When is a good time to inject Lantus?

[Celsus]

The 'old school' tradition of taking long-acting insulin in the evening before bedtime is actually no longer relevant with the modern glargine types of insulin (e.g. the Lantus). And especially not if you are no longer a teen/young adult and need to counter the dawn-effects from growth hormone being released in your early sleep phase. I am maybe myself one of the lucky ones, but tested that the Lantus typically stays active in my body for 22-26 hours. So I can do perfectly fine with just one daily injection of this. And I changed 7+ years ago, to take this in the morning instead. I have virtually not had one single night-hypo since then! What a world of a difference that makes to quality of life, for yourself and but also for your nearest and dearest that alternatively would have to deal with getting some sugar into that brain-fogged lunatic. Yeah, those hypnotic night-hypos could really take us on some 'LSD-inspired trips' in the good old days.

And the advantages of taking the Lantus in the morning are many, beyond most important mentioned above (No more night hypos during sleep!):
1. You take then the Lantus typically at home, and do not need to bring the extra pen with you at night going out.
2. You take it then typically together with your morning fast-acting shot. So you do not forget it either. And its typically then also always at the same time every day.
3. When you take it in the morning, then any peak that you might experience in effect will then typically come 4-6 hours after injection. Meaning that you will always be awake (compared to if you took it at night time), and thereby are conscious if you need to counter with sugar or not.

If your Lantus does not give you full 24h coverage, then you may need to split it up in two shots per day. I would then suggest morning shot with breakfast, and combo shot for dinner. So no shot just before going to bed. If you can avoid the habit of eating bednight snack, then that will still be very manageable and you still get advantage of no hypo during sleep. When dosed correctly, then your basal rate of Lantus will give you a completely flat bg curve during the day and night. Meaning that after e.g. 10pm at night (dinner all digested, and no late night snack before bedtime), then I am in perfect steady state till I wake up. I measure my bg just before bedtime, just to make sure I am at perfect level. (alternatively I adjust with a few grams of carb or 1 unit of fast acting insulin).

 

[tim2000s]

@CyberDyme, what can I say. You are one of the lucky ones. I found Lantus didn't last 24 hours and used to have variable absorption rates so it was very far from a flat basal insulin. Each of us is affected differently it would seem.

 

[Celsus]

@CyberDyme, what can I say. You are one of the lucky ones. I found Lantus didn't last 24 hours and used to have variable absorption rates so it was very far from a flat basal insulin. Each of us is affected differently it would seem.

Yeah Tim, we are all wonderful unique individuals!
What is your total daily dose of fast and long-lasting? Seen anecdotal evidence that hints towards those with higher total daily requirements typically cannot do just with one daily injection of the long-acting to cover well the full 24h cycle. My own total daily intake is typically 11 fast + 12 long.
You or anybody else with experience using the new Tresiba insulin? Allegedly it should last up to 42h for some. I intend to switch myself when seeing more clinical evidence from phase-4 trial data on effect and observed side-effects.

 

[Eldorado]

The 'old school' tradition of taking long-acting insulin in the evening before bedtime is actually no longer relevant with the modern glargine types of insulin (e.g. the Lantus). And especially not if you are no longer a teen/young adult and need to counter the dawn-effects from growth hormone being released in your early sleep phase. I am maybe myself one of the lucky ones, but tested that the Lantus typically stays active in my body for 22-26 hours. So I can do perfectly fine with just one daily injection of this. And I changed 7+ years ago, to take this in the morning instead. I have virtually not had one single night-hypo since then! What a world of a difference that makes to quality of life, for yourself and but also for your nearest and dearest that alternatively would have to deal with getting some sugar into that brain-fogged lunatic. Yeah, those hypnotic night-hypos could really take us on some 'LSD-inspired trips' in the good old days.

And the advantages of taking the Lantus in the morning are many, beyond mot important mentioned above (No more night hypos during sleep!):
1. You take then the Lantus typically at home, and do not need to bring the extra pen with you at night going out.
2. You take it then typically together with your morning fast-acting shot. So you do not forget it either. And its typically then also always at the same time every day.
3. When you take it in the morning, then any peak that you might experience in effect will then typically come 4-6 hours after injection. Meaning that you will always be awake (compared to if you took it at night time), and thereby are conscious if you need to counter with sugar or not.

If your Lantus does not give you full 24h coverage, then you may need to split it up in two shots per day. I would then suggest morning shot with breakfast, and combo shot for dinner. So no shot just before going to bed. If you can avoid the habit of eating bednight snack, then that will still be very manageable and you still get advantage of no hypo during sleep. When dosed correctly, then your basal rate of Lantus will give you a completely flat bg curve during the day and night. Meaning that after e.g. 10pm at night (dinner all digested, and no late night snack before bedtime), then I am in perfect steady state till I wake up. I measure my bg just before bedtime, just to make sure I am at perfect level. (alternatively I adjust with a few grams of carb or 1 unit of fast acting insulin).

Interesting, thanks. If you split the Lantus dose, do you split it equally, ie take the same morning and evening?
Yes, it's a huge relief to be free of the dreaded nighttime hypo.

 

[Celsus]

We all have different metabolism, so we are all different in many ways. You should split the dose based on what's best for you and gives you the best results. For some (especially younger people) you typically see a slight insulin resistance going up at night (growth hormones, ect), so nighttime dose is often set about 15-25% greater than daytime. My own two-split regime would be at 50/50. Fun observation is that I need slightly more in total when just taking one daily dose compared to if I split in two. (hinting towards not a 100% flat effect curve for me during all the 24 hours)

 

[tim2000s]

@CyberDyme, my tdd requirement with long acting for controlling fasting levels is 22u, which isn't massive. I use levemir because it gives me more flexibility due to activity levels and I can use it as two separate smaller basals that last around 12 hours. These then get modified according to activity and food to manage hypo and gluconeogenesis. It's all become a bit complex!

@robert72 and @smidge use Tresiba and are seeing good results. Don't think it would work so well for me though due to activity levels.

 

[Eldorado]

We all have different metabolism, so we are all different in many ways. You should split the dose based on what's best for you and gives you the best results. For some (especially younger people) you typically see a slight insulin resistance going up at night (growth hormones, ect), so nighttime dose is often set about 15-25% greater than daytime. My own two-split regime would be at 50/50. Fun observation is that I need slightly more in total when just taking one daily dose compared to if I split in two. (hinting towards not a 100% flat effect curve for me during all the 24 hours)

Thanks for your comments, Cyberdyme. I shall run all this past my GP tomorrow.