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Insanely frustrated

Discussion in 'Type 1 Diabetes' started by annapanna93, Sep 28, 2017.

  1. annapanna93

    annapanna93 Type 1 · Well-Known Member

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    Desperately hoping someone can help with this because I'm at my wits end!

    Recently my Lantus was reduced from 20 units in a morning to 18. Now during the day this is fine, I rarely have problems.

    Night time however is a whole different issue! Tonight I took more insulin than carbs counted. 2 hours later 9.3. 2 hours after that I'm in the 12s!

    So sick of having these slow spikes every single night

    I would really appreciate any help with this!

    Anna x
     
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  2. NeilASmith

    NeilASmith Type 1 · Newbie

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    Good Morning Anna, So first of all was the carb counting correct for the fast acting dose (I have made mistakes with mine) and secondly it maybe that the Lantas is running out sooner than you think as it is known to last between 18-24 hours. I have just switched my lantus to 2 injections, morning and night to ensure it doesn't tail off too early as it should now overlap sufficiently to prevent this and last the full 24 hours. I know it's a pain having to have an extra shot but might be worth a try. You could always try a carb free meal too on the last meal of the day to prove if the Lantau dose is the issue which it sounds like.
     
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  3. catapillar

    catapillar Type 1 · Well-Known Member

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  4. Deleted Account

    Deleted Account · Guest

    What time of day do you take your Lantus? If you look at the profile, not only does the peak/plateau not last a full 24 hours but also it takes a while to peak. I used to inject basal when I went to bed at midnight and found it would rise in the evening at the start of the night when I was asleep. I moved this to meal time (about 8pm for me) and found the dose was at its peak by the time I went to bed.

    The other thing I would do would be to have a slightly higher basal dose, go to bed a little high (about 7 or 8) and woke up about 5. I found daytime grazing (which I have always done) kept everything level for the rest of the day.
     
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  5. Levy

    Levy Type 1 · Well-Known Member

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    When I was having similar issues, I was moved to Levemir twice a day with a higher day time dose and lower nighttime (I need less insulin during the night than day). You could keep a diary for a few days, note down when you take your basal, what you eat for dinner/snacks in the evening to figure out if it's definitely your basal causing the overnight highs. If it is, your consultant should be able to help you figure out how best to fix it (ie. maybe changing the dose/time you take your Lantus, splitting it, or trying a different type of basal).
     
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  6. Daibell

    Daibell LADA · Master

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    Hi. I believe Levemir is slightly more predictable than Lantus but doesn't last more than 18 hours or so. Although many split their Basal it makes things more difficult to get balanced. I only inject my Basal once but vary my Bolus ratio to cater for the Basal tailing off
     
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  7. annapanna93

    annapanna93 Type 1 · Well-Known Member

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    Thank you everyone!

    I usually take my Lantus around 11am.
    I work in a restaurant so some evenings I'm only getting to eat my tea around 10. I thought this might be the issue, but when I'm at work I don't have a choice but to eat late. That's why I've been trying to take extra insulin than I actually need, based on my carbs, but that doesn't seem to be working either.

    It's so annoying.
     
  8. Scott-C

    Scott-C Type 1 · Well-Known Member

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    Could very well be the basal, but I've found even when my basal is right, I'll still get a later rise with low gi or fatty food: the novorapid had kicked in in the first 1 to 3 hours but if there's longer chain stuff like brown rice with, say, prawns in mayonnaise, some of the rice still seems to be digesting with the mayo slowing it down, and the tail end of the bolus might need a little help with a second bolus to stop a tail end spike. Don't know if you're familiar with pizza effect - might be a bit of that going on depending on the fat content of the meal.
     
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  9. Juicyj

    Juicyj Type 1 · Expert
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    Hi @annapanna93 As mentioned before Lantus tails off anytime from 18 hours to 26 hours so it's not an accurate 24 hour insulin - splitting your dose would ensure you have this cover, alternatively you could ask your DSN to try Tresiba which lasts 36 hours, it's more stable so working late, eating late - based on lifestyle I am sure that they could put you on this to try :)
     
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  10. TheBigNewt

    TheBigNewt Type 1 · Well-Known Member

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    Try Tesiba if there's any question about Lantus wearing off too soon. Levemir is a twice a day basal don't use that. I tried it briefly and it was bad news. I take my Lantus first thing in the morning FWIW.
     
  11. Peppergirl

    Peppergirl Type 1 · Well-Known Member

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    Hi, agree with the issue if eating late with carbs and the fat slowing rise until about 4 hours after. I can maintain good control with a bolus before but will need to bolus after too. On tresiba now and this works better for me than lantus
     
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  12. Glucobabu

    Glucobabu Type 1 · Well-Known Member

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    What I can't get my head round is taking Lantus twice a day! With Lantus lasting 18 to 24 hours would it not cause a perpetual overlap? And the same for Tresiba which lasts upto 36 hour. Can someone please explain how they cope with this compounding overlap! I have been on multiple Novorapid and one nightly Lantus for years now and despite the usual ups and downs can't understand the need for injecting Lantus twice or even using Tresiba which would last 36 hours!
     
  13. Daibell

    Daibell LADA · Master

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    I agree and I'm fine using Levemir once a day. Yes, neither Lantus nor Levemir last 24 hours but just tweak the bolus ratio to cover as I do? A single injection is much easier to balance than having to play around with two separate amounts in my view, but most seem to split so whatever. My DSN told me not to split so there you go...
     
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  14. db89

    db89 Type 1 · Well-Known Member

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    I started splitting my Lantus 12 hours apart on advice from my DSN (not 50/50) and it works for me. I actually tried to go back to 1 a day for my last holiday but was soon back on split dose.
     
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  15. DaveTC

    DaveTC Type 1 · Active Member

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    Have you considered trying to shift your dose to the evening? That way it'll primarily be working overnight.
    I personally only do one dose of Levemir in the evenings, but I'm also typically taking 34-40 units so that probably means it's working slightly longer for me than most people.
     
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  16. Chas C

    Chas C Type 1 · Well-Known Member

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    ditto, did this for around a year before moving to a pump and resolving all the night time issues.
     
  17. maria030660

    maria030660 · Well-Known Member

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    If you have alternative work times like working in a restaurant and eating your tea at 10 o clock at night I think youre better off using a pump. Its much easier to control the unregularity of the job vs your BG. Discuss it with your care team and tell them your work times. Also with a pump you can micro dose with 0.1 at the time.
     
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  18. emmay

    emmay Type 1 · Well-Known Member

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    Hi @Glucobabu
    I use Levemir and have done for the last 7 years, I split my dose as I don't need as much during the day as I do during the night (3.5/6u) there is no issue with overlap or if there is my dose allows for that, it also means if you have a really strenuous day you can adjust your dose accordingly. I suppose it's what you get used to
     
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