Lantus low? Help me work it out

[bmtest]

In ideal situation and i have forgotten where i picked this up is make sure blood sugar is at least 8 before Lantus injection before bed.

Say for instance you have busy evening and have unknown carb content meal a few drinks finishing off with ice cream or some other sweet in restaurant. You calculate carbs on past experience, you cram all this eating activity in to the latter part of evening. Say the last 3 hours before bed and you have work is next day and you are injecting fast acting insulin to cover meal etc and your lantus a couple of hours later.

You test when home the reading could be any side of the norm you still have buring embers of carb release from food the fast acting insulin is still in there.

To top it off you may be coming dowm with cold and the million dollar question depending on blood reading before bed do i correct with fast acting ?is my level still dropping ? I am tired and need sleep i dont want to wait an hour to test again.

All decisions based on unknowns if you have fast paced life and many variables and Lantus is product that is good but dont expect a solid 10 hours sleep without a low now and again.

 

[EllieM]

but dont expect a solid 10 hours sleep without a low now and again.

All too true unfortunately. I can cope with daytime "slow" lows, where one or two glucose tablets pulls me back before I descend into unconsciousness. What I don't like about lantus lows is that they can come so fast and I potentially need 10 glucose tablets to correct....

But I've taken to making sure that pre lantus level is at least 6 (maybe 8 would be better) and then testing 30 minutes after the lantus. Last night it was 5.3 pre lantus so I had a glucotab and then a second one when it was 5 30 minutes post lantus. I woke up on 5 so something worked....

 

[EllieM]

Just updating because I'm pretty sure I had another lantus low last night. (My diabetic specialist told me my options were lantus or move to a pump when I saw her a couple of months ago). My dexcom shows a flat line at 7.1 before I had the lantus at 11.15pm) and it immediately dropped down to 3.9 by 12.05am. I then had 3 hours of successive lows and glucose tablets, with a lowest level of 2.3 (meter was in the 2s as well). I stayed lucid but had a miserable night, and probably wasn't lucid enough to realise till afterwards that I needed to knock back serious carb (I just kept taking two more glucotabs). I ended up having a total of about 30g of glucotabs and half a mince pie (20g). In retrospect, should have had a good look at the dexcom graph and had a whole mince pie at the beginning.

Just having a winge really (sigh, I hate lantus and I hate hypos). I've generally been avoiding hypos recently but don't know what to do about the lantus. It's actually been working well as a basal for me recently, but a lantus low every 3 months is not filling me with enthusiasm. I've been on lantus for ten years without issue so is this something that my body has just now become prone to? Is there a possible manufacturing fault with the lantus????

(And happy Christmas BTW).

 

[Antje77]

I'm sorry for your miserable night, and happy you managed well!
I hope you'll have an easy day today to recover from the lack of sleep and the lows and munching glucotabs.

Is there a possible manufacturing fault with the lantus????

It's not a manufacturing fault, it's the way Lantus works which makes those lows possible. It doesn't seem to occur very often though.
I'm sorry Lantus is the only long acting insulin available to you!

 

[EllieM]

It's not a manufacturing fault, it's the way Lantus works which makes those lows possible. It doesn't seem to occur very often though.

Thanks for the sympathy. I guess I don't understand how my body has changed to make me suddenly prone to these lows, when I went ten years without any issues.... All I can think is that I'm lower carb and fitter than I was ten years ago, so some muscle on my stomach???

 

[Antje77]

Thanks for the sympathy. I guess I don't understand how my body has changed to make me suddenly prone to these lows, when I went ten years without any issues.... All I can think is that I'm lower carb and fitter than I was ten years ago, so some muscle on my stomach???

I've only had one Lantus low (before switching insulins as soon as I could) but it definitely wasn't due to muscels. While I am pretty strong, there is no way a 5mm needle could have reached those muscels with my 114 kilos.
Still, capillaries are everywhere, so hitting them seems to be a risk anyway.

a lantus low every 3 months is not filling me with enthusiasm. I've been on lantus for ten years without issue

A Lantus low every 3 months adds up to only 4 times a year. Are you sure you've never had a horrible low after injecting before Dexcom? And even if you haven't, it still fits in with chance. It's like throwing 6 dices at 6 in one go. Doesn't happen often, but if it does it's just coincidence...

 

[EllieM]

A Lantus low every 3 months adds up to only 4 times a year. Are you sure you've never had a horrible low after injecting before Dexcom? And even if you haven't, it still fits in with chance. It's like throwing 6 dices at 6 in one go. Doesn't happen often, but if it does it's just coincidence...

It's a good point. I've been thinking back to my years in Sydney (when I first started lantus) and honestly don't remember any. My bad ones were generally when I got tired during the day and therefore didn't treat a hypo. And I don't remember any hypos where I had to treat with so much carb....

And I've now changed my lantus needle to a 4mm so that doesn't seem to have helped.

I had some awful night hypos when I was pregnant but that was pre lantus.

Of course, I guess it's possible I've slept through some, though I always thought I woke for night hypos.

 

[Antje77]

I guess there's no way to tell now, after all this time.
How do you feel about the pump option?

 

[8amoreno]

Lower your dosage. If it causing lows. Maybe take it earlier in the night so catch lows before bed

 

[EllieM]

I guess there's no way to tell now, after all this time.
How do you feel about the pump option?

I don't want to touch the pump option ,as I have issues finding sites for my dexcom and I am already slightly allergic to it. Lantus would be perfect if it weren't for the occasional lows.... I'm not even having too many issues with dawn phenomena now.

 

[EllieM]

Lower your dosage. If it causing lows. Maybe take it earlier in the night so catch lows before bed

I could try the earlier at night, though I prefer taking it when there's very little bolus left in my system. Lowering the dosage wouldn't make any difference (unless I split it) as the issue is that most of the 24 hours dose is acting over 2 to 3 hours. I've been knocking back extra humalog all day just to keep my levels stable, as there's hardly any basal left in my system...

But if it happens again I'll be much more aware of it and confident about what to do.... (50g of carbs, most of which needs to be fast acting.)

 

[Antje77]

I could try the earlier at night, though I prefer taking it when there's very little bolus left in my system.

The bolus in your system doesn't make a difference with your long acting. I think @8amoreno might be onto something here. If you take it earlier you'd be certain you aren't dropping like crazy before you go to sleep, which fo me would improve my sleeping. But of course this is personal preference. I don't have a Dexcom to warn me, which makes a huge difference

Splitting could be helpful too: you'd only have half the amount to deal with when it acts up, and you'd at least have half your daily dose working as usual, so less chasing up with the Humalog. But of course, this too depends on personal preference.

But if it happens again I'll be much more aware of it and confident about what to do.... (50g of carbs, most of which needs to be fast acting.)

This is wonderful!

 

[Jaylee]

Just updating because I'm pretty sure I had another lantus low last night. (My diabetic specialist told me my options were lantus or move to a pump when I saw her a couple of months ago). My dexcom shows a flat line at 7.1 before I had the lantus at 11.15pm) and it immediately dropped down to 3.9 by 12.05am. I then had 3 hours of successive lows and glucose tablets, with a lowest level of 2.3 (meter was in the 2s as well). I stayed lucid but had a miserable night, and probably wasn't lucid enough to realise till afterwards that I needed to knock back serious carb (I just kept taking two more glucotabs). I ended up having a total of about 30g of glucotabs and half a mince pie (20g). In retrospect, should have had a good look at the dexcom graph and had a whole mince pie at the beginning.

Just having a winge really (sigh, I hate lantus and I hate hypos). I've generally been avoiding hypos recently but don't know what to do about the lantus. It's actually been working well as a basal for me recently, but a lantus low every 3 months is not filling me with enthusiasm. I've been on lantus for ten years without issue so is this something that my body has just now become prone to? Is there a possible manufacturing fault with the lantus????

(And happy Christmas BTW).

Hi,

Sorry you've had another rough time.

I have to admit, I'm not a masive fan of Lantus either. My Endo won't prescribe anything else.
& the Libre is out of the question too..

In my experience with recuring LLs. Don't keep hitting it with fast acting carbs. Pull it back up with fast acting then try drinking milk as a follow up or maybe add a biscuit? which hopefully will stop a recurrence..

Oddly. I've recently been doing a temp job with some night shifts. I injected my Lantus an hour earlier reduced the dose by 22%?
& was still getting hypos during the night at work. Bloods were fantastic with the odd dip during the day. (Whilst I caught up on sleep.) with my (self funded.) CGM set up, I found I was heading off lows using longer acting carbs with only a 5g fast acting starter.

 

[EllieM]

In my experience with recuring LLs. Don't keep hitting it with fast acting carbs. Pull it back up with fast acting then try drinking milk as a follow up or maybe add a biscuit? which hopefully will stop a recurrence..

Very helpful, will do.

I don't have a Dexcom to warn me, which makes a huge difference

Yes, I'm incredibly lucky to be able to afford to self fund this. It makes a massive difference to my life. I'm going to be very sad of my allergies play up and I have to stop using it (alas poor libre).

 

[Antje77]

I'm going to be very sad of my allergies play up and I have to stop using it (alas poor libre).

Just to make sure, are you aware of the Facebook group dedicated to reactions to Dexcom and Libre?
I'm not a member, as I'm one of the lucky ones with a skin accepting anything, but you might find some useful tricks there.
https://www.facebook.com/groups/393137240837215/

 

[Gnat]

Hi, I'm getting in here now. I'm trying to understand the sudden hypo which seemed to be related to Lantus after having an unusual event this week. I checked my blood glucose at 11.30pm, 6.3. Gave myself 0.5 U Novorapid correction (which I do above about 6.2 at night if no bolus on board), and 5U Lantus (split morning and night). Immediately to sleep. Husband heard me call out about 11.50 or soon after, came up to see me having a seizure. He tried to give me a glucagon - and only later saw the tablet in the vial hadn't dissolved so he mostly gave water, oops. Then he rubbed maple syrup on my gums. At 12.02 they called an ambulance. It arrived and I was coming around by then with a blood test of 2.2 - don't know what time that was. Was given 60g of glucose and half a piece of bread with jam. Got up to about 9.0 tops, and came down a little after that. I thought maybe putting it in my thigh around the outside part meant I had put it into muscle, but I'm about 24 BMI so should have plenty of fat over the muscle I would have thought?? However, had done a tramp with hills that day and a 30km bike ride and plenty of walking earlier that week. I checked my Novo rapid and it showed I had had 0.5U as expected, so I hadn't swapped the two around in error (and I was sure I could remember clicking the 5 U on the Lantus silver pen, also I do Lantus in the thigh and Novorapid in the stomach to help remember to think which one I am doing and how much. I wrote the doses down at the time. So, I don't think I made a mistake, but I have tried to look up information and surely if this was a known thing it would be more obvious in the medical literature than it is. Looking for any information anyone can give me on this. I've stopped using the thigh now, and will always give insulin at least 30 mins before bed to avoid this. Keen to understand if anyone else has had experience like this. When I correct I give myself one or two skittles and that is plenty. 60g is a lot.

 

[Antje77]

Looking for any information anyone can give me on this. I've stopped using the thigh now, and will always give insulin at least 30 mins before bed to avoid this. Keen to understand if anyone else has had experience like this.

You're definitely not the only one, here are a couple of old threads by people who've had the same experience on Lantus:
https://www.diabetes.co.uk/forum/threads/any-tips-on-how-to-handle-lantus-lows.176886/#post-2308677
https://www.diabetes.co.uk/forum/threads/another-lantus-low.168970/#post-2152753
https://www.diabetes.co.uk/forum/threads/very-rapid-bg-drop-caused-by-glargine.161359/#post-1988302
https://www.diabetes.co.uk/forum/threads/upsetting-experience.157478/#post-1901674

And here's an article going into the background of what might have happened a bit more deeply:
https://www.diabettech.com/diabetes/lantus-lethal-or-lifesaver-doc-gbdoc/

I've had it happen a couple of years ago, eventually passing out for 2 hours, but thankfully only after taking a LOT of quick acting carbs. I was surprised I woke up again.
I spent a couple of days upending the internet to find out what could have happened, as my blood sugar was usually usually very stable, it's not easy to find information on this.
When I found out, I insisted I wanted to be changed to either Tresiba or Levemir. While my HCP didn't exactly believe me, she still agreed with a change.

Wish you all the best recovering from your scary experience!

 

[EllieM]

Keen to understand if anyone else has had experience like this. When I correct I give myself one or two skittles and that is plenty. 60g is a lot.

That sounds exactly like my experience(s). I'd change to levemir if it was available in NZ, but as it isn't I muddle along by checking my bg 15 minutes after taking my night time dose. Still don't understand why I had 10 years of using lantus without issue, and am only now having problems, but I have a big jar of glucotabs next to my bed and I'm ready and willing to use them as necessary. But it's the steepness and speed of the fall, combined with the large amount of sugar required to stop it, that differentiates this from normal hypos.

 

[EllieM]

And here's an article going into the background of what might have happened a bit more deeply:
https://www.diabettech.com/diabetes/lantus-lethal-or-lifesaver-doc-gbdoc/

Thanks for the series of links. Maybe I should share them with my diabetic specialist. There does seem to be surprising ignorance of this issue among diabetic professionals (though maybe it's partially denial, as they don't have the ability to prescribe anything else here).

 

[Gnat]

You're definitely not the only one, here are a couple of old threads by people who've had the same experience on Lantus:
https://www.diabetes.co.uk/forum/threads/any-tips-on-how-to-handle-lantus-lows.176886/#post-2308677
https://www.diabetes.co.uk/forum/threads/another-lantus-low.168970/#post-2152753
https://www.diabetes.co.uk/forum/threads/very-rapid-bg-drop-caused-by-glargine.161359/#post-1988302
https://www.diabetes.co.uk/forum/threads/upsetting-experience.157478/#post-1901674

And here's an article going into the background of what might have happened a bit more deeply:
https://www.diabettech.com/diabetes/lantus-lethal-or-lifesaver-doc-gbdoc/

I've had it happen a couple of years ago, eventually passing out for 2 hours, but thankfully only after taking a LOT of quick acting carbs. I was surprised I woke up again.
I spent a couple of days upending the internet to find out what could have happened, as my blood sugar was usually usually very stable, it's not easy to find information on this.
When I found out, I insisted I wanted to be changed to either Tresiba or Levemir. While my HCP didn't exactly believe me, she still agreed with a change.

Wish you all the best recovering from your scary experience!

Thank you!!