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Lantus has lost its effect

L

luca ferrario

Member
Messages
9
Type of diabetes
Type 1
Treatment type
Insulin
Hi all, i'm Luca from Italy.
I'm 41 and I’m type 1 from the age of three so i have 38 years with my friend :)
i use pens, and until two months ago my values was ok, but from two months i have often hyper.
I use the latus at 9-10 pm and two months ago i did 16 units every day, now I’m on 26 units but sugar levels are often very high especially in the morning and late night, it is like if the lantus has lost his effect. My last Hba1c was wery high at 9,8 (usually was 7-7,5). I started to have some serious complications (retinopathy) 2-3 months ago.
I didn’t change anything in diet or in my usual activities, so I have to try to change insulin (ex detemir)? Any other advice?
 
Hi Luca,

It sounds like you understand this very well - your background isn't working so you need to try an alternative, something like Detemir/Levermir. the easiest way to know for sure is to do a fast and test throughout the day. Otherwise another possibility is that you have a bad batch of Lantus or you need to rotate around your injection sites ?

Background retinopathy can be reversed, Good luck ;)
 
Second what Juicy has suggested, change all your insulin and see if this resolves the problem, but first do check the temperature in your fridge to make sure its working correctly and storing your insulin at the right temperature.

Sometimes people can become resistant to the insulin they inject so might be worth considering a change to another basal like Tresiba (if available in Italy) if you rule out the above, ask for the input from your diabetes care team also to see what they have to say about it all.
 
Thanks for yor reply. Yes i have already tried to use another stock of lantus and to rotate the iniection sites but with no result.
This is a simple glycemic profile that i've done in one of the past days:

6am 15.76 (novorapid)
9am 10.33
12am 12.5 (humalog mix50)
3pm 10.56
7pm 9.22 (novorapid)
9pm 8.88 (lantus)
1am 9.89

Yes Tresibla is available in italy. I've the first level of a pre-proliferative retinopaty, maybe that this and the hyper are linked
 
Your overnight bg levels went up by nearly 6mmol which would suggest your insulin needs adjusting, as your using 3 different insulins I would ask your diabetes team on how to adjust your insulin to bring your bg levels into range. Good luck.
 
luca ferrario said:
Hi all, i'm Luca from Italy.
I'm 41 and I’m type 1 from the age of three so i have 38 years with my friend :)
i use pens, and until two months ago my values was ok, but from two months i have often hyper.
I use the latus at 9-10 pm and two months ago i did 16 units every day, now I’m on 26 units but sugar levels are often very high especially in the morning and late night, it is like if the lantus has lost his effect. My last Hba1c was wery high at 9,8 (usually was 7-7,5). I started to have some serious complications (retinopathy) 2-3 months ago.
I didn’t change anything in diet or in my usual activities, so I have to try to change insulin (ex detemir)? Any other advice?
Click to expand...
Hi Luca, I had the same problem with Lantus. It just stopped working altogether for me. I tested it by dividing my dose (16 units) into eight. Then I injected 2 units every three hours, as well as my normal use of Novorapid for meals. In that twenty-four hour period my blood sugars were perfect. I did that three times and my doctor was convinced that Lantus was no longer working for me. He offered me Levemir instead, but I chose to buy a pump.

But yes, I had the same problem. My blood sugars started running at around 250mg/dl most of the day. As if I wasn't taking a long-acting insulin at all.
 
Hi Luca, I had the same issue more or less 5 years ago. I became resistent to lantus. My initial dose of lantus was 22 units and I had to increase to 40. Then with my consultant we decided to try levemir, which worked ok for a period. Eventually I decided to give it a try with the insulin pump, which works with fast acting only insulin. I had to reduce of 1/3 my basal. I still use the pump and it's been the best choice.
 
Hiya Luca - Very interested in your article as I am having similar problems. I live in Spain and am a British Expat. Came out here 10 years ago. I am a T1 since the age of 27 in 1972. Came to Spain after a very active life mostly centered around boating. Was on daily Ultratard and Actrapid as required. I have been on Lantus for 5 years - 32 units a day and actrapid for main meals and as required. Mostly stable ... around 4 years ago I asked my doctor to put me back on Ultratard because the Lantus didn't seem to be working as a background insulin. Went back on Lantus after a talk with a new doctor who explained the advantages .... consistant output over 24 hours and no peaks. Been ok for the last couple of years until in April of this year I decided to lose a couple of Kilos so I could fit in my summer trousers. Tinkered with my insulin to account for my reduction in carbs which mainly consisted of taking out the Actrapid and leaving all the work to the Lantus which I hoped would take care of the background carbs.
Initially everything seemed to be ok although I wasn't losing any weight. Then about three weeks ago I started hypoing late in the evening and noticed a rise in BS levels during the day even though I was eating no carbs ... by 1800 when I take my Lantus it was in the region of 13 or 14 and the Lantus did not reduce it until about 2300 when there was a dramatic drop into a hypo situation causing me to eat carbs to get through it. Obviously Lantus is not meeting it's two greatest selling points ... it is having a peak release time with no plateau and consequently leaving me no background insulin to work through the day. I have done some close BS monitoring to confirm this. The reason I suspect is primarily the rise in temperature prior to the highs of the coming summer ... Lantus has a recommended storage temperature which is maintained by storage in the cool area of the refrigerator. Over the Winter period I keep Lantus at my bedside. I noticed a few days ago that the ambient room temperature here is over 25C which is the Maximum for Lantus when it is being used. So I now have to keep it all at 15C in the refrigerator - even the ready use stuff. I am still getting the highs late a night before bed so I went to the American Diabetic Association web page and some diabetics are having similar problems with Lantus and are now splitting their background insulin into two or three doses over the day e.g. daily insulin total of 30 units into three of 10 units every 8 hours or two of 15 units every 12 hours and this is what I am going to do over the next few days and see if I can plateau it out myself. This was why I changed back to Ultratard four years ago and it makes a nonsense to have to buy the higher priced Lantus if it's not fit for purpose and I shall tell my doctor so if splitting he dosage up over the day works ... I suspect that while I can keep the unused insulin refrigerated as soon as it hits my body through the pen my body deals with Lantus in a different way through the hot summer ... Hope this helps you
 
thanks all
i've some update that may can help someone else.
My doctor changed lantus with tresiba and it works well. I've only one problem about novorapid, usually i do the novorapid just before the meal but in this case if i check my bloody sugar 2hr after the meal the value is ok or slightly low (90-110) but if i check the bloody sugar 3/4 hrs after the meal the value is high (200 mg/dl). I think that the reason is that the novorapid has his maximum effect after 1,5/2h but the digestion of carb. has his maxium after 3 hr (in my case). So now i'll try to do the novorapid just after the meal and not before, one other possibility is to use a mixed insulin (50/50).
 
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