Help! Lantus Advice Needed Please.

Eldorado said:

I recently changed by injection of Lantus from bedtime to before breakfast. Mainly because I was FED UP with nighttime hypos. Now my BG tests during the day are much better, but the night time coverage isn't. I'm getting too high readings in the night and a horribly high result before the next injection. This morning it was 17! Yikes! So frustrating.
I'm seeing my GP tomorrow, but any ideas or advice would be greatly appreciated.
Thanks
Oh, my Lantus dose is 14 units, which I think is right for my weight.
I upped it to 16 this morning.
Grrrrrrrrr. The joys of being diabetic.

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You could ask about changing to Tresiba (i did about a year ago). It lasts about 42 hours but you take it once a day. The only obstacle might be that it's more expensive, but it's very flat and doesn't tail off before the next shot.

Eldorado said:

I recently changed by injection of Lantus from bedtime to before breakfast. Mainly because I was FED UP with nighttime hypos. Now my BG tests during the day are much better, but the night time coverage isn't. I'm getting too high readings in the night and a horribly high result before the next injection. This morning it was 17! Yikes! So frustrating.
I'm seeing my GP tomorrow, but any ideas or advice would be greatly appreciated.
Thanks
Oh, my Lantus dose is 14 units, which I think is right for my weight.
I upped it to 16 this morning.
Grrrrrrrrr. The joys of being diabetic.

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Changed many years ago to do the same (only taking Lantus at breakfast). Not a single night-hypo after that!
Took a couple of times (a full day at a time) to test what the right Lantus basal should be, and also if I needed two shots to cover full 24h or needed 2 shots a day to have sufficient flat curve throughout. Testing to set correct basal rate means: eating nothing the entire day and not doing any physical activity either. (that is the way I do it, others may have other creative ways to do it). When in doubt if my basal is still spot on, I do this exercise again, and then potentially adjust 1 unit either up or down.

Your split between basal and bolus is typically 50/50. If your basal is not high enough, then you typically take too much bolus throughout the day to keep it down. And then during night sleep it will peak up again (as the Lantus basal is too low to keep balance), giving the symptom you describe. How much is your daily total bolus to the 14 units of Lantus? Another important thing is that late night snacking is a bad idea if any glucose intake is involved, as you are not sure then to enter into sleep in stable balance with what is still being digested versus the bolus you might have taken to counter. So avoid eating the last 2-3 hours before going to bed. Then measure your bg before bedtime, so you know what level you are at at that time, so you can benchmark versus bg when you wake up again.

Excellent work @Eldorado, I to have the problem that Lantus doesn't last 24 hours and had to split doses.
I don't understand why they put T1s on single evening basal doses, it means the insulin peak will be in the middle of the night which is the worst time to have hypos.

Thought I'd chip in because I do basal Lantus before breakfast. I take 18 units. My bolus varies between 10 and 15 ish. I'm wondering whether to split my dose too, but unfortunately I can't see a consistent pattern. Sometimes, like today, I wake hypo (3.7) yesterday I woke on 7.3, Saturday 7.3 as well, but Friday 10.2, and I can't pin this variation to a cause, although, obviously I know the reason is out there somewhere. I used to do Lantus before bedtime, but my consultant suggested breakfast Lantus to avoid hypos on my way to work. I haven't changed my basal regime since then (though I've been low-carbing less than 50g carbs per day and have lost 1.5 stone and have reduced my bolus considerably). I'm none the wiser, but found all the experience and advice on this thread useful (Thank You) - and feel maybe I should do proper basal testing (which I've never done) and try to work out the best way to dose with Lantus.

Eldorado said:

Many thanks for your help. After a bit of trial and error the last week or so I've settled on 8 units of Lantus at breakfast and 12 units before dinner at 6.30. So far so very good. No nighttime hypos and no more dawn rises. Yay! I'm feeling quite smug and pleased with myself. Bg's are around 5 to 7. Better than they've been for longer than I care to admit. Of course a lot of the credit has to go to my new Accu-chek Aviva Expert. I rely on it now and would feel lost without it.

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Yes, I find the Aviva Expert very useful, but I've had mine for years and its screen is scratched now, plus I can't read it in sunlight.

zjed said:

Excellent work @Eldorado, I to have the problem that Lantus doesn't last 24 hours and had to split doses.
I don't understand why they put T1s on single evening basal doses, it means the insulin peak will be in the middle of the night which is the worst time to have hypos.

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Non-T1 Diabetics do not understand that taking one shot more or less means really nothing to us. And agreed, the night shot of basal is a terrible thing. Its actually a anachronism, as from the days when mainly young children got diagnosed as T1 vs the alternative all others got 'old-man diabetes'. And when you are young, you tend to have the dawn effect. And back then we did not have glargine type of basals available, but some insulins like 'insulatard' that had delayed/sustained effect curves. But all of them with quite an effect peak spiking up 4-6 hours after injection. Challenge was then to match the volume and time with your hormones' dawn effect. Today we know its more or less mission impossible, but back then you were just a non-compliant diabetic kid when you screwed up the good doctors instructions and made 'his numbers' look bad.

Eldorado said:

Back in the day when I was diagnosed I was put on one daily injection of insulatard. I was 30 and classed as a 'juvenile onset'! No wonder I struggled with it all. And back then it was eating to suit the insulin not the other way round. One of the things I hated the most was having to set when I didn't want to. It was all about snacks, snacks, snacks. Things have changed such a lot, thank goodness. My first BG meter cost £80 and was the size of a brick! Mostly it was urine testing, so my brick was pretty much ground breaking stuff. I'm showing my age, aren't I?

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The days when our endocrinologist shouted "Fantastic Great Control" when there was no ketones in the pee-sample being tested with the dip-stick, and we had to wait 3 days to get the bg test result back from the lab.

I remember my mother boiling the glass syringe!

zjed said:

I remember my mother boiling the glass syringe!

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The skeletons are tumbling out of the historical Diabetes horror cabinet !

Celsus said:

The skeletons are tumbling out of the historical Diabetes horror cabinet !

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Like, during my second pregnancy in 1985, and having a month before been diagnosed with T1, I was admitted to a day ward so that my blood sugar levels could be monitored. This was very kind of them but all I did all day was lie on a bed, reading!