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Changing To Lantus

A

azizdhl

Well-Known Member
Messages
64
Hi guys,
I am officially moving from Insulatard + Actrapid to Lantus and Novorapid, and I have some questions as I used your advice as a reference where am living in country with zero knowledge of diabetes


- Is it recommended to do this change, where I read that having Insulatard is hard to predict its peak and the problem with Actrapid is that it works after a long time after the sugar is high when eating which lead to serious complications in the feature

- Is there anybody before changed from Insulatard + Actrapid to Lantus and Novorapid and had any bad effect?

- Does 5 unit of Actrapid that cover 50g of carbs would cover the same amount in 5 unit of Novorapid?

- Any peak hours for both Lantus and Novorapid?

- How many times and days should I test my blood sugar after I changed in order to understand how it works with my body? 8 times? And when exactly?

- Do I need to a doctor to give me how many unit and when? I am thinking of putting the same 25u daily that was set for Insulatard to Lantus, and the same for Actrapid and Novo.

- The main reason for me to change was the frequent hype that happened to me while sleeping, so what is the best time to take Lantus?
 
Hello, I changed from Mixtard 30 (which is 70% insulatard and 30% actrapid) and actrapid to Lantus and Humalog (same thing as novorapid). To start, basal insulin is the slow acting insulin which is in this case the Lantus. It works 24 hours and has a very slight peak after 5 hours of injection, and takes 30 to 90 minutes to start acting. Bolus is your fast insulin in this case, Novorapid. It takes around 10 to 20 minutes to start acting, peaks from 1 to 3 hours, and stays up to 5 hours with minimal effect. Basically, from my own experience, I was on 16 units of Actrapid on lunch time but now I am on 8 units of Novorapid. So you might consider starting om just 2.5 or 3 units for 50 carbs to be on the safer side. It is not dangerous to consider this because it is merely 2 units difference. Regarding the Lantus, I didn't tryst my nurse that switched me over to 25 units of Lantus (80% of total insulatard=30 and take 5 out because I was afraid of hypo). Anyway, I started on my very own with 10 units of Lantus only before bed, aroud 11 or 12 o'clock, then, you increase your Lantus if you wake up out of range (4 to 7 or 72 to 126) EVERY 3 DAYS. Which means if you take today 10 units of Lantus, you are allowed to increase after 3 days only to allow the dose to settle. Afterwards I found my dose to be at 19 units. You should definitely test more. My experience, before every meal, 1 hour after the meal (optional) then 2 hours after the meal (necessary), before taking Lantus, (I test sometimes after 10 minutes of taking Lantus if and only if I see large amount of blood coming out because this might indicate that I caught a blood vessel. Eat sugar like crazy if you see a massive drop, keep testing every 5 to 7 minutes because it will drop very dramatically) and every hour after taking Lantus. Hope this helps.
 
Hi @azizdhl, The person who prescribes your insulin is responsible for advising you on what doses of the new insulins you should start with and what changes to make over time, in consultation with them. How often one changes a long-acting insulin dose will depend on the length of action of the particular insulin, in my experience, the longer acting the insulin the greater the number of days to allow BSLs to settle between dose changes.
Your prescriber should also be advising you on when and how frequently to test your blood sugar with this changeover.
We. on site, are not qualified to provide you with professional advice or opinion.
I wish you well in the changeover and hope you have much less hypos.
 
I agree I hope that he does not consider my story as an advice I did not intemd it to be so but I just gave my story and what happened with me.
 
thank you very much guys for your replies and support, am not going to take any advice to follow it but am trying to learn. the diabates knowledge here in my country is so stupid and bad, two of my friends died duo to wrong instructions from doctors, one of them was give a mixtard with actrapid and had suffered from hypo which lead to death and unfortunately there is no law here to take any action of that
 
guys one more question..

from what I know that I have to take novorapid before each meal which is 3 meals usually.. let's say I want to have like 5 or 6 times novorapid to cover extra meals does that have any bad effect on me?

my actrapid dose is 15units spilts into 3 meals.. if I take like 25 units daily for more meals does that consider an overdose insulin?
 
Hi, @azizdhl , if you want to eat more than 3 meals a day, there's nothing wrong with that. Novorapid has the flexibility to do that.

It's not a case of overdosing, provided the amount of insulin you take is balanced with the amount of carbs you're eating.

Do remember, though, that novorapid lasts for about 3 to 5 hours in your body. It gets used up as time goes by, but the last couple of hours can still lower you a lot, so if you eat and inject again for another meal during the 3 to 5 hours, you'll have two doses of insulin in you (it's called insulin stacking) and it can sometimes be unpredictable if you don't keep an eye on it.

So, if you're eating again within the 3 to 5 hours, remember to think I've still got some insulin in me from the last dose, so you might want to reduce the next dose a bit. There's nothing wrong with insulin stacking but it takes a bit of care.


Seeing as there seems to be little knowledge of T1 in your country, can I suggest you have a look at the online BERTIE training course:

https://www.bertieonline.org.uk

Many of us here and around the world go on week long training courses, like DAFNE, where six or so of us sit down with a dsn and dietician and go through some practical carb counting and insulin balancing examples to get a better grip on figuring out insulin doses.

BERTIE is an online version of that, so might be useful for you. I've not done it myself but other posters speak highly of it.

As a very, very general rule, most of these courses say that 1u of novorapid deals with 10g of carbs. It's a useful starting point but you'll need to experiment a bit to find out what the best ratio is for you - some people are higher than that, some lower.

Good luck!
 
If you want to eat 5 meals you can, split 3 hours as minimum and take 5 injections of novorapid each injection before each meal. You can't take all the novirapid at once.
 
What country?
 
Hi @azizdhl, I am truly sorry to hear of the fate of two of your friends.
The advice given to me by my doctor for testing blood sugars was to test : (and all the info below would need to be done ideally by you in consultation with your doctor or nurse):
on waking in the morning and then 2 hours after each meal. ( see information on this iste about normal ranges of BSL.
The idea being that the waking or fasting BSL gives information on how well the long-acting insulin is working overnight and the after meal BSLs give information on how well the short-acting insulin is working.
If the fasting BSL was high, I would check back on what my BSL after the evening meal and also just before bedtime were.
If both were high I would look whether to change the amount of carbohydrate eaten for dinner to less, or increase the short-acting insulin before dinner. In my case increase 20%,.
I would avoid a supper if only the before time time BSL was high. And review dinner diet again. PLus check BSL at say 2 am.
If after dinner and before bedtime BSLs were normal, I would then check my BSL at 1 am, 3 am and 5 am and watch out for any signs of hypo. A hypo would cause my liver to release more insulin and this plus any food eaten could send my BSL up resulting in a high fasting BSL. Hypo at night would mean that I would reduce my long-acting insulin by 20 % to start with.
If BSLs were normal at say 1 am 3 am but up at 5 am then I was told that the Dawn Phenomenon (DP) was probably the cause of the high fasting BSL. There is a topic on site about DP. Dealing with DP is tricky (and not every diabetic suffers from it) as I found increasing the long-acting insulin led to hypos. Some person have to wake at say, 4 am and give themselves I small dose of short-acting insulin to deal with this (not much fun !!). The only way I could find around this problem after many years of early wakings and jabs of insulin was to go onto an insulin pump.
The other way of checking my long-acting insulin dose was by skip a meal, say lunch (and not have the short-acting insulin before that meal) and see how the BSLs at say 2 hours intervals was BSLs > 8 to 9 mmol/l then altering long-acting insulin was something to consider. Again hypos at night is the main thing that limits increase in my long-acting insulin dose.
High BSLs 2 hours after meals indicates to me that I am eating too much carbohydrate for the insulin dose,
or the short-acting insulin dose is insufficient for the amount of carbohydrate in the meal.
The only way I can tell whether the amount of carbohydrate is too much for my body is if with normal blood sugars my weight starts to increase so I tend to weigh myself, same time, minimal clothing say every 2 weeks. If I am putting on weight I reduce carbohydrate of one meal, usually that meal with the most carbohydrate in it to begin with and ease back the short-acting insulin before that meal. And if losing weight I do the opposite.
I hope my experience gives you much to consider and discuss with your doctor.
My Best Wishes go with you.
 

You can inject as many times as necessary, I take a million shots a day and inject NovoRapid every time I eat something. This is what people on insulin pumps do and there's no reason it can't be done with pens or syringes. The idea should be that Lantus keeps you stable when not eating and NovoRapid is used every time you eat, whether it's a snack, a full meal or whatever. Actrapid can still be useful by the way, I use it along with NovoRapid when I am eating something high in protein and/or fat such as pizza, pasta, or steak. Since NovoRapid only lasts 3-5 hours, often protein will convert to carbs (gluconeogenesis) or fat will delay the digestion of food for hours after the NovoRapid has worn off, causing a spike. Actrapid takes an hour or more to kick in and lasts for 6-8 hours, so it is better suited to deal with delayed spikes from protein or fat.
 
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