of units extra of fast-acting insulin to cover the dawn problem.

Now if your problem isn't a BG rise in the early morning hours but rather a slow rise all night long, it is possible you simply need a higher dose of Lantus. You'd need to discuss that possibility with your doctor, of course. But I'd sure give the evening dose a try first. And also do some BG testing to see exactly when your BG is rising.

 
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Old 04-16-2017, 05:39 AM   #3
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Re: Question about Lantus

My fasting readings have been 40-60 points higher in the morning even after taking Lantus at bedtime. Something is happening overnight and I just can't figure this out. I did notice that the MORE Lantus I take at bedtime, the higher my morning numbers. Too much Lantus I think. I guess I'm going to have to take some middle of the night readings.

 
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Old 04-16-2017, 11:09 AM   #4
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Re: Question about Lantus

Sounds as though what you need to do is a proper basal test. This involves taking your BG at bedtime, making sure that you haven't eaten anything or made any bolus corrections for five hours. The last meal you've eaten before this should be light, without an overabundance of protein or fat. That's because roughly half of protein can be converted to glucose and can take five hours (occasionally even more) to do so, thus raising your BG hours later. And the fat just slows down the whole digestion, again causing an increase in BG in the middle of the night.

After taking your bedtime reading, set the alarm for every two hours and get up and take your BG. You need to know whether there is a gradual climb between bedtime and morning (which indicates too little Lantus), or if the climb starts about 3 or 4 AM like mine does (which indicates dawn phenomenon and needs more insulin starting in the early morning hours) or if the BG drops to a hypo range during the night, then increases in a rebound or Somogi effect from the liver, which requires less insulin to prevent the hypo. Testing every hour would be even better, but who wants to stay up all night?

I suggest you look up both "dawn phenomenon" and "Somogi effect" on the web. There are dozens, maybe hundreds, of articles about these night time changes in BG.

Last edited by Uff-Da!; 04-16-2017 at 11:11 AM.

 
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Old 04-16-2017, 12:52 PM   #5
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Re: Question about Lantus

Thank you, I will do this. You have explained this better than any Dr I've ever gone to.

 
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Old 04-17-2017, 06:06 AM   #6
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Re: Question about Lantus

Quote:
Originally Posted by Uff-Da! View Post
Sounds as though what you need to do is a proper basal test. This involves taking your BG at bedtime, making sure that you haven't eaten anything or made any bolus corrections for five hours. The last meal you've eaten before this should be light, without an overabundance of protein or fat. That's because roughly half of protein can be converted to glucose and can take five hours (occasionally even more) to do so, thus raising your BG hours later. And the fat just slows down the whole digestion, again causing an increase in BG in the middle of the night.

After taking your bedtime reading, set the alarm for every two hours and get up and take your BG. You need to know whether there is a gradual climb between bedtime and morning (which indicates too little Lantus), or if the climb starts about 3 or 4 AM like mine does (which indicates dawn phenomenon and needs more insulin starting in the early morning hours) or if the BG drops to a hypo range during the night, then increases in a rebound or Somogi effect from the liver, which requires less insulin to prevent the hypo. Testing every hour would be even better, but who wants to stay up all night?

I suggest you look up both "dawn phenomenon" and "Somogi effect" on the web. There are dozens, maybe hundreds, of articles about these night time changes in BG.
Ok, just tried to do my best yesterday. All day I went very low carb and my numbers dropped (a little too fast) because I've been used to such highs that a slight amount lower made me feel shacky as ever. Mind you, my numbers have been in the 200-300's so these numbers are great for me. This is what happened:

10am 146
2pm 119
5pm 144
7:30pm 156 Started feeling very shaky and had 1 slice of wheat bread with peanut butter.
10pm 242 (bedtime) Had 30 units of Lantis
3AM 257
7AM 262 wake up

 
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Old 04-17-2017, 06:57 AM   #7
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Re: Question about Lantus

It is strange that you started feeling shaky at BG 156 when you had had lower readings several times earlier that day. Sometimes the false hypo symptoms like shakiness occur due to the speed of a BG drop rather than because of the actual BG number.

I would personally have tried to "tough it out" if I started getting false hypo symptoms at a BG of 156. But I don't believe I get as strong symptoms as many other people, both because of my age (the elderly often lose some of the symptoms) plus I'm on medications that can tend to mask them. So you're the only one who can decide what your level of tolerance for the symptoms is. As your average BG goes down, the point at which false hypo symptoms appear should go down, too.

A slice of bread with peanut butter is probably around 18 grams of carbohydrate. That's probably more than a person should take for a false hypo. I've done some testing on myself and discovered that for me a 4-gram carb glucose tab will raise my BG 32 to 40 points, assuming I don't have any bolus on board. So I never take more than 4 grams for a hypo unless I have reason to believe my BG is going to drop lower. Now I know that my BG is far more sensitive to carbs than average. But I'd suggest that you plan for what to do about hypos or false hypos that won't raise your BG as much as the bread did this time. You'll want to gradually push your symptom level down to around 70 mg/dl.

Your BG level only increased 20 points between 10 PM and 7 AM, so that's pretty close to being the right level of basal. If it were me, I'd give it another test or two at the same basal level before deciding whether to keep it at the same level or change it. Confer with your doctor before changing it, unless he's already given you the okay to do your own adjusting.

 
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Old 04-17-2017, 07:23 AM   #8
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Re: Question about Lantus

Thank you so much. Will give it another try today. You are helping me SO much. So let me get this right. If I feel shaky, only about 4 grams of carbs should help (and retest) Hmmm wondering what 4 grams is. Any ideas?

 
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Old 04-17-2017, 11:37 AM   #9
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Re: Question about Lantus

While 4 grams carb raises my BG 32-40 points, it might raise yours only one-forth that amount. People are very different on that, depending upon their weight and specific carb sensitivity. At some point you'll want to do your own testing. You could try testing with milk, which doesn't raise one's BG quite as fast as a glucose tab. Milk has about 12 grams carb per cup. So if you tested half a cup some time when you are at least five hours past your last bolus, you could test again in an hour or hour and a half and get a pretty good idea of how much six grams raise you. Then you could judge what is likely to happen in the future. Of course if you've taken a bolus just a few hours before so there is extra glucose in your system that will continue to lower you and you are actually hypo (under BG 70), you might need a lot more.

I believe lifesavers are about 5 grams each. I keep a hard candy in my purse and at my nightstand to deal with unexpected real hypos. The medics recommend glucose tabs instead, but I don't see that they are enough faster to warrant having to eat the yucky things. The advantage, though, would be for someone trying to lose weight. They wouldn't be too likely to eat more than they really needed just because of their taste, as they might with candy.

 
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