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Dramatic Lantus adjustments.. Daily

Discussion in 'Type 1 Diabetes' started by Fatima_94, Mar 3, 2018.

  1. Fatima_94

    Fatima_94 Type 1 · Member

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    So a lot of you may think this system is completely crazy and dangerous, and admittedly it is, but I don't know what else to do.

    Up until around a year ago, I had been doing the normal thing of keeping the lantus dose roughly the same each day, this had worked very well for me for many years.

    Something changed around a year ago where I realised my sugars in the morning would change dramatically depending on how many carbs I had eaten/ how much novarapid insulin I had put in the day before..

    Even when my sugars were perfect in the evening, I'd sleep with it being 5 (it would be 5 after many hours of eating-- all food had been digested) and wake up to it being 15 but the next day the same amount would make me very low in the morning (if i had eaten a different amount of carbs compared to the day before)

    As a result, I started adjusting my lantus based on this.. ie, based on how much carbs I had eaten during the day/how much insulin I had put in that day.. I eventually came up with a 1.5 ratio, I divide the total novarapid insulin ive had that day by 1.5 and get my lantus dose.. (also, my novarapid ratio is also 1.5u to 10g carbs). Before this system, I had set numbers based on whether I'd eaten a lot of carbs, a small amount, or barely anything, on the day. This usually worked but sometimes didn't- sometime's I'd wake up high in the mornings and sometimes low.

    Most of the time this system works and my sugars are good in the morning, but on days where I can't remember how much insulin I've put exactly, its quite dangerous. And some days, I wake up low in the mornings. It used to be quite often until I started the ratio method, but on occasion, it does still happen.. and sometimes I wake up with levels of 8-9 (but this varies every day, most days it is 5-6).

    A doctor I had seen thought this system was very interesting but suggested possible solutions for the future- potentially splitting doses or changing to a longer acting insulin or a shorter one.. I was shocked to find out about these options as it had never been suggested to me before.. nevertheless, I'm excited to know that there are alternative solutions.

    Has anyone else got any advice for this? I have had advice of 'keep lantus dose the same daily' and i have tried many times but it simply does not work. I cannot ignore what my readings are telling me.. it used to work very well for me, but for some reason something changed and it no longer does.
    #1 Fatima_94, Mar 3, 2018 at 12:24 AM
    Last edited: Mar 3, 2018
  2. LooperCat

    LooperCat Type 1 · Expert

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    That’s so interesting! I’m not sure I could trust my brain to keep track of your clever system though, and I’m pretty good with numbers. My body just isn’t predictable enough. What sort of carb amounts do you usually eat? Are you going through any life changes that could affect your diabetes?

    I’ve always been told to keep my Lantus pretty constant, although slowly I increased it over the years when it looked like it wasn’t doing the job, and recently I’ve had to cut it drastically due to going low carb. I split it myself when I realised it wasn’t lasting the full 24.

    It wasn’t until I found these forums that I realised there were newer alternatives that had longer, flatter profiles. I have an appointment on the 12th, I’m going to ask about a change. 21 units a day is too much, 20 not quite enough.
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  3. catapillar

    catapillar Type 1 · Well-Known Member

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    Changes to a dose of lantus take around 3 days to take effect, so changing your dose daily won't tell you whether yesterday's dose was correct, or the day before, or today as they will all bleed into one another and muddy the water.

    If you want a basal insulin that is responsive to changes in dose you'd be better off using levemir, which is the NICE preferred basal insulin for type 1s. Levemir lasts around 12 hrs, so is recommended to be amen am and pm. And the impact of a change in levemir dosage is felt immediately, so might be better for people with varying requirements eg after a tough day at work or an intense workout lowering your levemir PM dose sufficiently would be immediately effective in reducing hypo risk.

    Basal insulin doses shouldn't really be impacted by carbs eaten. The job of basal insulin is to keep you flat-ish when not eating or bolusing. You might want to consider some basal testing to investigate your issues with dosing a bit further. Here's a guide on how to basal test - https://mysugr.com/basal-rate-testing/
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