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Lantus followed by 2.9 hypo

Discussion in 'Type 1 Diabetes' started by asyarlk, Feb 22, 2016.

  1. asyarlk

    asyarlk Type 1 · Well-Known Member

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    So last night I had dinner, 6pm and injected 1u of novo rapid to cover it. Went up to 7mmol 2 hours later.

    At 9.45pm went to take my lantus of 10u. Bloods around 6.5mmol.

    5 mins after taking my lantus my libre said 3.8 and a down arrow. A bit confused, I tested my blood, 3mmol. No hypo symptoms at this point which is very unusual for me. Are 3 glucotabs, waited 10 mins, tested 2.9. Panic mode set in and so did an incredible amount of sweat. I drank a whole glucojuice. Waited 5 minutes, 3.3mmol. 10 mins later, 4mmol. 35mins later 4.3mmol (a very slow increase) eventually I reached 5.2 and ate an alpen bar. My libre read LO for about an hour or so.

    I peaked at 11.4 at 2am. I've had minimal sleep due to this and now getting ready for work, around 7mmol.

    I was moving over to levemir this week but this has frightened me so much. Any ideas what happened?
     
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  2. LucySW

    LucySW LADA · Well-Known Member

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    Hi asyarlk, there's a thread by @tim2000s on this. Many similar experiences. It seems to be something Lantus sometimes does. Levemir doesn't.

    @tim2000s, can you point the OP to your thread?
     
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  3. mattmo86

    mattmo86 Type 1 · Well-Known Member

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    This has happened to me a few times on Lantus, but my team have told me Lantus wouldn't cause the low and it was my carb counting that was wrong!

    It's not happened for a while thou.
     
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  4. himtoo

    himtoo Type 1 · Well-Known Member
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  5. tim2000s

    tim2000s Type 1 · Expert
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    This is a little discussed side effect of Lantus. You can occasionally find that, if your injection misses the subcutaneous fat, either as a result of lipoatrophy or because you have lower body fat, instead of pooling, it acts like a fast acting insulin. It is designed differently from Levemir, which relies on protein "absorption" to act as its release mechanism. I found the move from Lantus to Levemir completely removed this issue.

    I wrote this post about it as there is plenty of evidence that Lantus has had issues with absorption going back ten years.
     
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  6. diamondnostril

    diamondnostril Type 1 · Well-Known Member

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  7. asyarlk

    asyarlk Type 1 · Well-Known Member

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    Thank you all so much for your comments, it has made me feel so much better to know I am not alone in this! It was such a scary experience and one I definitely do not want to repeat. I have seen my nurse tonight and she has prescribed me levemir in a half unit pen which I can collect tomorrow. Hopefully the worry can go and I can become more confident in dealing with my diabetes rather than this problem with Lantus. Thank you for all of the information and links, I will be reading them this evening!

    What a great forum for advice!
     
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  8. asyarlk

    asyarlk Type 1 · Well-Known Member

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    Day 1 of levemir and it all seems okay so far!
     
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  9. Mrsass

    Mrsass Type 1 · Well-Known Member

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    Hope it continues that way for you @asyarlk :)
     
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  10. himtoo

    himtoo Type 1 · Well-Known Member
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    cool !!! keep us posted with progress :)
     
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  11. asyarlk

    asyarlk Type 1 · Well-Known Member

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    So the levemir switch has gone well! Thank you for all of your advice. However, I was only on 10u of lantus and now I'm on 18u levemir split 8am/8pm and I'm having high ish morning numbers- always above 8. Do I need to keep upping my levemir? During the night I'm staying steady but my numbers have been consistently higher for the last 2 weeks (think the honeymoon has ended). I'm also injecting a lot more for low carb meals. Any ideas would be greatly appreciated.
     
  12. kemla

    kemla Type 1 · Newbie

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    I was on Levimir but it's length and type of operation did not control my BS. I was switched to Lantus. After a while it produced the same hypo reactions as others say. It was a desperate few years before I campaigned long and loud after discovering Degludec/ Tresiba through my own research. Despite all the heavy reluctance to prescribe it, I eventually got it 18 months ago. It has been a miracle, and I'm not kidding. I have not had a single night time hypo in that period and the high morning BS readings (Dawn Syndrome) have disappeared too. Frankly, in some people Lantus DOES peak when its supposed to be largely flat over time. Medical practitioners know it. Maybe it's a personal effect, but Tresiba has changed my life after desperation with Lantus.
     
  13. bhk

    bhk Type 1 · Well-Known Member

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    Lantus is the worst thing I have been in contact with since I am a type 1 diabetic (and it has been 22 years...). I thing that it might be well designed for people that are overweight, that have good amount of fats or that are mostly sedentary. My advice is as long as you are more slim than fat, or practicing sports/training, your basal insulin should not be lantus. I used to have very low and dangerous hypoglycemia situations like the one you described. And since I switched to levemir (which doctors were reluctant to give me, I think that they are sold to sanofi - lantus' producer), it has been a miracle; no more nocturnal unexplained hypos. THANK GOD levemir exists!!
     
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  14. cz_dave

    cz_dave Type 1 · Well-Known Member

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    I would try to up by a single unit in the evening, monitor the effects for a couple of days and then repeat if needed.
     
  15. snowleopard

    snowleopard Type 1 · Well-Known Member

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    Another aspect of using Lantus is the level over the 24 hour period. My DSN and lots of the literature tell you that Lantus gives a steady level for 24 hours then fades away. This is simply not true. An hour or two after injecting, the level is up to double the so-called steady level. After 24 hours, it is still 50% of the steady level. When you inject the next day's dose, the peak sits on top of that residue making for an even higher level. I adjust for that by making my breakfast bolus 1 unit per 15g carbs but 1:9 at supper time. See the dotted line in this graph: [​IMG]

    I take Lantus in the morning and adjusting my intake and bolus enable me to counter the uneven levels. Does anyone take Lantus before bed and do you get low overnight? And has anyone tried splitting it into 2 doses?
     
  16. Scarysugarmary

    Scarysugarmary Type 1 · Member

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    I am now a pump user but was on Lantus (& novo rapid) for many years.
    When I initially took it I had no problems but when I injected it at night, I have over many years (been diabetic 19 years) had hidious hypos resulting in 999 call outs and many hospital trips. I tried switching the dose to the mornings as my theory was I was awake and could catch my hypos (that also didn't work many times and resulted in a new front tooth as face planting on concrete is not recommended!), however I did switch to splitting the Lantus (9:30am and 9:30/10pm) which seemed to work pretty well. I was on around 20units and did 14 in the morning and 6 at night.
    As someone said, (and @snowleopard shows)they claim it works consistently over a 24hour period but I also did not find this the case. However with splitting it, my issues were vastly reduced.
    My sister, also a type 1 diabetic, on the same medication also split her Lantus but never had quite the issues I had!
    Hopefully your new meds will get it all sorted, just may take a little tweaking to get the levels right!
    Good luck
     
  17. LincolnLizzie

    LincolnLizzie Type 2 · Well-Known Member

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    I take 16 units Lantus at 6pm and don't experience any problems but I did switch it from 9am to counteract my BG rising during the night and it did seem to work. Haven't had any problems with it and am now starting to reduce it (just gone down from 18 to 16 units) by increasing exercise.

    I'm a type 2 and only take Forxiga to support it, low carbing has meant I was able to dispense with Glicazide completely.

    I have just been prescribed novorapid so I can occasionally have some higher carbs for special occasions as if I have a few starchy carbs, it takes between 4 days and a week for my BG levels to come down. I wont be using it very often, I've managed for six months on low carb without so I'm aiming to use it very infrequently!

    Any advice would be welcomed.
     
  18. jakay42

    jakay42 Type 1 · Member

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    I have been taking lantus before bed since I was diagnosed around 4 months ago. The pattern of nocturnal hypos shown (by using the libra) indicated that I was having hypos all the time during the wee sma hours. I was told to reduce the Lantus (from 12) and now take between 4 and six units depending on exercise. However in the past couple of weeks the Libra is indicating hypo's again during the night and this pattern has started during the day as well. Is this down to Lantus or exercise?
     
  19. TimLibre

    TimLibre · Member

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    **** I just had it again too. Abasaglar though, and for the second time abbasaglar. And after last time, when i thought i might have swapped abasaglar with fast-acting insulin, i check VERY carefully what i’m taking. This is definately caused by the abasaglar/lantus insulin. Giving me a massive hypo, to the scary point where i have to drink 2 pints of AA-drink (the sweetest mainstream drink ever) to recover.

    now sure i’ll be high until afternoon. Good morning cheap ess fake patent free insulin.
     
  20. searley

    searley Type 1 · Well-Known Member

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    Most detemir/ galrgine based insulin’s peak at about 4 hours and tail off upto 24 hours but some people struggle after 18 hours

    There are options to discuss with you healthcare team

    1
    Split dose this will give less peak as you are taking less but you’ll get 2 peaks.. but will have full 24 hour coverage

    2
    Is your dose correct now

    3
    Is it the right insulin for you
     
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