Lantus, how do i explain this?

[Klang180]

Hello All

So i am usually quite well controlled and thought i had my morning ratios sorted until this morning.

Before going to bed i was 7.9, no biggy, took my Lantus and did a few push-ups and went to sleep

Woke up 5 hours later and found i was 5.9

When i woke up a further 3 hours later i was 8.0. I took my usual 11.5 ratio and normal breakfast.

3hrs after breakfast i have rocketed to 14.6!

Can anyone explain this? I have been adjusting my Lantus dose a little as it was causing me to drop through the night but last night i took 14 oppossed to my previous usual 15. The night time numbers suggest even this was a little too much so why is it not working now?

Could it be that i went low between the 5.9 and 8.0 and have now had the rebound of symongi or is there something else at work?

The only difference is that i couldn't play football Friday night as usual as i have an inury but how could that cause any real affects 3 days later?

 

[bennyg70]

If you have lowered you lantus, could it be that this has thrown your fast acting out of sync now meaning less carbs too insulin ratio?

 

[Klang180]

If you have lowered you lantus, could it be that this has thrown your fast acting out of sync now meaning less carbs too insulin ratio?

Hello, thanks for the response. I don't think it would have such a dramatic result. I lowered by Lantus by 1 unit and this was to better control teh nightime drop. I guess the only way to know is to do a fasting test. Thing is if i am still going down overnight but going up during teh day what alternative do i have?

 

[bennyg70]

I wouldnt go changing anything straight away, give the new dose a couple of days to settle in maybe, and see what happens tomorow if theres a pattern emerging of highs after breakfast then you know something needs to change? Could it have been something else sending your blood sugar up, stress? illness etc?

Ive always found the first day after tweaking my lantus it throws in some unforseen results.

Someone on here recomended me doing the fasting tests and it taught me a hell of a lot about what was going on. Althoguh I dont believe that Lantus whatever the dose will ever hole me steady throughout the day like it should... My profile seems to hold steady over night, then rises a little throughout the morning and then heads down low throughout lunch, and then back up again as it tails off!!!

 

[Klang180]

Thanks for that Benny

I am really tryign to sort my lantus and i guess at this stage i would like ti to hold me fairly steady overnight and continue what it had previoulsy been doing during teh day.

I guess i need to do a fasting test at various times during the day to see what happens but actually setting up the conditions for this can be quite difficult i find. It is a rare day when i am not doing some sort of strenuous exercise and i also find that even after 4hours after my Humalog i can still go down even when it should be finished!

I guess this is why i need to do fastign tests three times a day rather than just the overnight one.

I will keep going with 14 and see what happens. One thing that did happen is that i had an unusual and very high fat meal on Saturday night which i think somehow is still conspiring against my control. I walked a lot yesterday to try and counteract and to a degree it did but i am just not sure if it could still be having an affect now?

 

[iHs]

Someone on here recomended me doing the fasting tests and it taught me a hell of a lot about what was going on. Althoguh I dont believe that Lantus whatever the dose will ever hole me steady throughout the day like it should... My profile seems to hold steady over night, then rises a little throughout the morning and then heads down low throughout lunch, and then back up again as it tails off!!!

I was exactly the same as you benny... always needed a large bolus to cover breakfast, then a bit less at lunchtime and then need a fair amount to cover eve meal even though I was nearly always eating no more than about 35g carb....

It is true to say I think that the more basal we inject,... the less bolus we will need and vice versa. Its all about balancing out the effect that one insulin has with the other...

 

[bennyg70]

With you there Ihs, Im fairly happy if my basel holds me over ngiht now, as long as I counteract the trends with adjusting my bolus to suit. Obviously for this you need to know whats going on. Im still learning about myself and how much i need at different point... I was honestly getting really close to cracking it, and then they switched me onto apidra. So its almost a backwards step but with the hope of moving forward further.

Klang,

High fat meals play absolute havoc with me, although I dont think ive had the issues hang around for that long. I did a bit of experimenting over the weekend with chippy chips and i spike after around 5 - 6 hours. I also has a friggin massive steak the other night and for the first time, i successfully split my dose over a number of hours and woke up with a good bg. If i have healthy brown carbs rice etc... I wake up to great bgs. If i have anything say over 30g of fat mixed ith carbs, i rocket in the morning after going to bed with good bgs.

The obvious answer for me is to give up the fatty foods... but i cant help every so often needing that treat!

 

[kt78]

I think the lantus profile does stay flat (although it doesn't last 24 hours!) - it's more that your insulin sensitivity goes up and down at different times. Typically, but of course, not always, people are most sensitive between 12am - 3am. Many people find they are less sensitive around midday and that this sensitivity increases again in the early evening. It may mean you have different bolus:carb needs at different times. Remember non-diabetics don't produce lantus!

Just to make it even more confusing! :crazy:

 

[kt78]

Oh, and if the pattern continues it could be seasonal... many people need more insulin in winter months :roll:

 

[Klang180]

I think the lantus profile does stay flat (although it doesn't last 24 hours!) - it's more that your insulin sensitivity goes up and down at different times. Typically, but of course, not always, people are most sensitive between 12am - 3am. Many people find they are less sensitive around midday and that this sensitivity increases again in the early evening. It may mean you have different bolus:carb needs at different times. Remember non-diabetics don't produce lantus!

Just to make it even more confusing! :crazy:

Thanks KT good advice.

My insulin sensitivity does go up and down all the time and i am much more sensitive in the evening and particularly at the times you mention. I am least sensitive in the morning (following your model).

So i think i have got the insulin sensitivity thing covered but bloody hell, seasonality as well! This gets worse.

It still doesn't explain why in this case i went high but let me see what happens tomo. it is an extra healthy low fat dinner for me tonight, let's hope it works!

 

[kt78]

Just be grateful you aren't a woman - we often have different insulin sensitivity depending on what time of the month it is too!! :***:

Let us know how it goes! Enjoy your dinner! :angel:

kt

 

[Klang180]

Just to provide an update to this.

I took my lantus last night at bedtime when 8.8, by the morning i was 5.5. I had my usual breakfast at my usual I:C ration and low and hehold two hours later i was 5.9. I even went a little low by lunchtime!

So i don't know what happened but i am back to my usual sensitivity.

Still got an issue however as my Lantus is dropping me too much overnight clearly.

 

[Laubie]

Hate to say this... but 2/3am testing may help?
I hated it but doing that very early morning test for me for just seven days taught me so much about what my BG was doing overnight!

Or talk to your doc/ dsn about splitting your dose? Can't be conclusive until you have tested more and found a pattern, but sounds to me like your dose of Lantus is actually too high in the evening if you are going low by lunch. If you are going high by bed time you may want to take a reduced dose at your normal time and 'supplementing' it with a further dose after lunch?
Though it could be that your bolus ratio in the morning needs adjusting. So best to keep testing and writing down everything at regular times for a period of a week or so to try and spot the pattern.

 

[Klang180]

Haha the dreaded 2am test, yes i have done a few of those, some planned and some not so much but it isn't helping a great deal. it shows a slow drop that culminates in a 3 point drop by morning. Problem is that during teh day the Basal seems about right. I guess it could be a little high, i mean on weekdays i eat 70 carbs for lunch and can actually get away with no bolus at all if i go for my 30min very swift walk. Then again i do put a large part of this down to the fact i am eating low G.I fruit and no fat whatsoever.

Anyway, i test and record and test and record and i guess slowly i am getting there.

 

[hanadr]

T1 husband is having problems gettig his Lantus to behave itself at the moment too. In his case however, Football playing id definitely NOT an issue.
Hana