Type 1 Lantus and novorapid.. Is it really all it's cracked up to be?

Sigh.

It never ceases to amaze me that people don't get told this and DSNs don't seem to know it. Yes, your weight is going up because your Lantus has gone up. It was understandable in a way to raise your Lantus because that matched your Lantus to your food consumption and brought your blood sugar down to an acceptable range. But, guess what, the food doesn't go away! With the Lantus in your bloodstream to effectively process the glucose from the food, that food gets stored as fat and you gain weight. Simples!

In order to lose weight while preserving good blood sugar control you need to:

1. find out your correct basal dose by doing a fasting day. probably your correct basal rate is a lot lower than what you are taking now
2. then after you change to a correct basal rate, find out your correct carb ratio and your correct correction ratio. your carb ratio is probably too low. your correction ratio may be slightly low.
3. now you can start dieting with some chance of success. reduce your calories, or better, reduce your carbs.
4. keep an eye on your basal dose and ratios, because dieting may affect them. for example your basal dose will reduce in line with your weight, and your insulin sensitivity may increase as you diet, and particularly if you exercise

Another problem that happens is that taking once every 24 hour Lantus can result in more basal insulin than you need, in order to cover the times of greatest need. This is because Lantus does not have a flat profile over 24 hours. For some people it can be helpful to split the Lantus dose into two daily injections in order to match your basal need better. This could be 50/50 and 12 hours apart, or it could be an uneven split of quantity and time - whatever is the best match for your basal requirements. A better match means you take less total insulin, and taking less total insulin makes you less likely to gain weight, more likely to lose it.

Unless you reduce total daily insulin, it is more or less impossible to lose weight as a T1, because you will either feel cravings and eat carbs as the extra insulin forces your blood sugar to drop, or you will ignore the cravings and have a hypo and eat carbs to treat the hypo.

I've been type 1 for 29 years, aged 30 at diagnosis. I started off on Actrapid and Insulatard. I don't know whether those are still in use. Like you, I'm now on Novorapid and Lantus glargine. In December I started to do a low carb high fat diet in an attempt to improve my blood sugar control which was in a bad state, so not like your situation. In 5-6 months my hb1ac has improved considerably, though, rather against my consultant's advice, I want to take it lower. However, also, the LCHF diet has caused me to lose a stone in weight - gradually and without any angst and I'm relieved to be back in the 'normal weight' bmi bracket. Like you, I feel it's possible that the Novorapid Lantus regime is fat-inducing but my situation can't demonstrate it because I had poor control, and was giving myself too much insulin - which, in itself, is fat-inducing.

It's possible that LCHF might work for you, and you could check it out on this forum and on dietdoctor.com
Best of luck, Rhiannon,
Luz

I've been using lantus and Novorapid near enough since they were first introduced in the UK, they both work well and do what they say they do. My lantus I take once a day (early evening) and currently inject 17 units, novorapid doses vary from 4 - 7 units depending on food and exercise.

As Spiker says to lose weight you need to reduce your calorie intake, burn more than you consume and the weight willl fall away, once you do lose weight you will find that your insulin needs will decrease.

That advice is gold.

noblehead said:

I've been using lantus and Novorapid near enough since they were first introduced in the UK, they both work well and do what they say they do. My lantus I take once a day (early evening) and currently inject 17 units, novorapid doses vary from 4 - 7 units depending on food and exercise.

As Spiker says to lose weight you need to reduce your calorie intake, burn more than you consume and the weight willl fall away, once you do lose weight you will find that your insulin needs will decrease.

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I've always assumed ( don't know why!) that I can only adjust my lantus in increments of 2 units, and my Autopen only delivers in increments of 2. So I was surprised to hear your dose of 17. I'm currently on 18 in the morning and I might want to reduce by one unit, not 2! I hope you don't mind me asking which pen you use, Noblehead?

Hi I'm on Lantus and Novarapid and have been for many years. My diabetes hasn't always been very well controlled and I was classed as obese. A few months ago I read a diet book by Zoe Harcombe whose brother is Type 1 which all seemed to make sense to me. Since then I have followed the Harcombe diet which is low carbs and have lost almost two stone, my bm is usually between 5 and 6 and I have reduced my Lantus by over half what I was on before and take less than 12 units of Novarapid per day. I feel fantastic and can't wait to see my next Hba1c reading. I also loaded a brilliant app called BG monitor for free, although there is an upgrade for a couple of quid, that helps keep a record of my carbs and insulin requirements. I find this really useful. This works for me maybe it will for you. Good luck.

lizdeluz said:

I've always assumed ( don't know why!) that I can only adjust my lantus in increments of 2 units, and my Autopen only delivers in increments of 2. So I was surprised to hear your dose of 17. I'm currently on 18 in the morning and I might want to reduce by one unit, not 2! I hope you don't mind me asking which pen you use, Noblehead?

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Not at all lizdeluz, I use the Solostar Pre-filled pens which come in a pack of 5, I was up until recently on 18 units but reduced the dose to 17 as I was getting a few readings in the high 3's and early 4's.

lizdeluz said:

I've always assumed ( don't know why!) that I can only adjust my lantus in increments of 2 units, and my Autopen only delivers in increments of 2. So I was surprised to hear your dose of 17. I'm currently on 18 in the morning and I might want to reduce by one unit, not 2! I hope you don't mind me asking which pen you use, Noblehead?

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I use a Sanofi Aventis Clik Star pen for Lantus in one unit increments.

Sent from the Diabetes Forum App

Spiker said:

I use a Sanofi Aventis Clik Star pen for Lantus in one unit increments.

Sent from the Diabetes Forum App

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I should change to that pen Spiker, not sure why my team changed me over to the pre-filled disposable pens from the insulin cartridges I previously used

Thanks both! I will ask for a new pen.

noblehead said:

I should change to that pen Spiker, not sure why my team changed me over to the pre-filled disposable pens from the insulin cartridges I previously used

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Yeah there was a craze for disposable pens a few years ago wasn't there? I tried them but didn't like them, they seemed flimsy and wasteful, plus instead of carrying a spare cartridge you are carrying a whole spare pen.

The Clik Star is really nice.

Sent from the Diabetes Forum App

Spiker said:

Yeah there was a craze for disposable pens a few years ago wasn't there? I tried them but didn't like them, they seemed flimsy and wasteful, plus instead of carrying a spare cartridge you are carrying a whole spare pen.

The Clik Star is really nice.

Sent from the Diabetes Forum App

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Just forget what pen I was originally using, you make a good point about the spare cartridge

Yes, reduce the carbs inline with reduced insulin and the weight should go down again. I agree that replaceable cartridge pens are a sensible choice. I have the Novo pens for my insulins. I don't carry a spare cartridge unless I'm about to need a new one as they can only stay out of the fridge for 28 days.

rhiannon49 said:

Hi there,

I'm a type 1, diagnosed age 6 so grand total of 15 years. Started off on humalog, then put on lantus and novorapid pretty much as soon as it was made! Can't remember really how I controlled my diabetes with humalog at all.

Was put on a animas vibe pump last year, I lasted six weeks. Hated being attached to wires and had a few episodes where scar tissue built up too much and ended up pushing the cannula out and I wasn't getting any novorapid so would end up with BGs of 30+. I lost a lot of weight when I went on the pump as well, nearly two stone.

Went back on lantus and novorapid. Doing between 6-10 units of novorapid before meals and 10 units of lantus at 8pm. Gradually had lantus increased to 24 units by DSN which has made my BG levels better, and now HBA1C of 6.3 however I have also put on a stone and a half since last September!!! I even came off the pill for a bit to prove that it wasn't that causing my weight gain because that's what my DSN tried to tell me.

I exercise every day, I go an hours walk (BRISK MAY I ADD!) every night and I do intense workouts three times a week. I eat well, no **** and when I have hypos I stick to glucotabs and glucojuice, and I never binge eat. I am at an utter loss! DSN won't listen to me and thinks I'm overreacting and over thinking things.

Just think it's a bit convenient that as my lantus has gone up, so has my weight!!

HELP




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Hi Rhiannon (good solid Welsh name, unless you're named after the Fleetwood Mack song...as my girlfriend is)

...anyway, I'm digressing. As others have said, more insulin means more weight gain. This is because insulin is used to carry glucose into fat cells where it is converted into fat.

There's one solution, with three ways of going about it. The solution is, you need to reduce your insulin. The ways are:

1. Exercise even more. This will increase your insulin sensitivity (you'll therefore need less). Try higher intensity, shorter time period stuff.
2. Take metformin. This does exactly the same thing as exercise in terms of increasing your insulin sensitivity.
3. Reduce your carbs (as mentioned by the clever people, above).