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Lantus in the Vein, maybe?

  • Thread starter Thread starter Matt2023
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Matt2023

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Hi there,

Earlier today I had a bad hypo and I think it was because I might have injected right into a vein by accident, but I am not totally sure so I want to ask if someone has done the same and if the following happened to you.

I am taking Lantus twice a day, a dose of 28 units at 9AM and 6 Units at 9PM.

This morning levels were a steady 8.4 mmol/L, which is good for me as I rise most mornings.

I took my Lantus (28 Units) and 20 minutes later my phone alarm was going off saying that I was dropping, checked the phone and it was like a cliff face.

I finger pricked to double check as I could not understand and my blood reading was 1.8 mmol/L, only 25 minutes after taking the insulin.

I only had one unit of quick acting an hour earlier, plus a cup of tea with milk, so I really do not think it was that.

30 minutes later and what seemed like a pound of sugar, I started to come back to normal and my sugars started to rise. They actually went down to 1.4 mmol/L, one if not the lowest reading I ever recorded in over 25 years of being diabetic.

Does this sound like I hit a vein or do you think I just stacked up on my long acting too much?

I only read the theory about hitting a vein for the first time on this forum about 4 days ago, could it be that coincidental that I then do it myself, when I have never done before, that is why I am seeking a second opinion, as I just can't believe after reading that it could happen, I actually do it only a few days later by pure and utter chance.

I am still trying to get my sugars back down as I ate so much sugar in haste and panic that I shot to over 25 mmol/L an hour later.

Thank you for your time in this matter,

Matt.
 
Hi @Matt2023 that does sound scary. I'm glad you are OK now.

I can't say for sure what happened here. Are you 100% sure that you didn't inject your fast acting by mistake? (Always a possibility, and I've done that one on occasion as well as the lantus low caused, presumably, by injecting into a blood vessel).

But I'm curious, is there a reason why you split the lantus the way you do? Personally I do mine 50/50 just because I don't like lantus lows and if I have one I'd rather have it with 10 units than 20 (my total dose is 20 at the moment)
 
Hi Ellie,

Thank you for your reply.

It was the very first thing I checked was that I took the correct insulin and I sure it was, the pens are different in color and it was the purple one with the Lantus in it, but yes that was my first thought, that I injected quick acting.

The reason why my Lantus is split like that is purely because I thought and I now may be wrong, that as I was taking 28 units before I switched to two Lantus injections a day, that I would still need 28 units throughout the day to deal with the amount of extra carbs that I would eat and that I would only need a small dose of 5 units throughout the night as I would not be eating carbs. Maybe I should now think about splitting it 14 Units at 9:00 AM and 14 Units at 9:00 PM, I know you are unable to give direct advice, so I will research into that more, so thank you for that pointer.



Matt,
 
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Matt2023 said:
This morning levels were a steady 8.4 mmol/L, which is good for me as I rise most mornings.

I took my Lantus (28 Units) and 20 minutes later my phone alarm was going off saying that I was dropping, checked the phone and it was like a cliff face.

I finger pricked to double check as I could not understand and my blood reading was 1.8 mmol/L, only 25 minutes after taking the insulin.

I only had one unit of quick acting an hour earlier, plus a cup of tea with milk, so I really do not think it was that.

30 minutes later and what seemed like a pound of sugar, I started to come back to normal and my sugars started to rise. They actually went down to 1.4 mmol/L, one if not the lowest reading I ever recorded in over 25 years of being diabetic.

Does this sound like I hit a vein or do you think I just stacked up on my long acting too much?
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It sounds almost exactly like what happened to me when I was still on Lantus, including the timeframe of only 25 minutes between injecting and the scariest low I ever had.

Still, a mistake between your insulins is a possibility as well, like @EllieM said.

Here's some background on the mechanism: https://www.diabettech.com/diabetes/lantus-lethal-or-lifesaver-doc-gbdoc/
 
Matt2023 said:
I only read the theory about hitting a vein for the first time on this forum about 4 days ago,
Click to expand...
I read that post and as a result I take half my basal in one spot and half in another spot on the other side of my body, just in case of hitting a vein, it would be for one of the half doses presumably. I still take it all at the same time though.
 
Matt2023 said:
The reason why my Lantus is split like that is purely because I thought and I now may be wrong, that as I was taking 28 units before I switched to two Lantus injections a day, that I would still need 28 units throughout the day to deal with the amount of extra carbs that I would eat and that I would only need a small dose of 5 units throughout the night as I would not be eating carbs. Maybe I should now think about splitting it 14 Units at 9:00 AM and 14 Units at 9:00 PM, I know you are unable to give direct advice, so I will research into that more, so thank you for that pointer.
Click to expand...

I can't give advice on dosing numbers but I can say that I think you may be misunderstanding the idea of a basal/bolus regime. Lantus is meant to cover all your insulin needs when you aren't eating. So if you aren't eating then your lantus should keep you level eg overnight. The bolus is meant to be adjusted to compensate for your food, with a ratio of insulin to carbs and a ratio to bring your blood sugar down if you are high (or low, you can reduce your mealtime dose if you are too low at the start of a meal).

Also, since lantus is supposed to be flat for 24 hours, if it really was flat for that time it wouldn't make any difference whether you split it or how you split it, because the various doses would all be acting for 24 hours before they stopped. In practice, many folk finds it doesn't act the full 24 hours so splitting it allows them to have some coverage in the hour before each new dose is due.

Of course, many T2s take lantus without being on a basal/bolus regime, but that is because they still produce some of their own insulin. I don't know whether you are attempting to use your lantus like this, but am pretty sure that your night time dose will still be acting for most of the day.

(Apologies for going off topic slightly, )
 
Thank you everyone who has replied. Your time is greatly appreciated.

Antje, that is a very informative article that you shared with me, and maybe I need to look at an alternative long acting insulin. I have a pen of Tresiba in the refrigerator that I want to try again, I had planned to do that this weekend, but now I have more info too on Lantus, I might stick with that for another week or so.

Ellies, yes I think I have been misunderstanding basal/bolus regime.

I understood that the quick acting was there to help when you ate, hence why I always carb count my food, but I was unsure what part the long acting played.

So this morning after doing further research online, I will only be taking 14 Units of Lantus at 9 AM and then 14 Units at 9 PM tonight and then adjust accordingly should I need to over the coming days. If after a few weeks my sugars have not settled down on Lantus, I will again look at using the Tresiba that I have, as like that article explained from Antje, just a change in insulin was life changing for them, literally overnight. I have been using Lantus for 5 years now and to think that I have been misunderstandings how it works, so thank you for that diamond piece of info for me personally.

Also I do believe that I did not inject quick acting insulin by accident yesterday as my blood sugars were still pretty stable this morning when I woke up, and had I not had Lantus at all yesterday morning it would have been 36 hours now since taking it last and I do not believe my blood sugars would have been so in range at 8.5 mmol/L had I not taken any Lantus yesterday.

JAT1, after reading that article and now that I am positive this happened to me yesterday, it makes perfect sense to split it in two dosages.

One thing I did do DIFFERENTLY yesterday morning, was that I injected my Lantus on the inside leg near the knee where there is no fat, usually I inject higher up inside the thigh were I have more fat.

I appreciate all your feedback and have a great day ahead,

Matt.
 
Hi Everyone who is watching this thread of mine.

Update. (14.00 HRS)

So this morning I choose on my own to try a new insulin regime and at 9AM I reduced my Lantus by 50% and took 14 units instead of the usual 28 Units.

I have been struggling to get my sugars under 10.0 mmol/L and have yet to get it below 9.

I have increased my Aprida dosage from 13 Carbs per unit to 10 Carbs per unit to help compensate, but has yet to get it down.

I did not eat until 13.30 HRS, ate 53 Carbs, took 5 Units and my sugars have shot up again, but it took 45 minutes to start shooting up annoyingly, as I thought I had figured it out, I do usually spike but 15 minutes after eating.

I know I need to give this a few days for the insulin levels to stabilize as tonight I will be taking the another 14 Units, instead of the usual 5 Units, so tomorrow morning when I wake up, I know I start the day off with the correct Lantus in me. 28 Units.

I am starting to think though I may have been taken these insulins all wrong for these past 5 years and that I should be taking more quick acting and less long acting.

I take on average 50 units of insulin in total per day that is usually 28 units of long acting with the remaining 22 units being quick acting throughout the day, usually in one or two unit increments, as I do not eat much.

Now I think maybe I should cut my long acting down to 24 or even 22 units per day and increase my short acting insulin to compensate for the food intake and carbs as at the moment it seems that I am not injecting enough quick acting.

When I calculate my insulin to carb ratio it has always come back to 10 (500/50=10), but I always found that was too much short acting insulin as I kept having hypos so I manually reduced it to 13 carbs per unit.

So if I now reduce my long acting insulin throughout the day but increase my short acting insulin to work with the food that I am eating that should in theory keep my short-term sugars in check better and also the app I use would actually make more sense when it's telling me to take a certain amount of insulin IE 5 units for 50 grams of food as opposed to four units of 50 grams of food. Plus I would still average 50 units in total in one day.

I feel I have already learnt so much in the week I have been on this forum, that is of course if I am right, I still have to do some further research in this but I may be on to something hopefully.

I will keep you updated on this thread if you're interested to see how I get on adjusting.

Thank you for your interest and have a great day ahead,

Matt.
 
@Matt2023 as your slow acting basal insulin is there to keep your levels stable, it will not bring them down (and nor should it). If your levels are over 10, you need to use your fast acting insulin to correct your levels. In addition to your insulin to carb ratios, you should have a insulin sensitivity ratio - how much 1 unit of insulin would lower your level. You can than use this to correct your highs. Most people add this to their "food dose".
For example, if 1 unit of insulin brings your levels down 4mmol/l, your level is 14 mmol/l and your target is 6mmol/l. You will add 2 units of insulin to your 5 units that you are taking for the 53g carbs.
Then, once your level are lower, you can do a basal test - in the absence of food, exercise, etc. (e.g. overnight) does your Lantas keep your levels stable? If it does, you have the correct dose. If your levels rise, you need more basal.
There are a few complications to consider such as Dawn Phenomenon - our body's helpful mechanism to dump glucose into our blood to give us the energy to start the day.
If you have a CGM such as a Libre (if you live in the UK you should be entitled to this on the NHS), this is easy to spot.

The reason I suggest reducing your levels before starting a basal test is that, when our levels are high, we become more insulin resistant. So the amount of basal insulin we need to stay at 15mmol/l is more that the amount we need to stay at 6mmol/l.
 
Hi In Response,

Thank you so much for taking the time to write such a lengthy email to me and to explain what these insulins actually do. It really is appreciated by me.

My insulin sensitivity is 2 mmol/L per unit. 50 units in total per day divided by 100 equals 2.

So if I have this right, what I should have done is this >>

5 Units for the 53g of Carbs. My sugars were 14 mmol/L and I want to bring it too 6, I subtract 6 by 14 = 8, then divide 8 / 2 = 4, so I should have taken 9 units in total. Is that correct? Is that how you work out a correction dose.

But now that I am not eating again as I am still trying to get it below 13, I should just take 4 units which in theory will bring me down to 6 providing i do not eat any more food for the next 2 hours. I will of course continue to monitor my blood. In fact I think I should also subtract the quick acting insulin that is currently in my blood from a previous injections or two, is that a correct assumption?

I do have a Libra 1 sensor, so yes I can see the morning spikes every morning and that is how I come onto injecting Lantus twice a day as opposed to once a day, to try and get these spikes or as they called “morning phenomenon” under control because that is the only real time I have trouble controlling my insulin throughout the day.

I am not on the sensors all the time only, now and again, because I pay for my Sensors and they are about $80 a shot. So I wear it for a month check to make sure things are in order and then come back off back and on to the finger prick technique.

So I am using this time right now to try and get on top of these morning spikes, so thank you to all for your suggestions and pointers they are most grateful and a big help to me personally.

Matt.
 
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Make sure when you are calculating correction doses to take into account how much fast-acting insulin you still have on board. This to avoid a hypo. Such as in a case when you are eating earlier and not all the fast-acting you took for the previous meal has been used, considering fast-acting can have a 'life' of 4, 5, sometimes more hours.
 
A few years ago, when I was on Lantus and Novorapid I gave myself the Lantus injection and within 10 minutes had a horribly low hypo which was very frightening. I too stuffed myself with sugar etc. and eventually got back to normal. I always injected my Lantus into the top of my leg and the Novorapid into my stomach. I was on one dose of Lantua a day but found that it wore off several hours before the next one was due so I split it into two doses and it worked much better. Several months ago I was changed from Lantus to Tresiba which is only injected once a day and apparently lasts for 48 hours. My blood sugar levels have been good, apart from suddenly going out of control for a couple of days for some unknown reason and then back to good levels again.

When I was on the Lantus and my sugar levels were rising I was putting the dose up thinking that the more Lantus I had the lower my blood sugar would be but found that the more I gave the higher my sugar levels were. When I started Tresiba I was advised to start with 22 units but this has now been reduced to 19 units which seems to suit me. As for the Novorapid, I am quite sensitive to it so only need up to 3 units after every meal and use a pen that gives half units but sometimes just an extra half unit can make me go hypo. When I was advised to carb count the diabetes nurse worked out the Novorapid doses and told me to give myself 10 units after every meal, I told her that if I did that I would be dead!
 
Hi Everyone,

Thank you so much for your continued replies, it really is appreciated as I am learning a lot.

JAT thank you for highlighting the fact about the fast acting insulin that I still had in my system. I have been keeping that in mind in the past when calculating because I found out I was having too many hypos when I first started using Apidra some years back, but it now seems that I have been using it all wrong in conjunction with Lantus.

Gloucestergirl, a lot of what you said I can actually relate to as well and as mentioned I think in an earlier post for me I too am looking at using Tresiba but I am still learning about Lantus and this might be better for me, I have to give it at least a week or two trial, but your experience with Tresiba inspires confidence in me that there is an alternative long acting insulin should I still not be able to work with Lantus.

Speedbird, thank you so much for that chart. I did not know that you could actually inject on your upper arm. Me personally I am just like Gloucestershiregirl was, Lantus in my thigh and my Aprida in my stomach, going around like a clock. But it is good to know that I can use my upper arms too.

Update on how I am progressing.

Last night for the first time I took 14 units of lantus and this morning my sugars were far better controlled, I did still have the morning phenomenon but it was easier to manage because it wasn't such a steep rise and it didn't happen straight away, it happened about an hour after I got out of bed, so I was up and about and already for it should it have happened, which it did.

Unfortunately I have not really been able to give the new regime its full go with meals as I have been unwell since last night and unable to stomach any food, but I am already feeling better than I did last night so I am hopeful tomorrow I can get back on track and have a breakfast and a lunch and maybe an evening meal and be able to watch my levels throughout the entire day. Today they have been very well under control but that's because I have not eaten.

Thank you everyone and I will update tomorrow once I've been holding consume some proper food.
 
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