Splitting Lantus to stop dawn phenomenon

[AlanaPerrin]

Something else you will have to consider is that you may currently be in a honeymoon period with your diabetes. This in itself makes things very unpredictable and is something that needs to be considered when things don’t always follow a day to day pattern.

I’ve been told I’m honeymooning, but I don’t really understand what that means. I was told three years ago I had GAD antibodies, but it wasn’t until this year that I became unwell. It would explain why sometimes I calculate carbs precisely and dose correctly and it doesn’t go to plan though!

 

[Antje77]

And would you suggest a bit of extra fast acting or extra Lantus in the morning? My glucose starts rising as soon as I wake (probably fight or flight reaction from my young sons waking me every morning ) so I’m guessing fast acting?

We can absolutely not advise you on what to dose, or when. That's solely up to you and your consultant. We can however tell you what works for us. Keep in mind we all react different, not all of us have feet on the floor effect, the amounts of insulin we use varies immensely and you may or may not find things very unpredictable thanks to the honeymoon period.

For me, this feet on the floor effect is very predictable. Apparently it's the liver dumping glucose in the bloodstream to get you going for the day. I figured it doesn't really make a difference if the glucose in my blood will come from food or from my liver, it's the same stuff. So I inject in anticipation, both for food and for the stuff my liver gives me, preventing large spikes.
I don't eat breakfast until many hours after getting up.

Should you decide to experiment, preferably with an OK from your HCP, please be careful, test an awful lot, especially if you don't use CGM/Libre, and keep hypo treatment in your pocket.

 

[AlanaPerrin]

We can absolutely not advise you on what to dose, or when. That's solely up to you and your consultant. We can however tell you what works for us. Keep in mind we all react different, not all of us have feet on the floor effect, the amounts of insulin we use varies immensely and you may or may not find things very unpredictable thanks to the honeymoon period.

For me, this feet on the floor effect is very predictable. Apparently it's the liver dumping glucose in the bloodstream to get you going for the day. I figured it doesn't really make a difference if the glucose in my blood will come from food or from my liver, it's the same stuff. So I inject in anticipation, both for food and for the stuff my liver gives me, preventing large spikes.
I don't eat breakfast until many hours after getting up.

Should you decide to experiment, preferably with an OK from your HCP, please be careful, test an awful lot, especially if you don't use CGM/Libre, and keep hypo treatment in your pocket.

Since I’ve done the Dafne course they’re happy for me to make adjustments within 10% of the original dose - no adjustments the day after a hypo, wait three days for a pattern before adjusting etc. I just wasn’t sure which insulin type you meant.
My team is pretty relaxed about things, which is nice in a way as it means I feel like I have some individual control.

 

[Antje77]

I just wasn’t sure which insulin type you meant.

My quick acting, as it is to counter glucose suddenly entering my bloodstream, just like food does

 

[therower]

@AlanaPerrin . Basically the honeymoon period works like this.....
Your pancreas is slowly failing in its ability to produce the required amount of insulin, this demise can take months. When it gets to a stage where we real something is wrong and start taking medication ( insulin ) we suddenly take a lot of pressure off of our slowly dying pancreas regarding insulin production. This in turn can tend to give the pancreas a second breath of wind as it were, all of a sudden it’s not under so much pressure . This reprieve can often result in “ spurts “ for want of a better word of insulin from the pancreas. Problem is these spurts are intermittent and unpredictable. This alongside regular and set amounts of injected insulin leads to unpredictable levels of insulin in the body. There isn’t much you can do about it but to accept it and wait for the time when your pancreas loses all of its ability to produce insulin. A sad day in some respects but it does make control far easier. You only have one source of insulin now and not the two you are currently experiencing.
Hopefully this makes some sense.
If not feel free to ask anything else.

 

[Antje77]

This reprieve can often result in “ spurts “ for want of a better word of insulin from the pancreas. Problem is these spurts are intermittent and unpredictable. This alongside regular and set amounts of injected insulin leads to unpredictable levels of insulin in the body.

Agree, in theory, but please keep in mind Therower said "can result in", not "will result in".
Again, like all things diabetes, this honeymoon thing can either be helpful or unhelpful, or you may not really notice it at all.
Using myself as an example, I've been able to regulate my bg pretty well from the moment I started using basal/bolus insulin, almost 3 years ago. A C-peptide test a year ago showed my insulin production at that time was below the low-normal threshold, but not as low as seen in long time T1's. Which suggests the honeymoon period was still going on at that time.
My insulin needs have gone up over time, but not in a very sudden, off and on or unpredictable way, although there seems to be a slow wave over the month.
I have no clue if I'm still in the honeymoon, but whatever honeymoon I had or have doesn't prevent me from tightly regulating my bg most of the time.
Hope it will be the same for you!

 

[therower]

@Antje77 . Agree that it is imperative to understand that nothing is set in stone regarding Type 1 or LADA.
As you have pointed out T1 and LADA are intrinsically the same albeit for the rate at which the pancreas stops producing insulin over a period of time.

 

[Antje77]

My team is pretty relaxed about things, which is nice in a way as it means I feel like I have some individual control.

This is wonderful if it suits you! For me finding things out by trial and error myself, without a consultant insisting I ask them before every change, made all the difference in being confident I could figure this thing out. Which in turn has prevented me from getting depressed over my diabetes, because mistakes turn to learning opportunities instead of 'doing it wrong', and I can try again next time.
People react very differently to a diagnosis. Some of us are better left to their own senses with a listening ear or a suggestion from a consultant, some of us do better on a strict regime at the beginning to allow for time to get used to the new situation.

The HCP who understands their patients benefit most from an approach that suits them individually is a very good HCP.

 

[AlanaPerrin]

This is wonderful if it suits you! For me finding things out by trial and error myself, without a consultant insisting I ask them before every change, made all the difference in being confident I could figure this thing out. Which in turn has prevented me from getting depressed over my diabetes, because mistakes turn to learning opportunities instead of 'doing it wrong', and I can try again next time.
People react very differently to a diagnosis. Some of us are better left to their own senses with a listening ear or a suggestion from a consultant, some of us do better on a strict regime at the beginning to allow for time to get used to the new situation.

The HCP who understands their patients benefit most from an approach that suits them individually is a very good HCP.

I’m so pleased with my team so far. I think I showed right from the start that I’m willing to learn and try things so I can adapt to a new lifestyle, and they’re embracing that. They put me down for the Dafne course two months after I was diagnosed, a month after starting insulin, and I honestly think its’s given me the confidence to make changes to my doses etc.

 

[AlanaPerrin]

@AlanaPerrin . Basically the honeymoon period works like this.....
Your pancreas is slowly failing in its ability to produce the required amount of insulin, this demise can take months. When it gets to a stage where we real something is wrong and start taking medication ( insulin ) we suddenly take a lot of pressure off of our slowly dying pancreas regarding insulin production. This in turn can tend to give the pancreas a second breath of wind as it were, all of a sudden it’s not under so much pressure . This reprieve can often result in “ spurts “ for want of a better word of insulin from the pancreas. Problem is these spurts are intermittent and unpredictable. This alongside regular and set amounts of injected insulin leads to unpredictable levels of insulin in the body. There isn’t much you can do about it but to accept it and wait for the time when your pancreas loses all of its ability to produce insulin. A sad day in some respects but it does make control far easier. You only have one source of insulin now and not the two you are currently experiencing.
Hopefully this makes some sense.
If not feel free to ask anything else.

This could explain why sometimes I feel like I’m getting things right when I get a nice flat line after a meal, and other times I feel like I’ve completely misjudged it and spike out of nowhere.

 

[Antje77]

and feel like I’m failing.

Try to get rid of this part. It's definitely not your fault when diabetes is being an *** .

 

[Antje77]

This could explain why sometimes I feel like I’m getting things right when I get a nice flat line after a meal, and other times I feel like I’ve completely misjudged it and spike out of nowhere.

Try to get rid of this part. It's definitely not your fault when diabetes is being an *** .

Hi @AlanaPerrin , I noticed you took my advice literally and took it out of your post, I think that's beautiful! Adjusting as you go, just like with diabetes
Just let me know if you want me to remove my reference to it. I quite like it there as a reminder but I'll be happy to delete.

 

[hyponilla]

Would you inject for eggs and cheese if you ate it for lunch? Or is the insulin because you know you rise in the morning? I’ve been sticking with exactly the same breakfast and the same dose, but this morning I tested my glucose a bit later than usual and noticed how much higher it had gone. I’ll have to start injecting as soon as I wake and eating earlier I think.

I would, but a lot less. I eat very low carb getting most of my glucose from protein, so I'm always dosing for that. It's only something you need to pay attention to if you follow a low carb diet though.

Sounds like you have busy mornings with the little ones. You could always prepare breakfast the night before, so it's just taking it out of the fridge in the morning.

 

[LooperCat]

Late to the chat, but FWIW I don’t eat “breakfast” (in quotation marks because I work shifts - in this case I mean on waking) but I dose for 15g carbs as soon as I see a rise in levels, and that seems to mostly deal with foot on the floor. I can’t preempt it because not only are my waking hours irregular, but it doesn’t always happen for some reason. The dawn phenomenon is taken care of by my pump.

 

[AlanaPerrin]

Hi @AlanaPerrin , I noticed you took my advice literally and took it out of your post, I think that's beautiful! Adjusting as you go, just like with diabetes
Just let me know if you want me to remove my reference to it. I quite like it there as a reminder but I'll be happy to delete.

Absolutely no need to delete it. I realised I was being hard on myself ... it’s a tough condition to live with!