Basal Insulin Help Plz!

[evej]

Hi,

I take 22 units of Lantus at 7am. My blood sugar is perfectly flat at night, but starts to rise around 5:30am. By the time I get up it is generally 3 or 4 mmol/L higher than when I went to bed. I don't think I need more Lantus because it's flat at night. But how do you KNOW you're on the right amount of basal?

I did try taking Lantus at night, but always crashed at night, so am reluctant to try that again.

Also, should I try splitting it? If so, what's the best way to do that?

Thanks!
Eve

 

[Alison54321]

It might be worth splitting, as if you're taking it at 7 am, that early morning rise could be the "dawn phenomenon" or the \Lantus not lasting a full 24 hours.

I split mine after I woke up with a 1.7 mmol/L one night, I decided I wasn't risking that again. I find it a lot more stable.

I can't remember the method by which I did it, I think I was so shocked by the very low blood sugar I just did it. I have a 50/50 spilt, and I'm happy with that.

You can test your basal by skipping a meal, and seeing if your blood sugar remains stable, I understand. I haven't tried that,but it apparently works.

 

[NoKindOfSusie]

I tried splitting lantus, because it was making me feel terrible. It didn't seem to make any difference at all to the actual numbers (but it did help the feeling terrible a bit.)

My numbers go crazy around the time I wake up no matter what I do, whether I eat breakfast, whether I don't, whether I take insulin, whether I don't. I've sort of given up. It is what it is.

 

[Alison54321]

I tried splitting lantus, because it was making me feel terrible. It didn't seem to make any difference at all to the actual numbers (but it did help the feeling terrible a bit.)

My numbers go crazy around the time I wake up no matter what I do, whether I eat breakfast, whether I don't, whether I take insulin, whether I don't. I've sort of given up. It is what it is.

I can sympathise with this. I recently got Freestyle Libre, and if I look at the daily graphs everyone for the overnight/morning period is different. There is no consistent pattern. It's just how it is. But at least now I don't have it randomly going very low.

Everyone's experience is different, some people seem to have very stable blood sugars, and others don't. You'll get very good at responding to the unexpected.

 

[evej]

I tried taking Lantus in the evening and also just before bed. Both times I went very low, so I'm a little worried about splitting it.

The other thought I had was to simply move it back to say around noon to see whether that would move the spike so I could manage it better.

Over night it seems as if the Lantus is the right amount because I stay stable all night until around 5:30. I have never tried a day-time fast to see whether it's the right amount for daytime.

 

[Alison54321]

I tried taking Lantus in the evening and also just before bed. Both times I went very low, so I'm a little worried about splitting it.

The other thought I had was to simply move it back to say around noon to see whether that would move the spike so I could manage it better.

Over night it seems as if the Lantus is the right amount because I stay stable all night until around 5:30. I have never tried a day-time fast to see whether it's the right amount for daytime.

As I understand it the Lantus action curve peaks after a few hours, so that would explain why it was going too low at night. If you did split it that peak would be smaller, because it would be only half the insulin peaking at that point. But I think you're right that moving it to a bit later might be a good way to test if the spike is just the Lantus running out.

 

[Juicyj]

I tried splitting lantus, because it was making me feel terrible. It didn't seem to make any difference at all to the actual numbers (but it did help the feeling terrible a bit.)

My numbers go crazy around the time I wake up no matter what I do, whether I eat breakfast, whether I don't, whether I take insulin, whether I don't. I've sort of given up. It is what it is.

Have you done any basal testing or invested in a libre to really see what’s going on overnight yet ?

 

[evej]

Have you done any basal testing or invested in a libre to really see what’s going on overnight yet ?

Juicy, yes I have. If I take 21 u in the morning, I stay nice and flat all night long, until 5:30 or 6am. I do have the Libre - it's awesome. I am thinking of getting the Dexcom though because my insurance may cover it. They don't cover the Libre.

 

[evej]

As I understand it the Lantus action curve peaks after a few hours, so that would explain why it was going too low at night. If you did split it that peak would be smaller, because it would be only half the insulin peaking at that point. But I think you're right that moving it to a bit later might be a good way to test if the spike is just the Lantus running out.

So do I split it at the same amount or go a bit lower? I'm taking 21 units, so maybe 10u at 7am and 8u at 7pm? Or maybe 10 and 6?? And how long do I stay at that level before I try moving it up a bit.

 

[evej]

As I understand it the Lantus action curve peaks after a few hours, so that would explain why it was going too low at night. If you did split it that peak would be smaller, because it would be only half the insulin peaking at that point. But I think you're right that moving it to a bit later might be a good way to test if the spike is just the Lantus running out.

Which do you think makes more sense? Splitting or trying later in the day to verify if it's the Lantus running out or Dawn Phenomenon?

 

[Alison54321]

Which do you think makes more sense? Splitting or trying later in the day to verify if it's the Lantus running out or Dawn Phenomenon?

Hello,

Sorry I turned off the internet early last night, and missed your question. I'm not sure which is best. You could try moving your long acting forward a couple of hours, and see what happens. But, if that isn't a convenient time to inject then that might not be a good option, in the longer run. It's always good to inject at a time that's convenient for you, otherwise I forget, or something, I find. So you'd want to keep the morning dose at a convenient time. So that's something to think about. But it might be a good way of testing the theory that the Lantus running out is causing the spike.

When I decided to split, I found something online saying doing that smoothed out the curve,, because the curve isn't completely smooth for Lantus.

It's worth thinking about how it would affect the rest of the day, as well. Is it working well through the rest of the day?

I tend to have an early morning rise in blood sugar, and I just correct it when I find it, with Novorapid, because from about 11 am onwards my blood sugars are always quite low, and I don't want them any lower, so I don't want to increase the Lantus, because of the knock on effects throughout the day. So I just correct it as soon as I can.

Did you go very low at night, with the Lantus, when you did it in the evening, or was it just a small dip? If your night time blood sugars are nice and steady at the moment, what do you think might happen if there was smaller Lantus peak at that time?

If you have a think about these things, and then decide. You can always change back if it doesn't work.

 

[novorapidboi26]

I tried splitting lantus, because it was making me feel terrible. It didn't seem to make any difference at all to the actual numbers (but it did help the feeling terrible a bit.)

My numbers go crazy around the time I wake up no matter what I do, whether I eat breakfast, whether I don't, whether I take insulin, whether I don't. I've sort of given up. It is what it is.

That can be sorted if you want some advice........well, the liver cant be stopped, but you can reduce the chaos....

 

[novorapidboi26]

I know you're reluctant but moving it to the PM is definitely a consideration.....just do it in a controlled setting obviously....

Lantus does in theory have a peak but it quite undefined, so shouldn't really be having a significant effect, but everyone's different....

you could try taking an hour or two before bed...that way you can get a 3 am test and confirm or deny the dawn phenomenon...

 

[evej]

I tried splitting it yesterday. Instead of 21 units, I took 15 at 7am and 5 at 7pm. Had a very poor day obviously, since my body is used to 21u lantus.

Went to bed at 12.9 (Too high, but my blood monitor averages 1 to 2 mmol/L lower than the Libre)
3am: 12.8 (Trending across)
5am: 13.4 (Trending across)
6am: 15.4 (Trending slow up - 2u Humalog)
7am 14.0 (Trending slow down)

The overall night-time trend line is a slow increase.

This is pretty much exactly what happened day before yesterday, except all numbers were lower. I always have to take a little Humalog early in the morning (around 5:30 or 6am), or my blood sugar will continue to rise. Mind you, that might have been Lantus wearing off in the morning. Or is it Dawn Phenomenon? How do you tell the difference?

I took 15u Lantus this morning. Do I stick with 5u Lantus tonight or bump it up?

 

[novorapidboi26]

the before bed and 3am are pretty much the same, which suggests your basal of 5 is sufficient....

the rise from 5am does look like dawn phenomenon...

ideally you should be looking to repeat the 5 units again for good measure....

if it holds you steady till again then you can conclude the 5 units is good.....

adding on a unit might be worth a go just to see if you can battle that 5 am rise a bit, but it might be too much....

 

[slip]

Try the changed basal regime for 3 days before making further changes - unless obviously it's having a catastrophic affect on you, with those results if I was you I'd stick with it again tonight and again the following night, how were your numbers during the day as well?

 

[evej]

the before bed and 3am are pretty much the same, which suggests your basal of 5 is sufficient....

the rise from 5am does look like dawn phenomenon...

ideally you should be looking to repeat the 5 units again for good measure....

if it holds you steady till again then you can conclude the 5 units is good.....

adding on a unit might be worth a go just to see if you can battle that 5 am rise a bit, but it might be too much....

Well, it's 9:40 and I'm still rising despite the Humalog. So, I would suspect 6u at night would still be fine?

 

[evej]

Try the changed basal regime for 3 days before making further changes - unless obviously it's having a catastrophic affect on you, with those results if I was you I'd stick with it again tonight and again the following night, how were your numbers during the day as well?

Numbers during the day yesterday were horrible (very difficult to control), but I don't think that should be surprising since this was the first day I went from 21u to 15u at 7am. I am still rising now though (9:30am), despite 4 units of Humalog. Ordinarily, everything settles down around 2pm and my evenings are much easier to control. That's why I decided to try the split. it seemed to me because I was rising from 5:30ish AM to around 2 pm that the rise would coincide with Lantus wearing off.

 

[Alison54321]

My blood sugars rise early morning. I usually take a couple of units of novorapid, to start pushing it down. That usually corrects it. Then an hour or so later I take 6 units of Lantus, (I take 12 in total) and have some novorapid for breakfast, and it's mostly in the normal range by then.

If you are taking 21 units of Lantus at 7 am your blood sugar should be normal before 2 pm. What are you doing for breakfast, and lunch? Maybe its worth making some adjustments there.

 

[evej]

I was taking 21 units of Lantus at 7am. Breakfast lately has been 2 hard boiled eggs, which shouldn't affect my blood sugar at all. Lunch is a sandwich. I think I may still have a ratio issue at lunch though.

We'll see what happens today, since yesterday was the first full day of split dose.

I suspect I might have to take a few units of Humalog in the mornings as well. I did this morning, but looks like not enough. Took 4 units.

I should mention I am also hypothyroid, and have been having thyroid problems lately. It's possible that once my thyroid is back in balance, my morning sugars might get better. This winter was very stressful with 2 UTIs, a broken wrist and a stomach flu that lasted over a month! So, I think stress is influencing morning blood sugar as well