Lantus to Insultard

[jameshallam]

Hi everyone...

My consultant recommended I changed to Insultard after a discussion we had last week.

I take 11u of Lantus daily at 9pm.
Currently my blood sugar in the morning is sky high after breakfast.
Typical readings would be:

7am - 8 / 4cps / 6u NovaRapid (1.5 ratio)
9am - 17
10am - 12
11am - 9
12pm - 5

He said switching to Insultard would help this as it provide a bit of a peak during this time.

So I switched last night at 9pm... Anyone got any advice, or done this before? I meant to post last week before I switched but didn't get round to it.

I have gone to 10u of IT (11u of Lantus) on the receommendation of the HCP - anyone know if the units are equivilent or is one more 'potent' than the other?

Any advice would be great! Thanks

 

[wsmum]

Hello James
Hope you get on well with the change to a new insulin. It might be worth thinking about your breakfast fast-acting ratio too, since your numbers 2 hours after eating are so high. It may be that you need a bit more insulin at that time of day.
Best wishes
Catherine (mum to T1 teenager)

 

[jameshallam]

Hi Catherine - That was my first thought too, however I started off on a 1:1 ratio at all times of the day.
Then I upped my breakfast ratio because of the high numbers.

I tried going to a ratio of 2:1, but anymore insulin with breakfast and I end up having a hypo mid morning before my lunch.

 

[ebony321]

Hi,

Have you tried fasting over this period for a few days? just until dinner?

This way you can see what your background insulin is doing without having to take your breakfast insulin into account.

I always find it difficult as i'm hungriest in the morning but it pays off. Simply skip breakfast and test every hour, do this over a few days to see if theres any patterns to highlight issues with your background dose.

However it can be difficult when doing fatsing tests as if you go hypo or too high that you need a correction you will have to abandon the test until the next day.

It's worth it if you persevere.

If your unsure your diabetes specialist should be able to talk you through it in more detail.

Good luck.

 

[jopar]

If you changed to insultard last night, don't make any adjustment until the weekend, as you need to give it a chance to settle in to see what it's effect really are! This goes for any time you adjust your background insulin, one adjustment wait a couple of days the review..

Firstly I am surprised that your consultant decided to change you to insultard before trying splitting your insulin, as your problems may be that either your Lantus is running out before the 24 hours (common) or with one injection you end up with having enough at one point, but too much at another point, splitting the insulin into am & pm helps to resolve both these problems..

Another consideration, is that when I used insultard many moons ago now, I took this am and pm this was the standard for injecting! with breakfast and teatime!

Looking at your breakfast reading..

A very nasty spike, but what is concerning as well your tail end part of the novorapid is dropping your BG by too much.. Shouldn't be having a drop of 7mmol/l's between 10am and 12pm this suggests that you have too much background insulin.. So the background instead of keeping your basal line stable it's actually working with the novorapid and reducing your BG... Not good..

Personally on Sat or Sunday morning I would arm myself with plenty of testing strips, hypo kit, and carry out a fasting test to see what my basal line was like!

Plan the morning so that you aren't running around or doing excessive exercise, start testing as early as possible then keep testing until dinner time if you can manage.. Avoid carbs and protien (protien will impact on the Blood Glucose) if you need to tie yourself over hunger wise (sugar free jelly is always helpfull) Then test every hour to see what's going on..

Don't forget though if you have an hypo or BG's gets too high, abort the testing and treat accordanly.. Even if you find you have to abort, hopefully you will have enough data to determin whether it's the background insulin or quick acting you need to be looking to sort..

As to your spike..

A bit excessive, but this could just be a timmig thing where instead of injecting before you eat breakfast you can curtail it by injection 20+ minutes before, it's a case of trail and error to find the point where you won't go hypo before or just after eating and the point where you bring the spike into a reason level for good control... Or whether you'll better changing the food you eat for breakfast to one that doesn't spike so high!

 

[jameshallam]

Thanks for the ideas all. I have done the fasting test before and had a pretty stable blood sugar from about 8am to 5pm. There was a small peak about an hour after waking (only by 2-3). the rest of the day it was completely flat.

This was a while ago, so next time ive got some free time ill do the same again for the IT.

The way I reasoned the spike was that I was having a morning high on top of the post eating high - which stacked up to a mega high! I normally eat 50g of Oat Crisp in the morning - which is less sugary than the other cereals. Including milk there is 40g of carbs. I tried moving to some egg on (wholegrain) toast (just under 40g) without much luck. Whenever I am away on business I have some assortment of cooked breakfast - this always throws me because the carbs are minimal but lots of protein.

The consultant said he doesn't normally split Lantus (there's no point he said since it lasts 24hrs). He said the next step would be to split the IT if this doesn't work.

I think my next step is to do some fasting tests to re-calc my ratios and background amount.

 

[janabelle]

Hi James,
Lantus to insulatard is definately the right way to go! Unfortunately I went from insulatard to Lantus and will regret it till the day I die :twisted:
Has your doc suggested splitting the dose of Insulatard? If you look at the profile it's easy to see why that works better. I did that for many years and now do the same with Porcine Isophane which has a similar profile.
best of luck with the change
Jus

 

[Pneu]

I went from a mixtard -> Levemir -> Insultard and it works much better for me...

I inject insulatard three times a day which may seem backwards but is what works best for me gives me the best control... I inject as follows:

35% total dose - 6 - 7 am - when I wake up
20% total dose 3pm - a small mid-late afternoon injection otherwise I find that I start to lose effectiveness late evening and I will get a BG rise before bed that will need a correction
45% total dose 10 - 11pm - just before bed

With the above I can run a totally flat fasting profile within 0.5 - 1 mmol/l, at the moment I inject around 70u of Insultard a day which may seem a lot but I was on over 200u of Levemir a day and used to just huge DP spikes... going from 5 mmol/l at 4/5am to over 15 mmol/l by 6/7am..

I think HCP need to realise that what works for one doesn't work for all... I have a helpful consultant that lets me experiment and make suggestions reference my own treatment.. so if you feel your insulin isn't working you should certainly do the research and then try and get it changed if you feel there is a better option

 

[Snodger]

The consultant said he doesn't normally split Lantus (there's no point he said since it lasts 24hrs).

well he's right that it is MEANT to last 24 hours but lots of people find their Lantus runs out sooner than that. As Pneu says, your consultant needs to grasp the fact that one-size-doesn't-fit-all when it comes to insulins.
This is what he (the doc) is probably using to make his decisions, may be useful to you: http://www.mims.co.uk/Tables/882439/Ins ... parations/

 

[Margi]

I can endorse splitting the Lantus. I think your consultant needs to come into the modern era a bit because most recognise that although it says on the tin that it lasts 24 hours, mostly it doesn't.

Like you, I used to spike at whichever end of the day I too my Lantus. I tried morning and night, then I split it and never looked back. I get on with Lantus very well, but I know many people don't, so as so many say, one size definitely doesn't fit all.

I used to be on Insultard and it's arc of effectiveness was a nightmare - quite often in fact with night time hypos. I never got on with it, and Lantus has been a Godsend. Quite the reverse experience of some of you.

 

[jameshallam]

A few conflicting messages so far...

I did a fasting test yesterday morning and found my sugars rose in the morning:
8am - 8.3
9am - 10.5
10am - 10.8
11am - 10.2
12pm - 12.8

I have also found that my BG rose before my dinner:

7pm - 6.4 (7 hours after lunch, no strenous exercise or anything)
8:30pm - 8.9

This makes me think that:
a) my BI dose is not high enough
b) it is probably running out (I take it at 9pm)

If I were to split it into 2 shots - would people recommend 50/50 at 9am/9pm?

 

[Snodger]

This makes me think that:
a) my BI dose is not high enough
b) it is probably running out (I take it at 9pm)

If I were to split it into 2 shots - would people recommend 50/50 at 9am/9pm?

I reckon you are right.
I think I'd be tempted to do exactly what you suggest, 50/50 split to start with, but it may be that the evening rise is more to do with it running out than it is to do with the amount of insulin. So it could be that you might need 60/40, say. Try it and see.

 

[jameshallam]

Well I decided to up the does rather than splitting it and it seems to have worked so far...

I went up from 10 to 12 on Friday night (due to a normal rise of BG by around 6-7 over night - I usually expect a drop og 3BG for 1 unit QA).

Last night I went to bed at 9, and woke up at 9.6 - am monitoring my BG in the day now. I would prefer to just have 1 shot of BI insulin, so will perservere this way until the evidence tells me I'm crazy!

Thanks for the advice everyone.