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Lantus low? Help me work it out
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<blockquote data-quote="EllieM" data-source="post: 2315217" data-attributes="member: 372717"><p>50 years T1. I'm on a basal/bolus regime, 16-17 units of lantus before bed, 1unit humalog to 3g carb of carb in the day (ratio varies a bit with exercise and time of day), self funding a dexcom due to poorish hypo awareness, particularly whenever my hba1c goes below 50. Hba1c's been running between 47 and 52 for the last couple of years, current estimated hba1c (from dexcom) is about 48. I've been very happy with my post dexcom control, generally not going below 3.8 and though I occasionally have teen readings at night my levels usually stay where I want them. 2-3 hour sessions at the gym per week, plus daily dog walk of 45 minutes to one and a half hours, fair amount of gardening. Lowish carb (50g to 100g a day because I am quite insulin resistant, T2 dad and a bmi of 29).</p><p></p><p>So, I was pretty happy with my current diabetic control, but I know have had 2 incidents of what I fear are lantus lows.</p><p></p><p>The first one was 4 months ago, my blood sugar plummeted after taking my nightly lantus, and I ended up taking about 50g of glucose tablets as I watched my levels fall (using a glucometer so as to see real time levels after warning from dexcom). It was as though I'd injected the equivalent dose of humalog, and I assumed that it was possible that I had accidently injected humalog instead of lantus. Normally 1 glucose tablet raises me by 2mmol/L so I rarely need more than 2 to raise my levels.</p><p></p><p>Last night I had my main meal (indian curry- beef in yoghurt plus plus cabbage in carrot plus a small amount of rice) at 8pm plus 9 units of humalog, blood sugar went from 6.7 before meal to 4 at 10.45, so I obviously overestimated the carbs in the meal and had 2 glucose tablets to push my levels up, and at 12.10am it was 5, and I had my lantus (16 units).</p><p></p><p>At this point my bg went into free fall and I got the dexcom low blood sugar warning at 12.25. I pulled out my glucometer, which started in high 3s but went progressively lower as I knocked back glucose, ending up with 40-50g worth of it before my bg started to go back up (dexcom read low and meter about 2.5 before my levels started rising). My dexcom now shows 2.4 as my lowest level, so maybe the LOW was just an encouragement to take more glucose. My lowest reading was at 12.43 and 2.3 according to my glucometer. My blood sugar started climbng at 12.48am and was at 8.5 at 1.30 and at 2.20 up to 11, at which point I had a correction dose of 2 units humalog and the rest of the night it hovered between 11 and 9.</p><p></p><p>So, this is what is confusing me. If I had a lantus low, ie all the lantus acts in one go instead of over 24 hours, why did my levels stay steady overnight once I'd corrected the overshoot? I was expecting to have steadily rising levels over night....</p><p></p><p>If it wasn't a lantus low, what happened? Yes, I'd had a hypo 2.5 hours after my meal but the humalog should have been out of my system by midnight, not throwing me into a sharp downward descent. But if I had a lantus low, why do I still have basal in my system now (10.20 am in New Zealand).</p><p></p><p>Suggestions gratefully received. I've already phoned my DN who has no clue what happened..... Though she did suggest I might have injected humalog earlier into fat (I do have some lipotrophy) and that it was caused by delayed humalog not lantus.</p><p></p><p>Only other thought, I've been working on trying to reduce insulin resistance via low carb and exercise, could it have suddenly gone down?</p><p></p><p>Will post tomorrow with what happens today, so far everything seems normal, other than a high start of 10.5mmol/L.</p><p></p><p>Help?????</p></blockquote><p></p>
[QUOTE="EllieM, post: 2315217, member: 372717"] 50 years T1. I'm on a basal/bolus regime, 16-17 units of lantus before bed, 1unit humalog to 3g carb of carb in the day (ratio varies a bit with exercise and time of day), self funding a dexcom due to poorish hypo awareness, particularly whenever my hba1c goes below 50. Hba1c's been running between 47 and 52 for the last couple of years, current estimated hba1c (from dexcom) is about 48. I've been very happy with my post dexcom control, generally not going below 3.8 and though I occasionally have teen readings at night my levels usually stay where I want them. 2-3 hour sessions at the gym per week, plus daily dog walk of 45 minutes to one and a half hours, fair amount of gardening. Lowish carb (50g to 100g a day because I am quite insulin resistant, T2 dad and a bmi of 29). So, I was pretty happy with my current diabetic control, but I know have had 2 incidents of what I fear are lantus lows. The first one was 4 months ago, my blood sugar plummeted after taking my nightly lantus, and I ended up taking about 50g of glucose tablets as I watched my levels fall (using a glucometer so as to see real time levels after warning from dexcom). It was as though I'd injected the equivalent dose of humalog, and I assumed that it was possible that I had accidently injected humalog instead of lantus. Normally 1 glucose tablet raises me by 2mmol/L so I rarely need more than 2 to raise my levels. Last night I had my main meal (indian curry- beef in yoghurt plus plus cabbage in carrot plus a small amount of rice) at 8pm plus 9 units of humalog, blood sugar went from 6.7 before meal to 4 at 10.45, so I obviously overestimated the carbs in the meal and had 2 glucose tablets to push my levels up, and at 12.10am it was 5, and I had my lantus (16 units). At this point my bg went into free fall and I got the dexcom low blood sugar warning at 12.25. I pulled out my glucometer, which started in high 3s but went progressively lower as I knocked back glucose, ending up with 40-50g worth of it before my bg started to go back up (dexcom read low and meter about 2.5 before my levels started rising). My dexcom now shows 2.4 as my lowest level, so maybe the LOW was just an encouragement to take more glucose. My lowest reading was at 12.43 and 2.3 according to my glucometer. My blood sugar started climbng at 12.48am and was at 8.5 at 1.30 and at 2.20 up to 11, at which point I had a correction dose of 2 units humalog and the rest of the night it hovered between 11 and 9. So, this is what is confusing me. If I had a lantus low, ie all the lantus acts in one go instead of over 24 hours, why did my levels stay steady overnight once I'd corrected the overshoot? I was expecting to have steadily rising levels over night.... If it wasn't a lantus low, what happened? Yes, I'd had a hypo 2.5 hours after my meal but the humalog should have been out of my system by midnight, not throwing me into a sharp downward descent. But if I had a lantus low, why do I still have basal in my system now (10.20 am in New Zealand). Suggestions gratefully received. I've already phoned my DN who has no clue what happened..... Though she did suggest I might have injected humalog earlier into fat (I do have some lipotrophy) and that it was caused by delayed humalog not lantus. Only other thought, I've been working on trying to reduce insulin resistance via low carb and exercise, could it have suddenly gone down? Will post tomorrow with what happens today, so far everything seems normal, other than a high start of 10.5mmol/L. Help????? [/QUOTE]
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