Basal timing change problems

[Snodger]

hello everyone, long time no post. I hope you are all well.

I have an odd problem I'd really welcome your thoughts on.
I've been on a basal dose of about 18 or 17 for ages (years) and had very few problems with it. It's Lantus, but I had no side effects and it genuinely seemed to last 24 hours. I was injecting at 10pm.
This last week I was merrily going on my way when I started getting night hypos. Reduced the Lantus; got a hypo the next night too. Reduced it again, got a hypo again. When I hypo at night it's always about 1 am, and I wondered if that was coinciding with the Lantus coming up to full strength, so I decided to shift it to the morning and see how I got on.
In preparation for this I took half my Lantus dose - 8 units - on the evening before, to tide me over into the morning. I reckoned that since lots of people split their Lantus dose that would work ok.
I went hypo again. On HALF the ordinary dose.
I took the morning half of my Lantus and went through the day. That night, no injection, because now I'm on morning jabs.
I went hypo again!
What is going on, and what can I do? I'm now taking 14 units Lantus at 8am, and carb-free tests show that I'm rising too high, i.e. that 14 units is not enough. And yet I'm probably going to go hypo again tonight because I'm still going to have the Lantus in my system.
I can't split dose because taking 14 units in the morning is not enough for the day, but even without a top up is too much for the night.
help!

here's a summary:
Normally: 10pm jab of 18 units Lantus. Happy as a sandboy.
Last Tuesday: 10pm jab of 18 units Lantus. Hypo by 1.30am.
Wednesday: 10pm jab of 17 units Lantus. Hypo by 1.30am
Thursday: 10pm jab of 16 units Lantus. Hypo by 1.30am
Friday: 10pm jab of 8 units Lantus. Hypo by 1.30 am
Saturday: 8am jab of 8 units Lantus. Hypo by 1.30 am
Sunday: 8am jab of 14 units Lantus. Hypo by 1.30 am
Monday: 8am jab of 14 units Lantus. Carb free day. Bg rose from 8.5 to 16.8 in 3 hours. So 14 units is clearly not enough in the daytime.

Just to note: it's not my quick acting sending me hypo, it's completely gone from my system by 1.30 and I'm going to bed with bg that's fine.

 

[noblehead]

Hi Snodger nice to see you posting again!

Strange you still went hypo even though you switched to a morning dose, one possible explanation is exercise.....do you work out on an evening?

 

[CarbsRok]

Hi Snodger,
Just a suggestion for you.
Lantus so I understand takes a good 3 days for a change to be noticed. So you need to think about making a change and waiting 3 days before the next reduction/increase.
Until things settle perhaps have a small snack before bed and see what happens.
I've noticed over the years that people on Lantus seem to be fine then all of a sudden problems start regarding hypos.
So another thought if you can't sort things out is to perhaps think about a change in basal insulin.

When you say carb free do you mean you run on empty? Because if you are eating prtien and fats then these will affect your blood sugars big time. Pumpers are told it has to be no food or if you really must a SF jelly.

 

[iHs]

Hi Snodger

It can take a few days for any adjustments to Lantus to have full effect on bg levels so at the moment it might be wise to test yr bg levels about 1am and if low eat a small amount of carb otherwise you may risk going hypo again. Lots of people do eat a bit of carb at bedtime in order to prevent overnight hypos caused by the peaking action that Lantus has on bg especially if their bg levels naturally lower anyway which may now be the case for you.

I dont think that you got the full picutre of the effect Lantus was having on your fasting bg levels in the morning as your bg level when you started the fast was 8.5mmol so that is why your bg level rose like it did. If you had done a small correction to get back to your target level first, then the lantus basal test would have given different results. Best to basal test though when your bg level is at the correct target range and then start fasting and testing without a bolus correction also working.

Give things a bit longer to work and then you will see a different effect on your bg levels and may well need to alter some of your insulin to carb ratios to suit the action of the Lantus and the new timing that you inject it.

 

[Snodger]

Ah I've missed this forum! Wise and speedy advice as always. Thank you.

You are all right of course that I should relax a little and maybe wait for the Lantus to properly exit my system. And perhaps not worry so much about going to bed on target; let it ride a little high. I'm really feeling ill from so many nights of hypo so to be honest a good night's sleep is going to be my priority tonight.

Interesting that it's not unusual to suddenly have problem hypos on Lantus, CarbsRok.

In answer to people's questions, and to add info,
- no exercise was involved, I've been a lazy slob all week
- I was doing hard core carb-free, not eating at all.
- I've also had an incredibly stressful morning worrying about various family members being ill/going into labour (!) and getting the cat to the vet for emergency surgery. Stress doesn't normally push up my bg but if anything was going to do it, this morning would have done so. Perhaps that made a difference too.

I was trying to get my head round the way Lantus works. I know it's a different action from Levemir but I can't remember how. Can anyone enlighten me? How is it possible to split Lantus into two daily doses without ending up with either too little or too much?

 

[noblehead]

It's not recommended that you split lantus although there has been members on here who've done this before. I would be inclined to switch to lever or Insulatard if your looking at split doses, I've tried switching to levemir once before but failed to get the same control as I do with lantus, it was interesting what Carbsrok says about lantus and hypo's :think:

Before thinking of splitting the lantus dose I would seek guidance from your DSN, here's a good explanation on the differences between the two insulin's:

http://www.diabeteshealth.com/read/2007 ... ifference/

 

[Snodger]

thanks. That lantus/levemir link is fascinating. Really well explained.
I was told on DAFNE to split Lantus - some centres are very keen indeed on getting people on split doses. It didn't feel 'right' to me so I stayed on my single dose (and then of course I was not having any problems).
Last night I went to bed a bit high, just to be sure, on 9.8. Woke at 1am anyway so checked blood, it was 6.8. Maybe my liver just stops chucking out sugar at 1am and goes into hibernation. Stranger things have happened.

 

[Mileana]

Now a strange suggestion, maybe.

Could you try with a protein snack before bed? It may just convert in time to get you out of the woods at 1am - as far as I have gathered from various posts, a non-carb protein meal will convert about 50 percent of the protein into glucose 'if it is needed'.

Maybe if you had 10-15g of protein before bed, this would be enough to get you through that rough patch.

I've personally stopped the great 'have some carbohydrate before bed' advice and turned to protein for this purpose - no spikes and as you are type 1 you shouldn't get any insulin response to it and it might just work.

GL

 

[Snodger]

Interesting idea! I'll give it a go.
Update in general, I'm sticking with 14 basal, jabbed once a day in the morning, for now. Today that seems to have stayed steady (so the rise the other day may well have been stress). And I'm going to bed a bit higher than normal - tonight I'll do the protein thing just to see.

 

[Snodger]

hello all you kind people,

I just wanted to update you on this weird problem.
Basically, I never did find the answer. I went oddly low as I described, then over a few weeks gradually crept up to 22 units of Lantus (previous usual dose 18). Then I gradually crept down again. Now I'm on 19 and it's perfectly fine, stable as anything again, but I still don't know what went on.

However! I am LOVING taking my basal jab in the morning. Best thing I ever did. Haven't had a night hypo of any kind since I did it, and have woken up with lovely bgs each morning. (once I'd got the dose right, obviously). Also, not having to do a bedtime jab any more feels like a holiday.

Not sure if I have any learnings from this whole episode except this one: if you post your problem on this forum you get intelligent advice and support, and you feel better even if you don't immediately solve the thing that was bothering you.

thanks all!

 

[Pneu]

Hey snodger glad to hear it all worked it's self out.. sometimes I think we just have to accept that our bodies do strange things to irritate us! or keep us on our toes!

 

[noblehead]

Glad you got the problem resolved Snodger. I moved my lantus back from injecting just before bed to early evening (around 6pm) and found this drastically reduced the amount of hypo's I was experiencing during the night.