How do you get on with Lantus?

[Deleted Account]

I was on Novarapid for 12 years. Like you, I took Lantus before I went to bed and often went low in the night. Then I started to look at the profile of Lantus. Although Lantus is sold as a 24 hour flat profile (it is consumed at a constant rate), this is not strictly true: it rises after 1 hour with a peak at 6 hours and last 18 to 26 hours. (Take a look at http://www.diabetesnet.com/about-diabetes/insulin/insulin-action-time.)
In other words, if you take Lantus at 10pm, you are likely to get a low around 4am.
I overcame this by taking Lantus with my evening meal (about 7:30pm) and going to bed (around midnight) with a BG between 7 and 8mmol/l. With this regime, I avoided night time hypos and awoke with a BG around 5mmol/l.

Incidentally, I have written this in the past tense because I am now a pumper which allows me to change the basal profile to match the needs of my body.

 

[Mark14400]

Just injected 9 units of Lantus...BG now 8.9....not very good...2 hours after food though...will give another shot of 9 units in the morning and give it 2 days to see if things improve...?

 

[noblehead]

And...if I were to switch to mornings...should I take the glucose hit and not inject the night before and inject in the morning....?

Hi @Mark14400

Not sure what you mean here, but if you want to move the timing of your basal dose do so in small steps.

When I changed my basal timing with lantus I did so in 2 hour increments as this is what my DSN said to do, so if you inject at 9pm take the basal dose at 7 pm the next day and 5pm the next until you get to the time of day where you want to keep injecting your basal dose.

In answer to your earlier post, if your not experiencing night-time hypo's now with taking your basal at 9pm then why change things?

 

[endocrinegremlin]

I took lantus for years when it was the best thing available to me. I would say do NOT simply move your insulin from evening to night without help from some sort of consultant. That would leave you in a gap where either you could have more or less insulin on board than you should. Nurses are available over the phone. I would get in touch with your local hospital and try to be more assertive in regards to an appointment. I would also hassle your GP's office to see if they can provide some sort of help. Changing the timing of your lantus may help but it could also be the dose. Some take lantus twice a day to balance their levels. To answer another questions anyone can outgrow any insulin and it has nothing to do with age but just our bodies changing, our diabetes changing. There are many other insulins out there that can work in the background but if you are thinking such a radical change as night to morning doses I would not simply rely on the forum to help. Our experience makes us good at our diabetes but not yours.

 

[endocrinegremlin]

Just injected 9 units of Lantus...BG now 8.9....not very good...2 hours after food though...will give another shot of 9 units in the morning and give it 2 days to see if things improve...?

Lantus is not always a 50:50 insulin. So if you have decided to split your dose as other comments suggest than watch over them. It could be you need a more 70:30 split or such.

I would urge you to contact someone at your clinic to observe this. Such drastic changes can end badly.

Your post food bg has nothing to do with your lantus so you need to ignore that for one. Carb free testing will show what your lantus is doing when but as others pointed out if you are not actually going hypo I don't see why you would change things in such a radical way given they could make things a million times worse.

 

[Sibyl]

I was on Novarapid for 12 years. Like you, I took Lantus before I went to bed and often went low in the night. Then I started to look at the profile of Lantus. Although Lantus is sold as a 24 hour flat profile (it is consumed at a constant rate), this is not strictly true: it rises after 1 hour with a peak at 6 hours and last 18 to 26 hours. (Take a look at http://www.diabetesnet.com/about-diabetes/insulin/insulin-action-time.)
In other words, if you take Lantus at 10pm, you are likely to get a low around 4am.
I overcame this by taking Lantus with my evening meal (about 7:30pm) and going to bed (around midnight) with a BG between 7 and 8mmol/l. With this regime, I avoided night time hypos and awoke with a BG around 5mmol/l.

Incidentally, I have written this in the past tense because I am now a pumper which allows me to change the basal profile to match the needs of my body.

Yes I learned more about pump therapy yesterday at my last BERTIE class. Loved the way one insulin does both jobs. The slow background drip feed to match you individual needs and the fast acting food insulin. I have pretty even control at the moment using Lantus (11 units every morning) and Apidra as my bonus insulin. But I feel happier knowing that should that change the pump system is there.

 

[PansyP]

Just injected 9 units of Lantus...BG now 8.9....not very good...2 hours after food though...will give another shot of 9 units in the morning and give it 2 days to see if things improve...?

When I changed to taking 8 units in the morning instead of at night, it was four units at night followed by 8 the following morning. Higher blood sugar fasting but no hypos during the night.

However I did this in conjunction with the medics.

 

[Mark14400]

Hi @Mark14400

Not sure what you mean here, but if you want to move the timing of your basal dose do so in small steps.

When I changed my basal timing with lantus I did so in 2 hour increments as this is what my DSN said to do, so if you inject at 9pm take the basal dose at 7 pm the next day and 5pm the next until you get to the time of day where you want to keep injecting your basal dose.

In answer to your earlier post, if your not experiencing night-time hypo's now with taking your basal at 9pm then why change things?

It's just something I really don't want to experience and having read up on Lantus. It does suggest if you inject all Basal at night Insulin blood concentration does tend to max in the early hours of the morning. I will take your advice and discuss with my DSN first. Thanks

 

[noblehead]

It's just something I really don't want to experience and having read up on Lantus. It does suggest if you inject all Basal at night Insulin blood concentration does tend to max in the early hours of the morning. I will take your advice and discuss with my DSN first. Thanks

Yes do speak with your DSN first Mark, also maybe discuss changing to Tresiba if at all possible, there's quite a few members on the forum who use this insulin and the feedback so far is very good.

 

[Wjohn]

Hi all,

I've been diabetic 25 years this year. For 10 of those I was on the basic two shot a day Humalin. Then when I was 15 I got moved onto Novorapid and Lantus. This worked brilliantly for me for a long time but recently I've developed a bit of a battle with the Lantus for example this morning I woke up and my Libre daily graph showed I'd been somewhere between 2 and 3 throughout the night. When I woke up I was 2.3 (I still function on low blood sugars my hypo awareness isn't great). Automatically I would assume I'm taking too much Lantus in the evening but if I was to fast throughout the day my bloods would rocket without any Novorapid, so I feel it's not working great in the background during the day.
Previously I have tried reducing it by a couple of units but that does the opposite they'll spike during the night then be sky high in the morning.
I don't have great hospital support. I've been waiting four years to see a consultant (finally got an appointment next month) and I never see the same person twice.
How do others get on with Lantus? Stupid question but is it possible I could have 'outgrown' it and would it be worth trying a different basal?

Thanks

Dear Linda ,
Sorry you are having problems with your Lantus and other diabetic things .Ive been a type 1 for 54 yrs and on Lantus for about 15 yrs . Had similar problems ,I experimented and had a lot of help from Edinburgh Royal Inf.. For me it turned out that my Lantus was doing its job correctly ,it was my Carbo./food intake that was causing the problems .
What I learnt was that the BG reading is either single dimension ,ie ,straight forward and very responsive to insulin ,OR ,Three dimensional ,where the food intake ,eg ,rice ,has a far greater depth to it and is very difficult to control .
Hope this helps ,John

 

[Kristin251]

Dear Linda ,
Sorry you are having problems with your Lantus and other diabetic things .Ive been a type 1 for 54 yrs and on Lantus for about 15 yrs . Had similar problems ,I experimented and had a lot of help from Edinburgh Royal Inf.. For me it turned out that my Lantus was doing its job correctly ,it was my Carbo./food intake that was causing the problems .
What I learnt was that the BG reading is either single dimension ,ie ,straight forward and very responsive to insulin ,OR ,Three dimensional ,where the food intake ,eg ,rice ,has a far greater depth to it and is very difficult to control .
Hope this helps ,John

I completely agree!! My insulin sensativity makes a big difference. I'm very low carb but if I eat a bedtime snack such as protein ( protein raises me) or too many nuts lantus doesn't work as well. Now I have the same snack every night and lantus is right on. Carbs before bed don't work at all for ME

 

[linda_b]

Interesting to read this ....I take 18 units of Lantus at 9.00 every evening on the dot...it does burn a bit when injecting (don't know why) but so far no issues...I am interested to know if morning Basal is better....very concerned about having hypos during sleep

Exactly same as me 18 units at 9pm without fail! After reading other peoples posts are you considering giving it a trial of injecting in the morning?

 

[linda_b]

I completely agree!! My insulin sensativity makes a big difference. I'm very low carb but if I eat a bedtime snack such as protein ( protein raises me) or too many nuts lantus doesn't work as well. Now I have the same snack every night and lantus is right on. Carbs before bed don't work at all for ME

Hi Kristin, Can I ask what sort of snack you have before bed? And roughly how wait before eating and then going to bed? Thanks

 

[linda_b]

@linda_b . I struggled with lantus, tried bedtime injections and then breakfast injections once a day. Undertook the DAFNE course and started to split my lantus twice daily, approx 9 pm 7 am. This works great for me and allows for more control at different times of the day and different days of the week.
We're all different and what works for one doesn't for another. Maybe have a chat next month and see if it's an option.
Good luck.

Thank you! Do you split the dosage in half or on a different ratio?

 

[linda_b]

Thank you for all the replies everyone! Been really interesting reading and finding out what everyone does x

 

[Kristin251]

Hi Kristin, Can I ask what sort of snack you have before bed? And roughly how wait before eating and then going to bed? Thanks

Silly as it sounds I have half of a chicken sage bf sausage. 2 small bites on my way up to bed. Or 1/4 beef hot dog. Seems senseless but I like a bite of something and when I don't have something I'm wide awake in an hour. Because of that I generally have one ounce of chilled vodka lol. But it helps me sleep. A small bite of cheese would probably work or a small bite of left over dinner protein. Sometimes I save some tuna, egg or salmon salad that I had for dinner or lunch. Again, I have no idea what's with the one hour point if I don't. I've tested and bs is normal.
What doesn't work is carbs of all kinds, nut butter, avocado, more than a few nuts. Too much fat. So it's just a small bite of protein.
When I say doesn't work what I mean is if I take 2 units and have my snack I'll wake up about 10-15 lower. If I have nuts or avocado I'm almost always 10-15 higher.
I typically am around 80 before dinner and inject half unit of novolog so I go up to the 90's before bed. I suppose I could inject one for dinner and take one
Lantus
I've always needed a bite before bed.
Though lantus is not meant to work on food, it does. When I was first DXd they only had me on 5 units lantus. No novolog. I would take 5 units with dinner and drop from 200-120 before bed. I moved it to 10pm after that nad once on novolog dropped the dose a lot.
Usually I have some nuts after dinner but ditching them for a bit. Last night took my usual 2 units and went to bed at 95 and woke up 70. Ouch. I have always known nuts effect my insulin needs. They don't raise me but they do inhibit my insulins effectiveness. Both novolog and lantus.
All that being said, food does effect lantus.

 

[therower]

Thank you! Do you split the dosage in half or on a different ratio?

Hi @linda_b . Splitting my dosage wasn't just a case of halving my original once daily injection. It took a little bit more planning and involved doing some basal testing to find the best ratios, insulin requirements vary throughout a 24 hr period.
Once daily I think I was injecting 28 units, when I first split to twice daily I was injecting 16/16. This wasn't too bad initially but with some basal testing I found that 16/18 on workdays and 18/18 at the weekend gave me better results.
It's all very bespoke to each of us, some people on the forum have split doses that vary a great deal more than me.
Hope this helps a little.

 

[MelissaC]

Hi @linda_b

I use to be on Levemir which I'd inject before bed. My consultant noticed it wasn't quite working for me as it doesn't actually last 24 hours like it's meant to. She said that I could either split my insulin (so inject some before bed and then some again at some point in the morning) or I could try a new insulin called Abasaglar. I opted to try the new insulin as I just thought it'd be easier than having to do yet another injection. The Abasaglar has made a difference and my sugars have definitely improved throughout the day. She also mentioned that anyone on Lantus would be moved over to Abasaglar at some point because of the same reason that it wasn't quite lasting 24 hours - although I'm not sure if that's just for folk down here in Cornwall or whether that's a countrywide thing!

Hope this helps

Melissa x

 

[Soplewis12]

Hi all,

I've been diabetic 25 years this year. For 10 of those I was on the basic two shot a day Humalin. Then when I was 15 I got moved onto Novorapid and Lantus. This worked brilliantly for me for a long time but recently I've developed a bit of a battle with the Lantus for example this morning I woke up and my Libre daily graph showed I'd been somewhere between 2 and 3 throughout the night. When I woke up I was 2.3 (I still function on low blood sugars my hypo awareness isn't great). Automatically I would assume I'm taking too much Lantus in the evening but if I was to fast throughout the day my bloods would rocket without any Novorapid, so I feel it's not working great in the background during the day.
Previously I have tried reducing it by a couple of units but that does the opposite they'll spike during the night then be sky high in the morning.
I don't have great hospital support. I've been waiting four years to see a consultant (finally got an appointment next month) and I never see the same person twice.
How do others get on with Lantus? Stupid question but is it possible I could have 'outgrown' it and would it be worth trying a different basal?

Thanks

Hi Linda, I previously took my full dose of lantus late in the evening & suffered terrible through the night hypo' s. Advised to change to morning dose which resulted in highs when waking. For a lot of people lantus only lasts 22-23 hours. I now split my daily dose of 14 units. 8 in the morning & 6 before bed. I don't get the results I would like, still a bit up & down but a definite improvement, few & far between hypo s through the night & not too many highs in the morning & I can most times out the highs down to slow digestion of my dinner if it's something with a higher than normal fat content. Hope this helps .

 

[Soplewis12]

Hi Linda, I previously took my full dose of lantus late in the evening & suffered terrible through the night hypo' s. Advised to change to morning dose which resulted in highs when waking. For a lot of people lantus only lasts 22-23 hours. I now split my daily dose of 14 units. 8 in the morning & 6 before bed. I don't get the results I would like, still a bit up & down but a definite improvement, few & far between hypo s through the night & not too many highs in the morning & I can most times out the highs down to slow digestion of my dinner if it's something with a higher than normal fat content. Hope this helps .

Should have added this was my consultants advice last October, not had my hba1c since change, will be interesting to see. I was 7.5 in old money, 58 New money but fingers crossed for even a slight reduction