INSULIN CHANGE AND LANTUS

[Blackadder]

Hi,

I changed my humalog mix insulin late last year to animal hypurin/porcine mix because after reading the IDDT report I felt that a lot of the conditions in there related to me and could potentially be human insulin.

Anyway after changing over I realised that animal was taking way too long to cut in, sometimes 5 or 6 hours for the fast acting to start working sometimes not at all. Although I wanted to low carb this kind of forced my hand slightly. I read Dr Bernsteins book and realised that I wanted to try and do it properly, not quite to his level of carb intake and with the odd day off too which wasn't possible with a mix insulin. What I have realised is that perhaps how bad I felt on the humalog was not down to the human insulin but more down to the spiking of the humalog and the overall control I was getting compared to now. I am currently getting average figures in the past month of 5.1 - 6.2 but with that a fair few numbers in and around the early 3's late 2's, more than I would like. A steady 4 would be good but not achievable on a mix routine I think.

So I decided basul/bolus was the way to go and am about to start. The theory is according to the Dr is that it is my tighter control and less spiking of the animal insulin is what has improved my symptoms so I am back on analogue. Lantus and Novorapid is the first try, but now I am slightly concerned, there aren't too many good things said on here about Lantus. There must be a lot of people out there who can achieve normal blood sugars and on this? I am also scared to death about night time hypos, how do people get round these and keep normal blood sugars. I have to inject lantus at 10pm once a day.

Please tell me some good stories about Lantus before I go mad...

 

[jopar]

Hi Blackadder

There is not written rule that lantus (or any bakground insulin) has to be injected at night time, the time of the injection should be based on a mimium of 2 factors, one is the individuals normal routine and also how the injection reacts concerning coverage... The only rule is that what ever time has been choosen the best time is stcuked too, so if 9pm is better than you keep to this time every day...

In theory Lantus should have a very flat profile and mimium tail off, for some find that they can get better results by changing the timing of there injection as in some lantus doesn't last 24 hours but tails off, some find spitting the injections into two provides better over all coverage...

If you finding that Lantus doesn't pan out well, Levimer is very similar even though it's profile suggests a slight peak and action starts to tail off quicker some finds this works better, Levimer also tends to lean itself to splitting a lot better than Lantus...

It's a case of trial and error to a certain extent I'm afraid to say

 

[suzi]

Hi Blackadder,
So you've heard the stories of users where Lantus didn't work, but i'm sure there must be plenty out there for those its has and is still working for them, if your so concerned perhaps you could suggest using Levemir along with novo rapid instead, as it has been found to have a far better basal line than Lantus.
Naturally you have to learn to carb count to take full advantage of your new basal bolus regime, its all trial and error i'm afraid. My 10 yr old started the basal/bolus regime in November using Lantus and humalog, unfortunately it wasn't for him and we are now using Levemir and Humalog and are much happier.
Hope this has been of some use to you,
Goodluck and take care
Suzi x

 

[fergus]

Hi Blackadder,

I used Lantus for a number of years, until I changed to Levemir a couple of weeks ago.

I was able to keep normal blood sugars on Lantus, 4's and 5's pretty constantly, but did have a few scares with it initially. When I first started, the advice I received was that it acted for 24 hours therefore should only be used once a day. That meant a dose of 10 units before bed. The result was low blood sugars first thing and rising blood sugars late in the evening.

I then decided to split the dose, and reduce it. I went to 5 before bed and 3 in the morning, then eventually to a 4/4 split. That kept my blood glucose on an even keel throughout the day.

I think surprisingly few people find 24 hour coverage from a single dose.

All the best,

fergus

 

[totsy]

hya,
i was having problems which i thought may have been the lantus but on starting basal bolus a few mnths ago after id stomped my feet i have found lantus and novorapid to be great,
i inject my lantus on a morning and it took a few wks to get the right basal dose right and ive had a few hairy moments with hypos in the day while learning to get novo intake,food and exercise sorted (im still learning) but i have to say i have not had one night time hypo and was having at least 5 a week before dropping severley low in the night,
i feel more in control of my diabetes now and would never change them, its difficult getting used to your ratio but with lower carb its not too bad,i am also no longer obese either,
like anything in life, what works for one may not work for another but its worth a try, you can always change back,
hope this helps

 

[chocoholic]

Hiya,
I'm on Novorapid and Lantus too. To begin with, I was taking one shot of Lantus a day...at bedtime. I found I was waking up at bang on 4.00 a.m. every night, shaking and sweating. I took advice on splitting the dosage and now don't have a problem with the Lantus at all.
Hope it all works out for yout too.
All the best, chocoholic.

 

[lilibet]

Hi Blackadder

Interested to read your post as i am currently on mix and have asked to move over. I also feel quite unwell but am having ongoing investigations which unfortunately appear to be flagging up more problems than just insulin . However, my endo is refusing on basis that my dose is too low, thinks still in honeymoon and it would be dangerous to attempt so am stuck

Im not happy with PP peaks on mix without going practically no carb I cant control them on the doses. Tried putting it up one u at night and had two hypos in 18 hours so back down again to previous dose

When I move over I had kinda decided to go for Levemir for the fact that dose can split but of course would prefer one less injection if possible so interested to hear the experience of others

L

 

[bonerp]

although on a pump - I am using Apidra quite successfully and have reduced my insulin intake by 30%. I am sure this has made me feel more normal than before when I was on novorapid. Along with exercise which has also help reduce BGs.

I find it works quicker than Novorapid and doesnt peak towards the end!

 

[phoenix]

I used to use lantus before the pump. I took it at the same time as my evening meal. The hospital started me at that time, I'm sure for no other reason than nursing convenience.
Actually, it didn't last 24 hours and I used to take advantage of that by exercising in the late afternoon/early evening. It meant I didn't hypo as often as when I exercised in the morning.

 

[janabelle]

Hi to Blackadder and all.
I will never have anything good to say about Lantus, but a lot of praise for the IDDT.
Lantus poisoned me and made my life hell. It did not control my blood sugars,and I still maintain that it is a faulty product. On Lantus I suffered joint, and muscular pains, felt exhausted, depressed and countless other symptoms. The symptoms have gone since changing to pork insulin.
If people have been on Lantus since diagnosis, which a lot of people are, what have they got to compare it with? Doctor's DO NOT listen, and people will soon think that feeling like I did is just part of the diabetic condition.
I feel better now than I have ever felt since being diagnosed 20 years ago, and being on "human" insulin. My time on Lantus was hell on earth, and I do not exaggerate.
I ask anyone with similar concerns about Lantus to contact me by sending me a private message.
Thanks
Jus

 

[timo2]

Hello Blackadder,

I can't say that I've ever noticed any particular side effects with Lantus, although, as many
others have found, I needed to split my dose in order to get a good even basal rate.

All the best,
timo.

 

[phoenix]

If people have been on Lantus since diagnosis, which a lot of people are, what have they got to compare it with?

Obviously we are all going to have different experiences. For myself, my comparison was with a normal functioning pancreas. I certainly didn't have any of the reported negative effects whilst taking lantus.

 

[Blackadder]

I am struggling with the Lantus still.

I take 12u of Lantus, one at 10am and one at 10pm daily. I find that between 8pm and 3am my blood sugars rise and never recover really by morning so I am taking novorapid to correct this and cover breakfast. for instance last night I was 4.5 at 8pm, 9.30 it was 6.0 and 7.2 at bed at 11pm without eating anything and after vigourous exercise. At 2.30 am 8.3 and on waking at 6am 6.6 where it rose to 9.0 by breakfast. I generally have low to no carbs for breakfast anyway. So for most of the day the BS's are fairly good but not as stable as I wished especially that I don't snack between meals either.

So I am confused, very confused. I am low carbing, not to the point of Dr B's 6, 12, 12 but probably up to 6, 15, 25 approx.

Anybody with any advice?

 

[jopar]

Blackadder

Two thoughts here...

You either need to increase your Lantus on the evening jab, and might need to take it slightly earlier..

The other one, is do you only get these levels/effect after you been exercising? As could be a rebound/reaction to your exercise and you might be one of the ones who require a small dose of quick acting insulin to composate..

It would be worth checking with your DSN...

 

[meela83]

I changed to Lantus 6 weeks ago from Humulin I and have had no problems I take one dose at night and it sees me through the day no problem, I have much better control and more energy! I think it is worth a try, if it doesn't work I am sure they will change it for you xx

 

[Blackadder]

Thanks everyone.

I think I have managed to potentially crack the evening higher readings by putting my second Lantus injection back to midday. It happened kind of by accident as I forgot 10am and ended up doing it around 11.15 to find that by the time it drifted out the 10pm shot was starting to kick in. I generally get upto to 1mmol fluctuation during the night now which is good. For instance last night I went to bed in 4.6, it was 4.4 at 3am and 3.7 on rising, the latter being a little low but then I played football the previous night.

So I am on 26u of Lantus twice daily and 3x Novo rapid at 6u each which seems to do the job although mornings I eat virtually no carbs for brekkie so I presume the readings are ok as it covers the dawn phenonmen or the increased insulin resistance after rising.

For what I eat and what I do for exercise it seems an awful lot of insulin to inject when I read other people's regimes on here. I am 5'10 and weigh 13st 6 but a lot of this is as I like to think muscle from years of footy and body building in the past. I have lost 1.5stone since starting low carbing in October and seem to be losing 1/2 - 1lb a week now. I really want to understand why I am taking so much insulin and eating very little. I have a 4g carb per unit of novorapid ratio and 1g of carb raises my mmol by 0.33. For corrective purposes I am about 1u per 1.4 mmol which seems low.

My concern is if I go out for a meal where counting carbs is going to be tuff I could end up injecting as much novorapid as Lantus of an evening which seems really scarey.

Oh and my BS's are generally in the 4-8 bracket. I test every two hours at the moment and my average for the past month is 5.7 which seems ok. Just a lot of insulin I sem to have to take.

 

[jopar]

BlackAdder

If you use the 500rule for carb coverage then you’re not far out with the carbs…

Working on the figures that you give of 70 units of insulin, the 500 rule would suggest that you would be looking at around 7g of carbs to 1 unit of insulin...

How ever it would be worth looking at your basal/background insulin to see if this dose is correct and doing its job...


In theory if you basal are set correctly then you should be able to achieve a 12 fast without your BG altering +/- 2mmol/l… with a normal day’s routine (not including excessive exercise)

Best to cover over several different days i.e

1st day, fasting 2am -12pm, you do a BG test at 2am then 6am, 8am, 10 am and 12 pm

2nd day, fasting starts sort of after breakfast BG test 10am, 12pm, 2 pm, 4pm and then 6pm

3rd day, fasting starts (assuming lunch is around 12pm) BG test at 2pm 4pm, 6pm and 8pm…

You need to remember during these times that a normal routine to be maintained, but not exercise type routines… If you feel high or hypo at any one time, check and take appropriate action abort the fasting test if hypo,

If you’re results show that you BG’s are fluctuating too much then your basal is not set correctly, however it may be that you can only get a close flatish basal rate, and some of the deficits will have to be over come by using a different ratio of carb- quick acting insulin at different parts of the day to maintain good control of your diabetes..

 

[mere193]

hen will they cure this think coplitely

 

[mere193]

ı mean when

 

[Blackadder]

Sorry Jopar I made a bit of a mistake in that. It's not 26u twice daily it's 26u in total 12at 10pm and 14at midday. .

I worked it out by trial and error mainly on what I ate to what injected.

Taking the 500 rule would mean 10g per unit which is way out in my case. I reckon 4g tops.