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Lantus insulin

M

mummy3

Member
Hi, im on 2 long acting injections a day 21 units at 730am and 4 units at 530pm. I am havi g low blood sugars at 330am most days. Any advice please
 
I think you will just have to play around with your doses to find out what works for you , if it were me I would start with the 5.30pm dose reducing it 1 unit at a time , good luck .
 
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Are you definitely having low BG in the middle of the night or is your CGM reporting a "compression low"?
This is where pressure applied to your sensor blocks the access of the filament to interstitial fluid (which is what CGMs measure to calculate BG) resulting in the sensor reporting a false low. This is most common at night when you might lie on your sensor.
It is easily checked with a finger prick but can also be identified by the CGM graph - a steep dip as you lie on the sensor and then a steep rebound when you move off the sensor.

If this low is confirmed by a finger prick, then as suggested your Lantus dose is likely to be too high. However, you may need to lower your morning dose - Lantus lasts up to 24 hours so it is likely that some of your morning dose is still active in the middle of the night with the overlap.
Is there a reason for splitting your Lantus dose? Have you tried completely missing out your 5pm basal dose? If your day and night insulin requirements are significantly different, a shorter acting basal such as Levemir may be more suitable.
 
In Response said:
Are you definitely having low BG in the middle of the night or is your CGM reporting a "compression low"?
This is where pressure applied to your sensor blocks the access of the filament to interstitial fluid (which is what CGMs measure to calculate BG) resulting in the sensor reporting a false low. This is most common at night when you might lie on your sensor.
It is easily checked with a finger prick but can also be identified by the CGM graph - a steep dip as you lie on the sensor and then a steep rebound when you move off the sensor.

If this low is confirmed by a finger prick, then as suggested your Lantus dose is likely to be too high. However, you may need to lower your morning dose - Lantus lasts up to 24 hours so it is likely that some of your morning dose is still active in the middle of the night with the overlap.
Is there a reason for splitting your Lantus dose? Have you tried completely missing out your 5pm basal dose? If your day and night insulin requirements are significantly different, a shorter acting basal such as Levemir may be more suitable.
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Hi, i dont have cgm monitors, just syringes, drs wanted me to get better control of blood sugars and was told long acting last 17hrs so on 2 a day. I increased my morning one by 3 as daytime sugars still not the best and getting better with doing higher dose. But still getting low in middle of the night, so keep lowering it, iam tempted to not do it but think ill just do it one unit at a time see how it goes not on much as it is
 
mummy3 said:
Hi, i dont have cgm monitors, just syringes, drs wanted me to get better control of blood sugars and was told long acting last 17hrs so on 2 a day. I increased my morning one by 3 as daytime sugars still not the best and getting better with doing higher dose. But still getting low in middle of the night, so keep lowering it, iam tempted to not do it but think ill just do it one unit at a time see how it goes not on much as it is
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My understanding is that T1s in the UK are entitled to free cgms, so you might want to chase that up with your GP or diabetic clinic (unless you don't want a cgm). ( That's assuming you are in the UK of course .)
 
EllieM said:
My understanding is that T1s in the UK are entitled to free cgms, so you might want to chase that up with your GP or diabetic clinic (unless you don't want a cgm). ( That's assuming you are in the UK of course .)
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Im not overly bothered having one, plus clinic said they wont give me one till all sugar levels under 10. Dont fancy having one attached to me all the time either
 
I was advised to make sure my bedtime blood sugar level was at a certain level at bedtime, a bit higher after any alcohol consumption. So an hour or so before bedtime I always check my level and have a small snack if necessary, half a slice of bread or a digestive biscuit seems to work.
depends what time you are having your evening meal and how long before you go to sleep.
 
mummy3 said:
i dont have cgm monitors, just syringes, drs wanted me to get better control of blood sugars and was told long acting last 17hrs so on 2 a day.
Click to expand...
I am surprised you have been told Lantus last 17 hours.
Many of us find it does not quite last the full 24 hours but I am not aware of any way to predict how long it will last for each patient.
When I was taking Lantus (I now use a pump), it was lasting about 22 hours. I would take it with my evening meal every day and use my bolus (NovoRapid) to fill the two hour gap.
I am not medically trained and the rules of the forum forbid us from providing treatment suggestions. However, you may want to look at the Lantus profile graph (just Google it and you will find it) and, if you interpret it as lasting longer than 17 hours, maybe miss out your evening dose one night to see what happens.

If you do are based in the UK and struggling to convince your doctor that you should have a CGM, you may benefit from the free Libre trial available form their website.
 
mummy3 said:
Hi, i dont have cgm monitors, just syringes, drs wanted me to get better control of blood sugars and was told long acting last 17hrs so on 2 a day. I increased my morning one by 3 as daytime sugars still not the best and getting better with doing higher dose. But still getting low in middle of the night, so keep lowering it, iam tempted to not do it but think ill just do it one unit at a time see how it goes not on much as it is
Click to expand...
Did you do a basal check to see if your Lantus dose needed changed? It could be that it's actually your quick acting insulin that needs increased during the day and not Lantus. Your morning Lantus increased dose could be causing the night time hypos.
 
I was on Lantus years ago and I was constantly having low sugars overnight , my consultant at the time put me on levimir , the reason he said was because they found Lantus” unpredictable as in when it would “ run out” since I’ve been on Levimir haven’t had a problem
 
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