Piecing Together What Happened With My Diabetes Management

[kitedoc]

Hi Jenny,
I may have missed something in the posts but wished to ask you, Have you measured your blood sugar levels at the time you feel unwell whilst taking Lantus? Are they less than say, 4 mmol/l at any time?
I have not heard of Lantus intolerance as a specific entity, only of local reactions to some brands of insulin when injected.
Also, as you mention, you think you may have a UTI. Could that be a possible cause of your symptoms?
If so, is it worth waiting until your UTI is treated ?

 

[Jenny15]

Hi Jenny,
I may have missed something in the posts but wished to ask you, Have you measured your blood sugar levels at the time you feel unwell whilst taking Lantus? Are they less than say, 4 mmol/l at any time?
I have not heard of Lantus intolerance as a specific entity, only of local reactions to some brands of insulin when injected.
Also, as you mention, you think you may have a UTI. Could that be a possible cause of your symptoms?
If so, is it worth waiting until your UTI is treated ?

Thanks @kitedoc, my UTI symptoms worsened so I sought medical attention and started on antibiotics. I also happened to have an appointment with my DN the same day, so she reviewed the diabetes side of things and we agreed on a plan.

I did check my BGs during each episode of feeling unwell, and they were all well over 4 mmol/l. My DN agreed that my body could be (mildly) intolerant to Lantus, and mentioned that the endo she works with has seen other cases of it and she would call to discuss my case. I say mildly because "intolerance" can mean completely unable to use a medication, and it's not as bad as that. I just feel unwell, which could be due to the UTI that, like the previous time, I had no way of knowing I had until the pelvic and flank pain started.

I am extremely sensitive to getting side effects from most medications, which seems to be common among people with chronic fatigue syndrome (CFS), which I have. Also, about an hour after my first Lantus dose, I felt a pronounced dizzy/lightheaded feeling that persisted for about 4 hours. I had to lie down and rest for some of that time.

Hindsight shows it was unfortunate to start Lantus at the same time as a UTI was brewing. It could be all UTI-related and coincidental. I won't know until the UTI is completely gone, which will a bit take longer than normal because of both diabetes and CFS.

In the meantime I am recording 7-8 BGs/day for 3 days in a form the DN gave me. We will then discuss the findings, along with any symptoms I may still have by that time. I'm open to the idea of staying on Lantus until we can be sure the UTI has gone, and making a decision then.

The insulin we are considering trialing if a change is warranted is NovoMix 30 (IIRC). This would have some advantages over Lantus anyway, since I might benefit from the mealtime effect and I prefer two meals and a snack each day.

Before starting on insulin I wasn't keen on a mixed insulin but now I can see it might be better than Lantus alone, and might obviate the need to add in a short acting insulin, which I'd like to avoid if I can.

I have an open mind and can afford a bit more patience now that my body isn't screaming "UTI!" at me. Once my BGs are more stable, they will hopefully give me an earlier warning of an infection, too, which should reduce the duration of it.

 

[kitedoc]

Thank you @Jenny15 . You have a great handle on your history and details.
I have not been prescribed Lantus.
At the time my specialist thought that Levemir insulin would suit me better as it also has a flat, relatively even and low effect on blood sugar like Lantus but lasts only about 12 to 16 hours. That allowed me to alter the long-acting 'profile' of my insulin every 12 hours or so, since we need less insulin at night generally than during the day. Something that Lantus does not accomodate all that well I have heard.
I was prescribed a basal-bolus regime, Novorapid (short-acting insulin) dose (bolus) before each meal according to BSL and carb intake for that meal and Levemir am and pm as background or basal insulin.
My fear with insulin mixtures is that they are fixed ratios. You have to eat X carbs in order to balance the insulin effect from the quicker acting part of the mixture and which in turn is gives so much effect from the long acting part.. If you need more long acting insulin to control say nighttime BSLS then you end up having to eat more carbs with meals. Having said that there are different ratios of short/long acting mixtures.
Some people have had to come off insulin mixtures because they tended to gain too much weight. Just a thought to mention and discuss with your DN. On the other hand there are less injections.
A relative of mine suffers with recurring UTIs and swears by regular intake of cranberry capsules as a preventative. Your DN and doctor may have some thoughts on that also.
I hope you are feeling much better soon and can return to a state of relative normality ( whatever that is in the world of diabetes)!!

 

[Jenny15]

Hi @kitedoc

Thank you for those excellent suggestions. I have a cranberry product I use during a UTI but I think it's time to buy the prophylactic capsules and use them for a while. Have had two infections this year after not having them for several years.

I think you are right about basal/bolus vs mixed insulin, now that I think about it. I had read these same arguments at Blood Sugar 101 before I started on Lantus. There is a possibility I can access funded Levemir, if the endo approves it. I assume NZ's government drug-buying agency went with Lantus partly because it is so well tolerated generally, but there should/would be provision for endos to authorize it where needed.

My route to Levemir would be through seeing the endo (I'm on a waiting list) or my DN getting approval before then. My DN probably picked NovoMix 30 as the best option for me from the insulins that are funded for the primary care sector to use, in case I really can't wait for a decision on Levemir. And if I'm lucky enough to have very little nausea and malaise after the UTI then I could probably cope with Lantus. Either way, I will have learned a bit about back up options should I ever need them.

Let's hope the agency doesn't just decide some other basal insulin will win the periodic sole supply tender process next time, or all the happy and settled Lantus users will be unimpressed.

There are some things the NZ health care sector does really well, but funding a range of options across all medication types is not one of them. We are told to appreciate that the lower overall cost allows more people to be treated. Which is a good thing, I admit.

 

[Jenny15]

Hi @kitedoc

And if I'm lucky enough to have very little nausea and malaise after the UTI then I could probably cope with Lantus. Either way, I will have learned a bit about back up options should I ever need them.

Hi @DJC3, @Fenn and @rab5 and anyone else who remembers this thread from 4-5 days ago.

I am now feeling so much better and I'm pleased to report that my UTI appears to be completely gone and my BGs today never went beyond 6.1 - 7.7. The latter was my fasting BG and still needs to be consistently under 7.0 for my DN and I to look at the next steps.

I started on 10u of Lantus and have titrated to 16u so far. I can now tell that (while some people are not well suited to Lantus) my symptoms of nausea etc were likely UTI related. I couldn't have known that at the time.

Perhaps the reason the nausea started one hour after the first Lantus injection was that any downward movement of BG pushed my delicate system over the edge into nausea. It seemed like Lantus was causing nausea but it was more complicated than that, as real life often is.

Overall, after 13 days on Lantus my impression is that it's a very gentle way to help reduce BGs... as long as you don't have an infection or other health issue at the same time. Now that I'm not sick, it's just gentle and ultimately, energizing. And it goes very well with moderate LCHF, too.

 

[DJC3]

Hi @DJC3, @Fenn and @rab5 and anyone else who remembers this thread from 4-5 days ago.

I am now feeling so much better and I'm pleased to report that my UTI appears to be completely gone and my BGs today never went beyond 6.1 - 7.7. The latter was my fasting BG and still needs to be consistently under 7.0 for my DN and I to look at the next steps.

I started on 10u of Lantus and have titrated to 16u so far. I can now tell that (while some people are not well suited to Lantus) my symptoms of nausea etc were likely UTI related. I couldn't have known that at the time.

Perhaps the reason the nausea started one hour after the first Lantus injection was that any downward movement of BG pushed my delicate system over the edge into nausea. It seemed like Lantus was causing nausea but it was more complicated than that, as real life often is.

Overall, after 13 days on Lantus my impression is that it's a very gentle way to help reduce BGs... as long as you don't have an infection or other health issue at the same time. Now that I'm not sick, it's just gentle and ultimately, energizing. And it goes very well with moderate LCHF, too.

Really pleased to read this @Jenny15 seems it was just rotten luck - the timing of UTI and starting lantus, like you say, you couldn’t have known.
The main thing is you are feeling so much better now, and with the lchf eating I’m sure you’ll go from strength to strength.

I have thought a lot about your original post. I hope it stays with me, and I remember the lessons you were imparting. I can see how easy it is to feel blase and slide gradually away from the techniques and support which are so invaluable at the beginning. Thank you.

 

[Fenn]

Hi @DJC3, @Fenn and @rab5 and anyone else who remembers this thread from 4-5 days ago.

I am now feeling so much better and I'm pleased to report that my UTI appears to be completely gone and my BGs today never went beyond 6.1 - 7.7. The latter was my fasting BG and still needs to be consistently under 7.0 for my DN and I to look at the next steps.

I started on 10u of Lantus and have titrated to 16u so far. I can now tell that (while some people are not well suited to Lantus) my symptoms of nausea etc were likely UTI related. I couldn't have known that at the time.

Perhaps the reason the nausea started one hour after the first Lantus injection was that any downward movement of BG pushed my delicate system over the edge into nausea. It seemed like Lantus was causing nausea but it was more complicated than that, as real life often is.

Overall, after 13 days on Lantus my impression is that it's a very gentle way to help reduce BGs... as long as you don't have an infection or other health issue at the same time. Now that I'm not sick, it's just gentle and ultimately, energizing. And it goes very well with moderate LCHF, too.

So happy to read this, so relieved for you, onwards and downwards