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Novorapid Lantus help

V

vikz2006

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Hi all

I've been type 1 for 32 years and over the last 10 years have been on the Lantus Novo mix. However HBA1C's run very high around 9-11 and yet during each day i'm constantly yo-yoing between very low then very high BS. I have only just found out about novorapid's acting profile and realise that it peaks at 2-3 hours so testing an hour after a meal is throwing high readings so I try to compensate with more insulin. Also I feel my basal levels are too low as I shouldn't be going so high in the first place. Currently on 14u Lantus (morning injection) and Novo-4-6u

So should I either split the Lantus into two? If so how would I dose it? Or do I move to Levermir and split? Or do I try increasing Lantus gradually and see what effect this has? My DB team are useless and have never given me any guidance on insulin profiles etc. Also how does Lantus work? does it also peak at a certain point?

I'm also a gym user and walk alot and do HIIT workouts and how do these affect my BS readings? I know short quick bursts tend to make you go high as glycogen is released whereas a long walk tends to lower my BS-but dioes it cause any latent effects?

Finally I've just bought Think Like a Pancreas as many of you recommend it
 
Hi Vicky,
The best way to figure out if your Lantus is correct is by comparing bedtime and before breakfast readings. You need to make sure that you haven't eaten or injected a few hours before the bedtime reading as this may skew the results. If you have a change of more than 1.6 mmol/l then you need to adjust your Lantus by 10%. This is the technique from Gary Scheiner's Think Like a Pancreas book and it works very well for me.

Another sign that your Lantus needs adjusting is changes is your levels between meals, although this is more subtle.

Also in Scheiner's book, he talks about changing your insulin when you exercise. This has been invaluable to me as I'd frequently have hypos after exercise because I was giving myself fixed insulin doses. When you exercise your body produces hormones that make your muscle cells more absorbent, this makes insulin work more efficiently, which is why you have hypos after exercise. After I've done some high intensity exercise (enough to be out of breath for 10 mins or so) I need to drop my next Novorapid dose by 1 unit (as I normally have a meal after exercise). I also need to drop my Lantus by 10%. Scheiner says this lasts for 48 hours, so after 48 hours I put my Lantus back to what it was.

Sometimes I need to give myself insulin when I exercise to stop myself going high. When I play rugby I'll need insulin, but when I go for a run I'll need sugar. I think the intensity and stress of a game of rugby means that I'm producing glucogen.

Being dynamic with my insulin after exercise has been one of the best things I've done with my diabetes. It's stopped the hypos and highs. It's all about intelligent testing and figuring out what your body needs. If you spot patterns of highs or lows, then take action next time you do a given activity.
 
Hello,
I've had similar problems to what you have been describing. I'm on levermir and humalog with meals. I've had to increase my levermir in both the morning and night. I'm on quite large doses now but my blood sugar readings have now come down to single figures. It was a lot of perseverance and took a bit of time. But good luck with it


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I'm on lantus and novorapid too. I don't think there would be much point in splitting the lantus dose as it provides a steady dose throughout the day, with no peaks. I'm having similar troubles to you as my pancreas is still getting worse, so I'm constantly having to adjust. My diabetes nurse recommends changing the lantus two units at a time and then waiting a day or two to see what the effect is. I put mine up a couple of points last week as my novorapid doses were creeping up. I then started having a hypo every afternoon, so I've put it down by one, we'll see what happens next! :smile:

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thanks very much guys invaluable replies

Sam-thats great to hear and i definitely have noticed a trend of going low later afternoon and early evening so am taking the lantus down a little I tend to do weights in the mornings 3 days per week then HIIT 2-3 evenings per week so I need to watch the lantus as well as the Novo as i'm still going low before bed or overnight

I'm testing every hour and jotting down exercise, food etc so I can find a pattern

As it appears to be happening in the evening mainly does that mean lower Novo for evening meal and maybe drop lantus?

Its trial and error as always

Carandol-good news on the not splitting-wasn't keen to have another injection!!

Thanks all-I'll update you after the weekend to see how im getting on x
 
As it appears to be happening in the evening mainly does that mean lower Novo for evening meal and maybe drop lantus?
Click to expand...

Is this after you exercise? If so then yes I'd drop the Novorapid by a unit. I don't normally need to change my next-meal-Novorapid or Lantus dose if I do weights, but do if I do cardio. So if I were in your shoes, I'd drop my Novorapid to avoid the hypos and if there's a significant change in overnight levels (>1.6 mmol/l - see the Scheiner rule in my earlier post) then I'd drop my Lantus by an appropriate amount too.

As you said it's trial and error, the best way to find out is to test!
 
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