Does Lantus Have A Peak?

[azizdhl]

Hi guys,

I switched to lantus a few days ago ONLY for the reason that it doesn't have any peak time unlike Insulatard which I had many many hypo with it during my sleep. So at the first day of my Lantus + Novorapid changeover I took my 3 unit novorapid at 10pm with my dinner ( 36g carbs ) and 15 unit of Lantus at 10:30pm. My BG was 124 before dinner.. 3 hours later go down to 51 then i took 31g of carb to sleep without scared of hypo, 45min later BG go up to 84 then I sleep. 2 hours and half my mother woke me up with BG 59!!! which is exactly after 6 hours of last novorapid injection and 5.5 hours of last lantus injection.

then my friend told me that Lantus may have some peak for some people, I was really disappointed, this changer over cost me almost 1000usd. now does lantus have a peak? why there is no profile graph showing that peak? or the second hypo happened with me because of novo affect which i thought that i does make a big differ like that only with first three hours?

 

[Deleted Account]

In my experience, Lantus has a small peak after about 3 hours.
If you take a look here: https://www.diabetes-support.org.uk/info/?page_id=408, you will see the peak.

For this reason, I took my Lantus with my evening meal rather than just before I went to bed - to avoid night time hypos.

I am not sure about Insulatard but some insulins stay in your body for a few days.
Although the strength of them deteriorates pretty quickly, the low level amounts may affect your BG when you switch from one insulin to another. This may (or may not) be causing your recent hypos.

My other thought is whether your dose is correct.
I cannot advise on what dose you need to take as we all differ.
But perhaps you could notch the Lantus down a little for a week and gradually bring it up until your night time BG is level.
The usual advice is to give Lantus at least 3 days to "bed in" when you make a change.

 

[Circuspony]

I took Lantus in the morning to avoid night time hypos - on the advice of my consultant.

 

[scotteric]

Hi guys,

I switched to lantus a few days ago ONLY for the reason that it doesn't have any peak time unlike Insulatard which I had many many hypo with it during my sleep. So at the first day of my Lantus + Novorapid changeover I took my 3 unit novorapid at 10pm with my dinner ( 36g carbs ) and 15 unit of Lantus at 10:30pm. My BG was 124 before dinner.. 3 hours later go down to 51 then i took 31g of carb to sleep without scared of hypo, 45min later BG go up to 84 then I sleep. 2 hours and half my mother woke me up with BG 59!!! which is exactly after 6 hours of last novorapid injection and 5.5 hours of last lantus injection.

then my friend told me that Lantus may have some peak for some people, I was really disappointed, this changer over cost me almost 1000usd. now does lantus have a peak? why there is no profile graph showing that peak? or the second hypo happened with me because of novo affect which i thought that i does make a big differ like that only with first three hours?

How do you know your Lantus dose is correct? You may need less. You may also need different amounts during the night and day. Some people split the dose and take it before bed and when they wake up, taking different amounts to solve this problem. I do this with Levemir, as typically I need more basal insulin at night than I do during the day. You may need less, but you can only figure this out through trial and error (and, most importantly, testing). Remember also many things can affect your basal dose, and it isn't necessarily the same every day. If I am generally stressed in life I need more. When the weather changes I need more or less (not kidding). If I eat a high-protein/fat, slow-digesting meal I need more at night. If I've barely eaten or barely eaten carbs all day I need way less. I change the dose on a daily basis depending on what I anticipate I will need. Sometimes I'm right and sometimes I'm wrong, consequently I might wake up high or low. It's just the reality of diabetes and the current treatments we have for it.

 

[azizdhl]

How do you know your Lantus dose is correct? You may need less. You may also need different amounts during the night and day. Some people split the dose and take it before bed and when they wake up, taking different amounts to solve this problem. I do this with Levemir, as typically I need more basal insulin at night than I do during the day. You may need less, but you can only figure this out through trial and error (and, most importantly, testing). Remember also many things can affect your basal dose, and it isn't necessarily the same every day. If I am generally stressed in life I need more. When the weather changes I need more or less (not kidding). If I eat a high-protein/fat, slow-digesting meal I need more at night. If I've barely eaten or barely eaten carbs all day I need way less. I change the dose on a daily basis depending on what I anticipate I will need. Sometimes I'm right and sometimes I'm wrong, consequently I might wake up high or low. It's just the reality of diabetes and the current treatments we have for it.

hI, I really appreciate your answer

whe you siad spilt the dose one before skeep and the other one we wake up.. how can I spilt two doese within few hours only? wouldn't that rise the chance of hypo where two doese will be effective as the same time?

 

[azizdhl]

In my experience, Lantus has a small peak after about 3 hours.
If you take a look here: https://www.diabetes-support.org.uk/info/?page_id=408, you will see the peak.

For this reason, I took my Lantus with my evening meal rather than just before I went to bed - to avoid night time hypos.

I am not sure about Insulatard but some insulins stay in your body for a few days.
Although the strength of them deteriorates pretty quickly, the low level amounts may affect your BG when you switch from one insulin to another. This may (or may not) be causing your recent hypos.

My other thought is whether your dose is correct.
I cannot advise on what dose you need to take as we all differ.
But perhaps you could notch the Lantus down a little for a week and gradually bring it up until your night time BG is level.
The usual advice is to give Lantus at least 3 days to "bed in" when you make a change.

thank you so much for your amazing answer.

is it right that when changing frim insulin type to another it take 3 days for thexample new type to start showing the result?

and one more question.. does lantus really cover 24 hours? coz I noticed that after 18 hours if I eat a tiny thing my bg go up quickly.. how can I make sure that I doesn't work for me after 18 hours should I test every hour after the 18 hours till next injection time to see if the blood is rising? If I didn't eat after that 18hours and tested every hour will I see any rising or it will be stable?

 

[Deleted Account]

thank you so much for your amazing answer.

is it right that when changing frim insulin type to another it take 3 days for thexample new type to start showing the result?

and one more question.. does lantus really cover 24 hours? coz I noticed that after 18 hours if I eat a tiny thing my bg go up quickly.. how can I make sure that I doesn't work for me after 18 hours should I test every hour after the 18 hours till next injection time to see if the blood is rising? If I didn't eat after that 18hours and tested every hour will I see any rising or it will be stable?

My understanding (and I have experienced some of this when changing from Lantus to a pump) is that there was a low level of Lantus in my body for a few days which lowered my BG.
However, the usual level of Lantus does not last for 24 for all people - quite a few need to take two doses twelve hours apart.
I have no idea if this is the case for Insulatard: it is just a theory.

As for mentioning 3 days, this is the recommended time to allow a change to take affect and see what the impact is.
This is probably due partially to the insulin but I suspect also because BG is not 100% predictable and it is best to change doses based on trends over a few days rather than what you see on one day.

 

[scotteric]

hI, I really appreciate your answer

whe you siad spilt the dose one before skeep and the other one we wake up.. how can I spilt two doese within few hours only? wouldn't that rise the chance of hypo where two doese will be effective as the same time?

Ideally you would want to take about half of your total daily dose approximately 12 hours apart instead of the total dose at once, and that way each half dose should last about half the amount of time and there will be no overlap. Of course it doesn't always work this way and there will be overlap, but you can experiment with the timing of doses and amounts to deal with this. Many people split simply to get more even coverage over 24 hours, because as you noticed, it doesn't last that long for most people. The duration is dose-dependant to an extent, meaning that if you take less units it will not only not be as strong but not last as long. The amount you take is not just spread evenly over 24 hours as the pharma company would have you believe. If you look at the literature you will see the doses that last 24 hours are usually much higher than what the average person would take.

 

[scotteric]

hI, I really appreciate your answer

whe you siad spilt the dose one before skeep and the other one we wake up.. how can I spilt two doese within few hours only? wouldn't that rise the chance of hypo where two doese will be effective as the same time?

Remember also that some overlap can be used to your advantage. For example when I use Levemir I take my morning dose 10-11 hours after my bedtime dose intentionally to have a couple hours of overlap. This helps with the dawn phenomenon and with controlling breakfast spikes which are often the worst of the day. The key is to experiment as safely as you can, forget arbitrary rules or how things are supposed to work, and find out what works best for you.

 

[alphabeta]

Hi guys,

I switched to lantus a few days ago ONLY for the reason that it doesn't have any peak time unlike Insulatard which I had many many hypo with it during my sleep. So at the first day of my Lantus + Novorapid changeover I took my 3 unit novorapid at 10pm with my dinner ( 36g carbs ) and 15 unit of Lantus at 10:30pm. My BG was 124 before dinner.. 3 hours later go down to 51 then i took 31g of carb to sleep without scared of hypo, 45min later BG go up to 84 then I sleep. 2 hours and half my mother woke me up with BG 59!!! which is exactly after 6 hours of last novorapid injection and 5.5 hours of last lantus injection.

then my friend told me that Lantus may have some peak for some people, I was really disappointed, this changer over cost me almost 1000usd. now does lantus have a peak? why there is no profile graph showing that peak? or the second hypo happened with me because of novo affect which i thought that i does make a big differ like that only with first three hours?

Before you panic, can you please keep a space of 4 hours between Novorapid injection and Lantus? And 124 is considered a bit low for a Lantus injection, 144 or 8.0 is the lower limit for type 1 diabetics before taking Lantus. Anyway, Lantus should account one third to one half of your total daily insulin needs. According to Novo Nordisk, you can read it on the Novorapid leaflet that Novorapid should cover 50% to 70% of total daily insulin needs. The rest should be covered by the long acting. What are your total Novorapid needs?
The slight peak in Lantus is barely noticed at 3 to 5 hour mark but as I mentioned earlier, you might be going to bed at lower reading than usual, and I assume you are taking Lantus and Novorapid together. I avoid doing so in order to pinpoint the changes in BG whether being caused by the basal or bolus.

 

[Deleted Account]

Before you panic, can you please keep a space of 4 hours between Novorapid injection and Lantus?

What is your reason for suggesting this?
For about 10 years, I took one immediately after the other (because it was convenient and advised by my diabetes team) and experienced no adverse reactions.
To be honest, whilst I am awake, I rarely go 4 hours without eating so would struggle to have such a break between basal and bolus. Doubly so if I was to split the basal dose.

 

[alphabeta]

What is your reason for suggesting this?
For about 10 years, I took one immediately after the other (because it was convenient and advised by my diabetes team) and experienced no adverse reactions.
To be honest, whilst I am awake, I rarely go 4 hours without eating so would struggle to have such a break between basal and bolus. Doubly so if I was to split the basal dose.

I explained it, if you get any hypos, how would you know which insulin caused it? Mind you that OP is still newly switched over to Lantus and Novorapid

 

[scotteric]

Lantus takes 2-3 hours to kick in and should be taken around the same time every day. It doesn't matter if it is taken at the same time as rapid insulin. I am not familiar with any rule stating your blood sugar needs to be a certain number before taking it. It's a basal insulin and if it's taken at the right dose it should keep your blood sugar stable for its duration. In reality it may have a peak that differs depending on the dose and user, but arbitrary rules like "never be below a certain number before injecting" aren't helpful.

 

[alphabeta]

Lantus takes 2-3 hours to kick in and should be taken around the same time every day. It doesn't matter if it is taken at the same time as rapid insulin. I am not familiar with any rule stating your blood sugar needs to be a certain number before taking it. It's a basal insulin and if it's taken at the right dose it should keep your blood sugar stable for its duration. In reality it may have a peak that differs depending on the dose and user, but arbitrary rules like "never be below a certain number before injecting" aren't helpful.

Actually that's what my nurse told me when I switched to Lantus. Never be below 140s mark because she wanted to eliminate the risk of a nocturnal hypo. Regarding the time of injection, we already know that Lantus lasts for around 18 to 20 hours for most users, for me around 19 hours. If I were able to take Lantus at 11 PM instead of 8 PM that will cover me extra hours during the day. Mind you, OP recently changed insulin so he is still not completely settled down at a dose. It took me around 1.5 months to find my sweet spot. Running slightly higher around the 170-200 mark might sound reasonable before bed until you know your dose sounds very comforting to me as a type 1 diabetic. It won't cause any damage BUT AGAIN I am not a professional and that is just a personal opinion and perspective.

 

[evilclive]

Shouldn't the blood sugar level when going to bed be the same as when waking up if you've got the Lantus dose right? Yes, maybe start with a buffer for a bit if you don't have an alarm, so if the dose is high you reduce the risk of hypo, but in not very long after tweaking the dose you should know that dose X doesn't drop your sugars over night, so it's safe to start reducing that buffer.
It sounds like you've implied this with "until you know your dose", but you did say "Never be below 140s mark", rather than "at the beginning, run a big higher".

 

[azizdhl]

Actually that's what my nurse told me when I switched to Lantus. Never be below 140s mark because she wanted to eliminate the risk of a nocturnal hypo. Regarding the time of injection, we already know that Lantus lasts for around 18 to 20 hours for most users, for me around 19 hours. If I were able to take Lantus at 11 PM instead of 8 PM that will cover me extra hours during the day. Mind you, OP recently changed insulin so he is still not completely settled down at a dose. It took me around 1.5 months to find my sweet spot. Running slightly higher around the 170-200 mark might sound reasonable before bed until you know your dose sounds very comforting to me as a type 1 diabetic. It won't cause any damage BUT AGAIN I am not a professional and that is just a personal opinion and perspective.

rally appreciate your answer.

you said that lantus are working 19hours for you.. please tell how are you covering the 5 hours left? if you didn't eat anything during that 5 hours will the blood glucose will be rising or stay stable?

am having the same issue but for me it's 18 hours.. am considering changin my dosecond to 6am so the 18hour's will finish when am sleepin at 1am.. will that will rise my BG at the morning?

 

[alphabeta]

Shouldn't the blood sugar level when going to bed be the same as when waking up if you've got the Lantus dose right? Yes, maybe start with a buffer for a bit if you don't have an alarm, so if the dose is high you reduce the risk of hypo, but in not very long after tweaking the dose you should know that dose X doesn't drop your sugars over night, so it's safe to start reducing that buffer.
It sounds like you've implied this with "until you know your dose", but you did say "Never be below 140s mark", rather than "at the beginning, run a big higher".

Regarding the 140s mark it seems to be creating a bit of a point of an argument here. Strange. This is exactly what my nurse told me, however, Lantus might not necessarily work the same same for us all! In fact, not even the same for me anymore! I used to drop around 70 points on Lantus alone and if I reduced by even one unit I would wake up higher. I had no option. Now I am on way less Lantus and I do wake up same as I sleep, it does go down a bit but then it goes up back to its initial levels. I was on 19 units, now I am on 8 units. I was unable to be even on 18 units but heaven knows what diabetes wants to act like.

 

[alphabeta]

rally appreciate your answer.

you said that lantus are working 19hours for you.. please tell how are you covering the 5 hours left? if you didn't eat anything during that 5 hours will the blood glucose will be rising or stay stable?

am having the same issue but for me it's 18 hours.. am considering changin my dosecond to 6am so the 18hour's will finish when am sleepin at 1am.. will that will rise my BG at the morning?

For me, I take Lantus at about 11 PM but I try to push it as late as possible to gain extra time in the day. It runs out about 6:30 or 7 o'clock and starts rising because there is no insulin on board. Personally, I was going to switch to Tresiba as an ultra long acting insulin (up to 42 hours) but I had few problems and I haven't switched. You can have a snack and take insulin at around the time you feel that you are going to be out of insulin and that is something I did at 6 PM then dinner at 9PM (beware not to stack insulins Novorapid might need 4 hour separation between doses) or sometimes I can be around 140s to 160, I used to (and still) take 1 unit bolus without eating food or 2 unit if I want to eat some nuts and some tea so by dinner I would be perfect. There is one thing I might do more which is taking Lantus 12 hours apart (I need to see my nurse first and so do you) where I take 1 unit only at 11 AM or 12 PM. I only did this once and my sugar was 114 mg/dl by dinner compared to low 200s. Please do not take my advice as a professional opinion, I am not a doctor, just a type one diabetic who have been theough lots of mistakes.

 

[scotteric]

Actually that's what my nurse told me when I switched to Lantus.

Nurses and CDEs give all kinds of terrible advice. I'm not saying there aren't good ones but most are more concerned about hypos than maintaining normal blood sugars. If injecting Lantus at a higher blood sugar helps you then by all means do it, I just personally hate these rules that nurses and CDEs who don't have type 1 themselves quote as dogma.

 

[scotteric]

beware not to stack insulins Novorapid might need 4 hour separation between doses

This is also not true. You do not need to eat to take NovoRapid if you are taking a correction dose and you do not need to wait 4 hours between doses. You can dose every time you are eating and every time you need a correction. It is not stacking if you are dosing to eat more food and dosing according to the carbs.