Best time to take Lantus

[fiona35]

I just wondered when was the best time for taking Lantus.
I used to take it in the morning but my overnight levels were not great rising rapidly in the morning, so it was switched to take a bedtime but my levels are still not that great so I wondered about switching to dinner time or if it really doesn’t make a difference.
Thank you

 

[EllieM]

Hi @fiona35

Is lantus the only insulin you are taking or do you take a short acting one as well?

As a T1 who takes both, and adjusts both, I personally find my lantus works better if I split it. But I don't make any of my own insulin whereas many T2s do.... (And before I split it I did take it at night to try to counteracrt the dawn phenomena, where my blood sugar rises first thing in the morning).

I find that lantus doesn't quite work 24 hours so splitting it works well (for me).

But it may just be that you need to change your lantus dose? What do your team say?

 

[fiona35]

I also take Novorapid to cover my meals.
I’m currently on 40 units of Lantus and 6 units of Novorapid at breakfast, lunch & dinner.
From around 12 noon to when I go to bed my levels are stable around 6-7 and before bed it’s usually between 8 & 8.5 but it seems from about 11pm onwards when I’m asleep my sugars start rising and sometimes will peak at 18 around 3am. It will then drop to around 9 and then start rising around 5am so I wake with a reading of around 12. It then goes down by lunchtime and I stay in range until I go to bed!
At the moment the DSN has told me to increase my basal by 2 units each week until I start sugars in the green zone. As mentioned it was taken in the morning but they changed it to bed time and I wondered if it was better taken at dinner time so it could get in my system.
Sorry all of this new to me and I’m still finding my feet as only been on this regime since end of August.

 

[In Response]

There are a few things with Lantus which could impact when you take it
- it has a bit of a spike in performance at around 5 hours
- it often does not last a full 24 hours

I could understand how this could be causing you an issue if you were still taking it with breakfast.
However, you are seeing the opposite which suggests your basal requirements are higher overnight.
The risk of taking more Lantus is hypo during the day if you are currently reasonably stable.

Would you and your nurse be open to considering a different type of long acting insulin such as Levemir which is taken twice a day. The advantage of this is that you can take different doses morning and night to accommodate your body's different needs at different times of the day.
Splitting Lantus is an option worth trying although it is not usually used that way. You may find you need a different dose in morning and night.

Changing the time you take it to dinner time is unlikely to help with your higher needs at night.

 

[fiona35]

I don’t know much about Basal insulin, only that Lantus was the one the DSN put me on.
I will talk to her to see if there is a better suited Basal Insulin for me, thank you.

 

[Westley]

How late are you eating your evening meal, and what kind of food?
If it's something protein/fat rich and/or late, that rise for the first part of the night could be a delayed rise from dinner.
For me when eating 3 meals a day the rise from dinner is usually slower than other meals whatever I eat. A late heavy dinner is often problematic, and I find shifting more of my calories to earlier in the day makes things easier.

 

[fiona35]

I usually eat my dinner around 7pm, then I’m afraid I’m a bit lazy before going to bed around 9.30pm.
I take onboard your comment about shifting my meals around, maybe I do eat too late.

 

[In Response]

I usually eat my dinner around 7pm, then I’m afraid I’m a bit lazy before going to bed around 9.30pm.
I take onboard your comment about shifting my meals around, maybe I do eat too late.

I would not interpret this as eating too late (I eat later). But I do agree that it is worth considering whether your night time rise is due to insufficient bolus (NovoRapid) with your evening meal rather than due to insufficient Lantus.
Do you carb count for your NovoRapid or take fixed doses?

 

[fiona35]

I currently take fixed doses for my Novorapid which is 6 units at breakfast, lunch and dinner and typically my dinner consists of meat & vegetables with the odd potato thrown in or it might be a salad with meat/cheese & egg. Sometimes I make soup with lots of vegetables if they need using up and add a bit of cream to it but I don’t eat bread/pasta/rice/potato generally as it’s always made my blood sugars rise. I admit to a new potato occasionally with some butter on!
The DSN said to walk before I run and I need to get used to the fixed doses before they introduce carb counting.
I get the impression that they want to see the results of my recent blood tests.

 

[In Response]

Could well be that your evening NovoRapid dose is not high enough.
I would be nervous about increasing your Lantus if it is ok during the day, especially if you see the rise every evening.
There some times seems to be an assumption that carb counting at the start will be too much for us. However, this can cause more problems unless we eat very similar meals every time. I remember a nasty hypo when I was on fixed doses and had quiche and salad for lunch instead of sandwiches.
As a starter, you may find it helpful to keep a note of the carbs in your meals so you can see (and share) the variation with your nurse. This will be be useful to compare with you nights when your BG goes higher.
It is definitely not the right thing to try to use Lantus to make up for the lack of NovoRapid.
At first, this could be a bit of a pain to check packets or Carbs and Cals app but it soon gets easier.

 

[fiona35]

Just an update but I increased my Novorapid at Dinner to 10 units and for the first time in a long time I’ve had a wiggly line between 6 & 7 all night rising as per usual this morning at 5am! I’ve actually woken up with energy!
Thank you everyone for all your help, hope it can stay like that now! Lol