CRACKING UP!!! Please help.

[mammamia2006]

I have been a diabetic since I was 3years old, I am 28 now.

I have always been a terrible fiabetic, never checking bgl and only taking Lantus, rarely took Novorapid.

From 4th May, I started checking bgl, have been to Diabetic Clinic and have seen the Dietitian approx 3 times.

I take different levels of Novorapid (carb counting) and always take Lantus at 7.30pm (28 units)

However, between 3pm & 4pm, my bgl starts to rise, I was 6.9 before breakfast, 6.1 before lunch and sitting at 10.6 now and not due to have my Novorapid until hubby is home from work @ 6.30pm.

Should I consider splitting my Lantus dose and inject twice daily or should I ask to be changed to Levemir? I have heard about Tresiba but it is currently unavailable for me as I live in Scotland.

VERY close to cracking up and need all the help I can get.

 

[Pipp]

I have been a diabetic since I was 3years old, I am 28 now.

I have always been a terrible fiabetic, never checking bgl and only taking Lantus, rarely took Novorapid.

From 4th May, I started checking bgl, have been to Diabetic Clinic and have seen the Dietitian approx 3 times.

I take different levels of Novorapid (carb counting) and always take Lantus at 7.30pm (28 units)

However, between 3pm & 4pm, my bgl starts to rise, I was 6.9 before breakfast, 6.1 before lunch and sitting at 10.6 now and not due to have my Novorapid until hubby is home from work @ 6.30pm.

Should I consider splitting my Lantus dose and inject twice daily or should I ask to be changed to Levemir? I have heard about Tresiba but it is currently unavailable for me as I live in Scotland.

VERY close to cracking up and need all the help I can get.

I don't know. Bumping post in hope someone does. So you don't crack up.

 

[dancer]

Why don't you contact your DSN and ask what you should do? I think, when I was on MDI, my consultant said I might have to split the Lantus dose but I never had to. I know it's quite common when using Levemir but not sure about Lantus.

I certainly wouldn't go ahead and split the dose yourself because it most likely won't be a split of half and half.

Speak to you DSN

 

[Juicyj]

I have been a diabetic since I was 3years old, I am 28 now.

I have always been a terrible fiabetic, never checking bgl and only taking Lantus, rarely took Novorapid.

From 4th May, I started checking bgl, have been to Diabetic Clinic and have seen the Dietitian approx 3 times.

I take different levels of Novorapid (carb counting) and always take Lantus at 7.30pm (28 units)

However, between 3pm & 4pm, my bgl starts to rise, I was 6.9 before breakfast, 6.1 before lunch and sitting at 10.6 now and not due to have my Novorapid until hubby is home from work @ 6.30pm.

Should I consider splitting my Lantus dose and inject twice daily or should I ask to be changed to Levemir? I have heard about Tresiba but it is currently unavailable for me as I live in Scotland.

VERY close to cracking up and need all the help I can get.

Hey don't crack up you are doing really well, it can be reigned in so try not to worry and your not rising to excessive levels, on your DSNs advice look to split. I would be very pleased with your results, you know what to do so try not to fret

 

[DunePlodder]

You've already made a big step forward by deciding to sort this out - well done you.
Your readings for morning & lunch time are good! Even the high you are having isn't disastrous so you can give yourself a pat on the back.
What do you eat for lunch? It may be that you need to increase your ratio for the afternoon session (mine, for example, is higher in the morning than any other time of day). Perhaps you are eating something high in fat which delays absorption?

It is possible that your Lantus isn't lasting the full 24 hours & the effect is fading by 3pm, though that does seem rather early if you inject at 7:30pm. As others have said, have a chat to your DSN.

 

[Daibell]

Hi. It sounds like you Basal may be a bit too low? I woul discuss increasing it a liitle bit every few days and chekcing your morning fasting (my DN's target was 5 -7 mmol). Levemir is often split but Lantus less often as it tends to last almost the full 24 hrs. Levemir is sometimes better than Lantus if you are having problems and now the preferred insulin to start with according to NICE.

 

[noblehead]

However, between 3pm & 4pm, my bgl starts to rise, I was 6.9 before breakfast, 6.1 before lunch and sitting at 10.6 now and not due to have my Novorapid until hubby is home from work @ 6.30pm.

Should I consider splitting my Lantus dose

Try doing a basal check, have a low-fat breakfast around 8am and then start checking your bg levels hourly from 12-1pm, if you find your bg steadily rises as the afternoon moves on then your basal insulin is running out, if your bg levels stays relatively flat with little fluctuations then your lunch-time I:C ratio may need adjusting, the following explains how to do a basal check:

http://www.salforddiabetescare.co.uk/index2.php?nav_id=1007

 

[mammamia2006]

Thank you all so much, I was at 6.1 this morning so going to call the clinic and see what they say. No matter what I eat, proper meal, bowl of cereal, couple bits of toast, it always starts rising at around 3pm. Guessing its the Lantus running out, I was told 2 weeks ago to reduce Lantus from 28 to 26 but readings were all in double figures so I changed it back to 28, phoned and told clinic.

Also, checked with NHS24 last night (& my aunt who is a nurse) and both have said that Lantus should NOT be split because of the time ot lasts for/runs out etc.

 

[dtennant9]

First of all, well done for taking control @mammamia2006 !!

Before going on the pump I was on Lantus and I did split my dose.

I used to take part of my dose at around 9am and the rest at around 7pm. Before splitting I was getting high in the evening. At the time when I added in the morning dose it wasn't a case of splitting what I was already taking, the morning dose was an extra dose on top of what I was already taking in the evening.

I only changed on the advice of my DSN and seemed to work for me, but wouldn't necessarily be good for others.

 

[Dillinger]

I used to use Lantus and now split Levemir - I don't really believe the claims that these long acting insulins last 24 hours. It certainly sounds like your basal is running out.

Until you can get it sorted out can't you do a small correction dose with short acting to sort out the mid afternoon peak?

Or what about taking your Lantus 2 hours later than you are so that it lasts until you eat in the evening?

Best

Dillinger

 

[Juicyj]

Thank you all so much, I was at 6.1 this morning so going to call the clinic and see what they say. No matter what I eat, proper meal, bowl of cereal, couple bits of toast, it always starts rising at around 3pm. Guessing its the Lantus running out, I was told 2 weeks ago to reduce Lantus from 28 to 26 but readings were all in double figures so I changed it back to 28, phoned and told clinic.

Also, checked with NHS24 last night (& my aunt who is a nurse) and both have said that Lantus should NOT be split because of the time ot lasts for/runs out etc.[/QUOTE
Hiya did they discuss changing your lantus to something else then ? Or give you any other advice ? Changing your basal would be the next suggestion.

 

[tim2000s]

The experience of many of us is that the longer acting insulins (maybe with the exception of Tresiba) don't last for 24 hours. Those of us who have found this have split their insulin. Some of us deliberately don't use Lantus for other reasons, and operate Levemir as two separate basals, one for daytime and one for night-time, taking advantage of the fact that it doesn't last 24 hours and getting a lot more flexibility.

I am another how has split Lantus doses in the past (i ran it like that for a few years) and a I am aware that many others do. Whilst there is a theoretical period of operation, many of the DSNs and HCPs don't live with it and don't understand the issues that these things cause. That's why many of us operate on what we have found to work for us, outside of the HCP guidelines.

When I moved to Levemir, for example, I was advised that I should probably continue with the splits I used for Lantus, (which I had arrived at without HCP intervention and they were happy with) and adjust accordingly. It all depends on how confident you are with managing your Diabetes yourself.

 

[ConradJ]

Try doing a basal check, have a low-fat breakfast around 8am and then start checking your bg levels hourly from 12-1pm, if you find your bg steadily rises as the afternoon moves on then your basal insulin is running out, if your bg levels stays relatively flat with little fluctuations then your lunch-time I:C ratio may need adjusting, the following explains how to do a basal check:

http://www.salforddiabetescare.co.uk/index2.php?nav_id=1007

Touche @noblehead !

I was going to say the same thing: how do you know it's your lantus that's wrong? Run several basal tests over the next fortnight just to be doubly sure and then consult with your DSN and post your findings on here to get the range of input you'll need to properly resolve the issue.

As far as Lantus goes, it may work for you or it may not, but if you suffer soreness, lumps, stinging etc., when you inject it whilst not getting the same issues with the Novorapid (do exclude cold-insulin if you keep yours in the fridge!), then it's possible you have an intolerance to one of the ingredients in which case you need to explore alternatives.

But also do consider Berstein's point about quantity of insulin delivered per injection: his mantra is no more than seven units before you run the risk of your body's immune system reacting to an invasion of an unwelcome visitor.

Perhaps try basal testing as per the link @noblehead included and then perhaps do some using Bernstein's multiple injection process for your lantus dose (e.g. four injections of 7 units in quick succession but in different sites).

 

[Heathenlass]

I agree with what others have said - Lantus can be split and is done so by many people, but may not be the answer to your particular problem . It's a shame that so many HCP's are behind the times in knowledge regarding the long acting insulins, even the so called gold standard of DAFNE issued a statement that Lantus does not last 24 hours, and that it is unsuitable for many people due to absorption problems .

The other thing is ratios, as mentioned by @DunePlodder and @noblehead , it is seemingly rare that a person has the same ratio throughout the day . All in all, a wee chat with your diabetes team seems to be in order

And can I say that you are actually doing amazingly well ? To take charge and control is a big thing and a great thing to do. It sounds as if you have broken the back of it so to speak, and have moved on to the fine tuning part. Congratulations, and well done you !

Signy

 

[mammamia2006]

Thank you all for your help and advise. Now, any of you from Aberdeen?

 

[dtennant9]

Thank you all for your help and advise. Now, any of you from Aberdeen?

Close, I'm in Angus, almost in Dundee.

 

[mammamia2006]

Too far away to go for lunch lol.

 

[mammamia2006]

Gotta see nurse on Tuesday to see about changing from Lantus to Levemir, fingers crossed!

 

[dtennant9]

Gotta see nurse on Tuesday to see about changing from Lantus to Levemir, fingers crossed!

Hope it all goes well!

 

[mammamia2006]

Dtennant9, fingers crossed!