Another Lantus low

[broccoliSK]

Hi everyone,

I just need to get this off my chest. A few days ago, I injected Lantus (12 units) and must've hit a vein or something, because after 20 minutes I started feeling very dizzy, measured my blood sugar and was at 1.2 mmol/l, which is the lowest reading I've ever seen. I live alone for the most part, so there was no one to help, but I managed to drink a bunch of juice and eat some honey and my blood sugar slowly crept up. For 15 minutes or so I genuinely thought I was gonna die. Needless to say, I'm quite shaken by the experience.

This has happened to me once before, about 2 years ago. For the moment, I'm measuring my BG 15-20 minutes after injecting Lantus so as to prevent any unpleasant surprises.

Here's a disconcerting thought though - what if you accidentally inject bolus insulin into a vein? Does it get consumed and lower your BG within minutes or seconds, giving you essentially no warning?

I'm also tagging @tim2000s as I recall he had lots of information on how Lantus works.

 

[Antje77]

Happy you're here to tell us!
It happened to me once, and yes, I thought I wouldn't wake up again too. Luckily I did, and after a couple of days of upturning the internet concluded I had had one of those Lantus lows.
It scared the **** out of me and I switched to Tresiba the next day after basically telling my HCP I wasn't going to take my Lantus anymore.

what if you accidentally inject bolus insulin into a vein?

Nothing. Lantus is as far as I know the only insulin that can do this because of the way it works.
It's made slow acting by having it react with the fatty tissue under your skin. If it doesn't react with that because it hits the bloodstream it's not long acting anymore.
Other long acting insulins are made long acting by different means.

 

[broccoliSK]

@Antje77 Thank you for the reply. My doc wanted to put me on Toujeo but since that's still insulin glargine, I figured I'd stick with Lantus for now as it works well for me (when it doesn't have side-effects, that is).

Nothing. Lantus is as far as I know the only insulin that can do this because of the way it works.

Really? Is that true even for fast-acting insulins like Humalog or Novolog? I've found quite a few articles about Lantus lows but none about similar problems with fast-acting insulins.

 

[Antje77]

Really? Is that true even for fast-acting insulins like Humalog or Novolog? I've found quite a few articles about Lantus lows but none about similar problems with fast-acting insulins.

Yes, none of them do the reacting with fat thing. They'd possibly act a little quicker but nothing like the trick Lantus can pull.

 

[scotteric]

@Antje77 Thank you for the reply. My doc wanted to put me on Toujeo but since that's still insulin glargine, I figured I'd stick with Lantus for now as it works well for me (when it doesn't have side-effects, that is).



Really? Is that true even for fast-acting insulins like Humalog or Novolog? I've found quite a few articles about Lantus lows but none about similar problems with fast-acting insulins.

It's not that the other insulins can't, but more that with Lantus you are generally taking much larger doses than with rapid-acting insulin and they aren't being taken for food, so if you inject into blood there is nothing to prolong the absorption and it will act just like you had injected NovoRapid or Regular/Actrapid into blood. You can try Levemir or Tresiba instead which are much safer options. These basal insulins bond with the albumin in your blood, so they won't drop you low even if injected straight into blood.

 

[EllieM]

You can try Levemir or Tresiba instead which are much safer options. These basal insulins bond with the albumin in your blood, so they won't drop you low even if injected straight into blood.

So why do doctors start with lantus rather than Levemir/Tresiba? Is it a cost issue?

 

[Antje77]

So why do doctors start with lantus rather than Levemir/Tresiba? Is it a cost issue?

Because lots of people are on Lantus and it works pretty good for many. Levemir is more of a hassle, as it has to be taken twice a day, Tresiba is possibly more expensive and newer so less known and Lantus has proved itself as a very useful insulin.
It's not like all people on Lantus have horrible lows all the time or such. Your HCP has probably never heard of those lows, and neither of the joints/muscle aches that are a rare side effect. Why would they not prescribe Lantus?

 

[scotteric]

So why do doctors start with lantus rather than Levemir/Tresiba? Is it a cost issue?

It just depends on your doctor. I was prescribed Levemir when I was diagnosed. You would be surprised how much they don't know about basal insulins. Lantus was the first basal insulin analogue, but that doesn't mean it's the best.