Upsetting experience

[Tracie1212]

I had a really terrible experience Monday evening after injecting 23 units of Toujeo my blood sugars dropped like a stone. From 14 to 2 in half an hour. I put emergency plan into action .orange juice, dextrose, wine gums, biscuit, chocolate, half sandwich and sugar in water. Eventually called ambulance as really felt would pass out blood sugars started to move after two hours. Have seen DSN this morning who thinks the insulin pooled and one of those unfortunate events that happen. I've never experienced anything like this and found it frightening. Toujeo reduced to 21 units. Now I find my levels are high appreciate the knock on effect of reducing doses. Ate lunch at 1 injected with correction dose of 2 . Two hours later levels hit 20 felt unwell so put in another correction dose of 1.5 But levels still high food time is approaching don't want to insulin stack. So do I wait until fast acting insulin ends at 7 then eat put in another correction knowing food will initially push my levels higher and feel unwell. Then background insulin due at 9.30pm. Feel like whatever I do it's never right.

Thanks

 

[Antje77]

As far as I know Toujeo is a cousin of Lantus. If it works in the same way as Lantus, you could google this as 'Lantus low'. Happened to me once on Lantus and scared me so much I more or less demanded to get another insulin. Lantus (and perhaps Toujeo) is the only insulin I know of that can do this.
It's slow acting because it somehow reacts with fatty tissue, making it form some sort of chrystals which then get absorbed slowly. Should you hit a small blood vessel, it won't form chrystals and acts as a fast insulin.
I don't know if this is how Toujeo works as well, but your story sounds a lot like mine, except I did pass out after eating a lot of sugar and woke up again, still low.
My DN had never heard of it, but was happy to prescribe me Tresiba.

 

[evilclive]

As far as I know Toujeo is a cousin of Lantus. If it works in the same way as Lantus, you could google this as 'Lantus low'. Happened to me once on Lantus and scared me so much I more or less demanded to get another insulin. Lantus (and perhaps Toujeo) is the only insulin I know of that can do this.
It's slow acting because it somehow reacts with fatty tissue, making it form some sort of chrystals which then get absorbed slowly. Should you hit a small blood vessel, it won't form chrystals and acts as a fast insulin.
I don't know if this is how Toujeo works as well, but your story sounds a lot like mine, except I did pass out after eating a lot of sugar and woke up again, still low.
My DN had never heard of it, but was happy to prescribe me Tresiba.

<insulin nerdery warning>
Yes, Toujeo is the same as Lantus, they're both insulin glargine. Toujeo is just 3x the strength in solution, so behaves slightly differently. Glargine is basically insoluble at human body pH, but soluble at a different one - so in the vial, it's kept soluble, but should crystallise out when injected. Which means no problems like the old suspension of insulin used to have (insultard etc) where you'd have to shake it before injection.
The problem you describe sounds reasonable - never happened to me, but I can see how it might work.

(wikipedia is quite good at this sort of thing )

There's also Levemir, which is working for me at the moment with two daily doses to cover basal needs.

 

[Lynz84]

Hi Tracie1212. Ive recently moved from toujeo to levemir as toujeo is an inflexible nightmare. 1 slight change, even 1 unit is enough to drastically alter your sugars either way. I would not recommend toujeo to anyone. Too unpredictable. Lever x2 daily has me comfortably in range and easily tweaked. X

 

[Lynz84]

*levemir

 

[Tracie1212]

Thanks everyone for your replies my internet connection not good otherwise would reply sooner.

I am having a nightmare I'm struggling everyday saw DSN last week who said she doesn't know much about Toujeo and to stick with it. She wasn't prescribing DSN . I was on lantus which wasn't great but Toujeo is stopping me living my life. I was prescribed Toujeo in hospital, like you say it's unpredictable I thought it would give me better control and steady 24 hour release. It's messing up my ratios and I never know what I'm going to get and how I feel one day to the next. I have many times in the day where I feel shaky but readings are ok. My main worry is not having repeat of major hypo. Which other insulin I can use and what will my transition be like. Toujeo is ruining my life.

 

[alphabeta]

Hello, I had a scary experience with Lantus which is similar to Toujeo as mentioned above. My sugar was about 15.7 and then I injected 19 units Lantus. I saw a considerable amount of blood coming out after I removed the pen. I didn't know much so I just ignored it. After 15 minutes I experienced some sort of hot flashes, weakness in my arm but most notably my heart was racing. I tested and my sugar was already 8.8 mmol/l. I started eating table sugar like crazy and it kept droping to 5.9 after 15 minutes before it started going up to reach ~8.5 after 1 hour of injection and I was above 18 after another hour. I did inject into a muscle because my injection site was wrong and I had a 6mm needle. Mind you I am a skinny person. I still use Lantus till this day but never had this issue again with proper injection techniques and shorter 4 mm needles.

 

[kitedoc]

Hi @Tracie1212, What a terrible experience you have had. From my experience as a T!D, not as professional advice or opinion: The injection of part of the insulin into a blood vessel is the most likely explanation. I have done a similar thing once with Isophane and medium to long acting insulin years ago. In the 'good old days' we were taught to draw back on the syringe once the needle was under the skin to see whether we had hit a blood vessel, in which case we could take the needle out of the skin and try again. The insulin pens do not allow this, you cannot draw back on them (unless someone has somehow found a way)!?! but I would still look for any blood in the insulin before injecting.
The other thing to note dosage-wise is that Tresiba and Toujeo are different in effect unit for unit. So when moving from Lantus to Tresiba sources quote a 1:1 conversion rate (see images of Lantus to Tresiba conversion chart)( if on 24 units of lantus take 25 units of Tresiba to begin with) where as for Lantus to Toujeo it is 1: 0.8, Lantus 25 units the recommended conversion is to 20 units of Tuojeo. (Conversion Lantus to Toujeo reddit.com). Of course any conversion would only be done with the advice of a suitable healthcare provider.

 

[Tracie1212]

Thanks all, I was told that my experience was unusual interesting this has happened to others . I am quite skinny won't inject in my right leg since this happened. I will be transitioning to tresiba soon have posted another message.