Has anyone seen Lantus do this?

[tim2000s]

Gym phenomenon kicked in last night as usual, and I glycogen dumped, only last night I felt sick with it, like you do with a glucagon shot. Bloods rose as they normally do.

Anyhow, at about 9pm, I took 2u correction of Novorapid and at 10.30 the last 15u shot from the older bottle of Lantus, and then this morning, started on the new one.

The morning Lantus was taken at 5am, and was similarly 15, but from a new bottle from the fridge. But look at the slope. Basically I've dropped from 11 (sensor) to 1.6 (finger prick as I was feeling low) in 1.5 hours . Now I've done nothing different in my eating, insulin or gym work and I injected in a usual site.

Has anyone else experienced this with Lantus? It's not behaviour I expect.

It also seems to be exactly the same as the issue I had about three weeks ago.... http://www.diabetes.co.uk/forum/threads/well-that-was-embarrassing.66872/

 

[diamondnostril]

Hi Tim,

Yes, I've had 2 types of similar problems with Lantus.

The first was when I used the last vial from an 'old' carton and switched to a vial from a 'new' carton. The 'old' carton had been stored outside the fridge for a while during a big location move, and over months (without noticing) I had gotten used to injecting more due to the reduced effectiveness. When I finally switched to the new carton (obtained locally and always stored in fridge) I got a shock! I only connected the dots with benefit of hindsight.

The second was my mistake in not taking enough care with my Lantus injections and injection sites (details on the below Post).

http://www.diabetes.co.uk/forum/threads/hypo-after-lantus.52342/#post-480900

Lantus CAN act like a Rapid Insulin in certain circumstances. Of course, this can be extremely dangerous and I wish that the manufacturer would mention the details in the information leaflet in the box. (Understanding exactly HOW Lantus works was a big AHA moment for me which explained problems that I'd been having for months!)

Maybe your problems this morning were to do with similar circumstances to one of these? Or even a combination?

I like Lantus; when it is working as it should, it really works well for me. But I have found I need to keep a close eye on it to make sure.

Regards,
Antony

 

[LucySW]

So could this just be something as simple as Lantus deteriorating very quickly? Bernstein mentions that as one reason why he stopped using Lantus. He mentions practicality and cost not safety, but still. ????

Lucy

 

[tim2000s]

@diamondnostril, thanks for that. I've only noticed it happening significantly in the last month or so, which has coincided with my body fat dropping below 15%. I've also modified the injection site area so I feel pretty confident that this is the likely cause of the issue.

To say it was slightly disconcerting is an understatement, and I think that this is something that really should be much more widely publicised. I don't know whether Lantus operates differently from other Longer acting insulins, but given the higher doses that we give ourselves, the potential for disaster is rather higher than many people would imagine.

I guess the other side of this is that it means I now don't have the full complement of longer acting insulin operating in my body so will have to keep a tighter eye on my BG throughout the day.

Out of interest, how did you find out about how Lantus operates within the body, and do you know whether others such as Tresiba, Dugludec, etc do the same thing?

@LucySW I suspect that it is a combination of factors. I dispose of Lantus after 29 days every time as I've noticed that it drops off in efficiency and you need larger doses (29 days seems to be the end point from the experimentation I've done) once that goes. Secondly, with a reduced body fat level, the opportunity for the insulin to go "straight through" is also greater.

Now I come to think of it though, after about three weeks I generally notice a difference in performance so maybe I should be discarding the "out of fridge" Lantus a week earlier than I do.

 

[LucySW]

Tim, I think you ought to flag this on the Insulin forum and see how common it is. If it's something that happens a lot, then it's important and people really ought to know.

 

[tim2000s]

All done Lucy. Time to wait and see what comes out!

 

[smidge]

@diamondnostril,Out of interest, how did you find out about how Lantus operates within the body, and do you know whether others such as Tresiba, Dugludec, etc do the same thing?

@LucySW I suspect that it is a combination of factors. I dispose of Lantus after 29 days every time as I've noticed that it drops off in efficiency and you need larger doses (29 days seems to be the end point from the experimentation I've done) once that goes. Secondly, with a reduced body fat level, the opportunity for the insulin to go "straight through" is also greater.

Now I come to think of it though, after about three weeks I generally notice a difference in performance so maybe I should be discarding the "out of fridge" Lantus a week earlier than I do.

@tim2000s - I use Levemir and have no idea how it works. However, I have relatively frequently experienced a situation where my BG is fairly high before my evening basal e.g. 8mmol + but within 1hour of injecting Levemir, my BG has plummeted into the 4s. My last Apidra would have been 12.30pm. I have explained this to Consultant, DSNs etc but I've been told that can't happen.

Earlier this year, I started throwing Apidra cartridges away at 20days and carrying them in a Frio bag permanently because they seemed to lose their potency after a couple of weeks. Again, it was nothing I could prove and I was told it doesn't happen.

Smidge

 

[tim2000s]

I'd guess that Levemir works in a similar fashion, without having any knowledge of it properly.

That's the beauty of something like the Libre. Not only does it happen, you've actually got visual evidence of it happening.... Now all we need is a few more people to come forward and let us know that they've experienced it.

EDIT: @smidge I've just found this really interesting paper that describes how Glargine and Determir (Lantus and Levemir) differ: https://ispub.com/IJEN/4/1/11800

The main difference is that:

• Lantus has an acidic nature and when introduced into the fatty tissues of neutral pH, crystallizes to form its reservoir.
• Levemir remains as a liquid reservoir with a larger surface area and is structured very much like Tresiba (as described by someone else recently) in terms of binding to fatty acids.

I'd guess that the reason for Levemir not lasting as long for some users as Lantus is linked to this reservoir and then breakdown mechanism (and if you are a significant user of fatty acids, as a Low Carb diet user might be), your body may be more used to breaking down those fatty acids so disrupting the release mechanism for Levemir.

 

[phoenix]

Lantus and levimir work differently.
short video from lantus http://www.lantus.com/hcp/about-lantus/how-lantus-works
one from levimir (annoying intro and not that clear) https://www.levemirpro.com/pharmacology/mechanism-of-action.html

You should report the problem to the MHRA.
One thing I did notice is that you said you injected into a usual site . As I mentioned to another poster yesterday, could this be the cause of variable absorption? Do you need to change your site completely?

 

[tim2000s]

Lantus and levimir work differently.
short video from lantus http://www.lantus.com/hcp/about-lantus/how-lantus-works
one from levimir (annoying intro and not that clear) https://www.levemirpro.com/pharmacology/mechanism-of-action.html

You should report the problem to the MHRA.
One thing I did notice is that you said you injected into a usual site . As I mentioned to another poster yesterday, could this be the cause of variable absorption? Do you need to change your site completely?

Hi Phoenix, updated my earlier post with a paper describing the differences.

When I say usual, I mean "My leg". I randomise across both legs, both up and down and round and round, if you get what I mean. Typically, I've found that I build up fat around injection sites, but haven't noticed variable absorption in other areas particularly. I think that's one to keep an eye on rather than change immediately.

I think the transcripts on those websites are quite interesting and describe it very well. In theory at least, what the medical professionals told Smidge is true. With the Albumin binding that is undertaken for Levemir, missing the subcutaneous layer shouldn't result in the same effect as Lantus not hitting the appropriate layer properly.

 

[diamondnostril]

Out of interest, how did you find out about how Lantus operates within the body, and do you know whether others such as Tresiba, Dugludec, etc do the same thing?

Hi Tim,

I guess I did exactly what you have done this morning and consulted Mr Google.

I made a small experiment (switched my Lantus injection to the morning), the results of which made it 100% clear to me that the Lantus injection had caused a severe low blood-sugar 3 hours later. Armed with this info, I set to work in Google trying to discover how this could happen.

I think if you kinda know what you are looking for, that's a great start to being able to find something online. As soon as you choose the correct search words you can hit the jackpot and find the info you need.

I guess I shouldn't post a link here to another forum, but I first found the info on US Diabetes forum website, on a thread with the same topic as this one. This was my AHA! moment, and enabled me to search in more detail to confirm the info.

I do not know the method of action of other background Insulins . . . but I guess they all must have some method to produce a steady, flat release over time, rather than working immediately. From that point-of-view, possibly they are all susceptible to their particular method being disrupted by one thing or another.

Regards,
Antony

 

[robert72]

Here's a link to how Tresiba (Insulin Degludec) works:

http://asweetlife.org/feature/insulin-like-a-string-of-pearls-how-degludec-works/ thanks to @drahawkins_1973 for originally posting this link

I used to find Lantus unpredictable at times, although when it worked it was good. This is why a asked to switch to Tresiba. So far, so good.

 

[tim2000s]

Now I'm experiencing the other side of this "phenomenon". I had a meal at lunchtime that was minimal carbs and contained peppers, a few tomatoes and nothing you'd be considering as "carbs". My basal insulin is clearly mullered as my BS is ascending like a rocket. A proper spike that under normal circumstances would be covered by the basal.

This really isn't much fun, and I'd suggest is a massive flaw in the way that Lantus works.

Thinking longer on the topic, it also explains the unexplained overnight hypos that I've had in the past. I've already booked a conversation with the doc to change to Tresiba.

 

[Beaver Lee]

I'd guess that Levemir works in a similar fashion, without having any knowledge of it properly.

That's the beauty of something like the Libre. Not only does it happen, you've actually got visual evidence of it happening.... Now all we need is a few more people to come forward and let us know that they've experienced it.

EDIT: @smidge I've just found this really interesting paper that describes how Glargine and Determir (Lantus and Levemir) differ: https://ispub.com/IJEN/4/1/11800

The main difference is that:

• Lantus has an acidic nature and when introduced into the fatty tissues of neutral pH, crystallizes to form its reservoir.
• Levemir remains as a liquid reservoir with a larger surface area and is structured very much like Tresiba (as described by someone else recently) in terms of binding to fatty acids.

I'd guess that the reason for Levemir not lasting as long for some users as Lantus is linked to this reservoir and then breakdown mechanism (and if you are a significant user of fatty acids, as a Low Carb diet user might be), your body may be more used to breaking down those fatty acids so disrupting the release mechanism for Levemir.

Thanks for putting this paper up. Also for summarising it

Beaver Lee

 

[Beaver Lee]

Here's a link to how Tresiba (Insulin Degludec) works:

http://asweetlife.org/feature/insulin-like-a-string-of-pearls-how-degludec-works/ thanks to @drahawkins_1973 for originally posting this link

I used to find Lantus unpredictable at times, although when it worked it was good. This is why a asked to switch to Tresiba. So far, so good.

I found this interesting about insulin, It has diagrams of the things that your link speaks of.
"Insulin preparations and analogues: structure and properties"
http://www.thejournalofdiabetesnursing.co.uk/media/content/_master/2994/files/pdf/jdn2-5-150-4.pdf
Hope things are working out well for you,
Beaver Lee

 

[tim2000s]

Here I go again. Lantus injected in a different location from last time, couple of glasses of wine on the previous evening and we're on the lantus magic roller coaster once again.

Fortunately I was able to check it and eat ahead of the crushing descent into madness this produces.

It begs the question as to whether this is alcohol or injection site related though.

 

[LucySW]

Tim, do you use one injection for all your Lantus? Bernstein makes people split doses over 7u into several injections in different sites to counteract the unreliability of insulin delivery. There can be up to 30% variation in insulin absorption, apparently.

It's here, if you're not familiar with it:

http://www.diabetes-book.com/cms/ar.../1707-richard-k-bernstein-md-face-facn-fccws-

Might be worth thinking about.

 

[tim2000s]

Tim, do you use one injection for all your Lantus? Bernstein makes people split doses over 7u into several injections in different sites to counteract the unreliability of insulin delivery. There can be up to 30% variation in insulin absorption, apparently.

It's here, if you're not familiar with it:

http://www.diabetes-book.com/cms/ar.../1707-richard-k-bernstein-md-face-facn-fccws-

Might be worth thinking about.

Hadn't heard that before, and it was never something that was suggested to me by any doctor! May give it a go.

 

[LucySW]

He really impresses me. Every time I re-read him, more.

 

[tim2000s]

So here's another interesting chapter in this little story.

I was running high yesterday, not entirely sure why, but the indicators are that I now have a cold.

In the graph below, you can see my bg from 10pm last night, when I took my evening lantus. A fairly flat bg overnight running at too high, but operating as it should.

Then at 5am, the second shot. And then we see the steep slope again. This time the lantus was split into three, but it's still not the kind of response I'd expect, so I wonder if one "missed" fat and didn't precipitate. Notable this time is that there was no alcohol the night before so this is not a linking factor.