Tired of hypos

[jessie]

Hi,

I'm hoping someone may be able to help... I am attempting to fine tune my Lantus at the moment because I seem to have a pattern of fairly high readings 2 hours after eating (7-10) and most days I'll have a hypo before lunch (when I start getting hungry) and another late afternoon. I can deal with my lows quite easily because I'm expecting them and I try and snack on nuts etc - but I'm aware that by doing this I'm 'feeding my insulin' and I shouldn't really need to eat so much in between meals. I follow a relatively low carb diet and count my carbs very carefully. I find that I do need to take a bit more insulin in the evenings and I never seem to hypo after my evening meal.

I take 3 units of Lantus just before breakfast (7.30am) and 4 before dinner (6.30pm). This seems like quite small amounts compared to some people and I'm worried about dropping it any further, is there a minimum amount of basal insulin that we need?!

Regular hypos are starting to become quite draining so I'd love to sort this out.

Thanks :wink:

 

[tasha]

Hi Jessie,

I had the same problem for years and was also convinced it was the lantus. I persuaded my doctor to let me try Levemir which I found instantly better. At the time, my DN was quite angry that I changed telling me it would make no difference. She insisted that looking at my results it was my quick acting insulin that was the problem. I argued that my elevated morning readings but many hypos 3-4 hours after eating didn't make sense (not necessarily morning effect because it happened irregularly).

She suggested that I give the Levemir a try (very reluctantly) but insisted I try apidra. It is a much quicker acting insulin than novarapid. She was convinced that my hypos up to 4 hours after eating were not down to my background insulin but the novarapid still working in my system. Apidra only lasts for approx 2 hours whereas novarapid can stay active for double that. As I was also eating a reduced carb diet it kinda made sense.

Anyway, I'm rambling. The fact is, she was right! I have changed to levemir and I find it much more predictable than the lantus I was on for 6 years. But, the apidra has fine tuned it even further. My HBA1c has dropped by nearly 0.5% in only 3 months whereas it had stuck on exactly the same reading for over 2 years previously.

Hope that made sense!
Tasha

 

[jessie]

Hi Tasha,

Thank you for the suggestion - it definately sounds like an option. I will speak to my DN about it next time I see her. Glad you've got your readings under control and things are going well!

All the best,

Jessie.

 

[Slinger]

i think that you need to fine tune ur quick acting insulin and not ur lantus. but if you are sure u want to fine tune ur lantus how are u doing it. do u wait 3-4 days before making any adjustment. it will take that long for ur body to settle to the new dose. also when u do change it, r u only making 10% changes

Ste

 

[jessie]

Hi Ste,

Yes I have only taken my Lantus down by 1 unit (from 8 to 7 per day) and have been taking this amount for a week now. If I drop my Novorapid it might help with hypos but then the highs I'm having 2 hours after eating are going to get worse. It's so difficult to get it right!!

Jessie.

 

[LittleSue]

Jessie, can you adjust by half-units? If not, bet a half-unit pen. With small doses a 1 unit change can be way too much.

I'm on small doses too and find Levemir much better than Lantus.

 

[jessie]

HI Sue,

My Lantus doesn't do half units unfortunately but I recently changed my NovoRapid to a half unit pen and it made a great difference. So I'll look in to it...

Thanks!

 

[LittleSue]

I changed my Levemir to a half-unit pen as soon as I found out they existed, then the Humalog one much later. The Levemir one definitely made the most difference. After all, you can eat a little extra with a meal to 'round up' to the next unit, but half a unit too much/too little of Levemir/Lantus will affect you all day or all night.

 

[iHs]

HI Sue,

My Lantus doesn't do half units unfortunately but I recently changed my NovoRapid to a half unit pen and it made a great difference. So I'll look in to it...

Thanks!

Hi Jessie

Although Aventis don't make a half unit pen for Lantus or Apidra, you can use their cartridges in a Lilly Humapen Luxura HD which delivers in half unit increments.

Littlesue is right. Half unit up or down of Lantus or Levemir can make a huge difference to bg levels.

 

[Sweet3x]

You can take Lantus more than once a day?
I didn't know that!
You do realise it lasts 24 hours, yes?
Learn something new every day

 

[jessie]

Thanks guys,

I can see how those half units could make a difference, I think I'm due an appointment soon so I'll ask about it.

Hi Sweet3x, you can split your Lantus as some people find it doesn't quite last the full 24 hours. I was getting some higher readings in the evenings so that's why I did it. I think it's helped a bit.

Jessie.

 

[LittleSue]

Edited to remove duplicated message. Some kinda glitch happened

 

[LittleSue]

If your GP/DSN isn't clued up about half-unit pens, if necessary email the manufacturers to confirm the pen is suitable for your cartridges. Then ask your GP/DSN to either prescribe it or get the company rep to deliver one to them. I got my hospital DSN to get it from the rep, as I wasn't confident I'd get the right one via the GP surgery.

My bs has been erratic for a few days, wondered if I was getting a cold or something. Increased my bedtime Levemir by half a unit last night. Tested 4 times between midnight and 7am (for safety, because I can sleep thru hypos) and bs hardly moved, compared with rising by 4 to 10mmol overnight before! Surely a whole unit extra would've been too much. Everythings far more stable if basal is precisely set. Just half a unit too low and bs bounced around like mad.

 

[Sweet3x]

Hi Sweet3x, you can split your Lantus as some people find it doesn't quite last the full 24 hours. I was getting some higher readings in the evenings so that's why I did it. I think it's helped a bit.

Jessie.

Cool something to remember for the future

 

[Sweet3x]

oh, one other thing You said in your first email that you get high bs 2 hours after eating. My doctor explained to me that this is because the insulin I was on (Humalog) works for 3 hours after taking it. She said that bs of up to 10 2 hours after eating was fine. I should check my bs 3 hours after eating, and it should then be back to normal. I now test my blood 3 hours after, and she's right they are always back to normal. When I was basing it on 2 hours after, I'd take more insulin, and go hypo.

 

[jessie]

Hi Sweet3x,

It's interesting what you say, I'm on NovoRpaid and when testing after 3 hours my levels are OK, it's just the 2 hour ones that have been concerning me.

My DN actually told me I didn't need to test between meals - that if my before meal readings were OK then that was all that mattered. I took advice from this forum though and decided to test 2 hours after eating. Maybe I shouldn't worry so much if my 3 hour ones are OK?? Or is there anything stopping us from taking bolus about half an hour before eating?

Sue - the half units definitely make a huge difference. I must get my basal sorted!

Jessie.

 

[kegstore]

Jessie

I know I'm on a pump. but the principle's the same. NovoRapid is already a fairly fast acting insulin, so my advice would be to be a bit careful about how long before a meal you take it. Tricky to do too if you're not hyper-organised or are eating out. Oh dear that says a fair bit about me...

It's interesting how the advice we are all given varies. The post-meal bg reading is the only way you know your meal bolus was correct, so it's vital piece of the puzzle. The 2 hour post-meal reading gives you a good idea of this, and should be no higher than 2 mmol/l above the pre-meal value. So if your pre-meal was 8 THEN your post-meal can go up to 10 and you're "within tolerance". At least this is what I've experienced, albeit lower down the scale.

I was very interested to read about Apidra, someone mentioned it in this thread, sorry I can't remember who.

Jo

 

[jsn]

Just a quikie - i'm type 1 (35 yrs,since the age of 5!) and use Lantus, usually 26-28 units once a day,Bovine (beef insulin) for meals. I went through a phase of having severe night time and early morning hypos - seizures, the full works! So my nurse suggested having my one Lantus shot in the morning,on waking which helped hugely - also not having a before bed jab (Lantus) free's up your evening! you potentially can stay out late (with dextrose tabs in pocket) without the need to inject at a certain time before bed, also I haven't had a severe night hypo since - about 2 years now,however I do have plenty of day time hypo prob's which is a seperate issue!!
ps - any questions, ask your nurse not a so-called 'Diabetes Specialist' my experience of them is that they contribute virtually nothing to my diabetes care, and believe me i've had a lot of balance problems - signed off work for last 6 months! NO hypo awareness! Also I've read that 'Human' insulins were clinically trialed for only 5 months before release - they are cheaper than refined animal insulin so were launched a.s.a.p! They also have reduced my Hypo awareness - which has lead to A LOT of problems....