Scared of 'Lantus Low'

Hello lovely people!

I am writing because I am currently going down the spiral of absolute fear.. Obviously too much Google and 'what if' long story short I am a very anxious person and usually super scared of various health things - Im one of those people who constantly fears something is wrong with me. Well I have been using Basaglar insulin which is Glargline for quite a few years. And theres some weird stuff going on with supply shortages of that specific one over here so I was thinking about switching to Lantus because its kind of the same thing. Now I never even knew about this Lantus low thing and now the more I read I realise that the risk is also there with Basaglar and I got to the point where I have no idea how Ill inject it tomorrow night without freaking out. Ill probably have like a 2 liter bottle of coke right nearby me and warn everyone in the house or something haha.

Anyways I think I understand the principle of it but Im not entirely sure. So does it only really happen when you inject it into muscle or blood? Is it most risky when you are slim and / or inject into not so fatty tissue like the the leg? Now Im not overweight but I have some belly fat and I try to always pinch it. Its just that now im spiraling out of control with worry of what if this happens and what do I do then..

@EllieM Very sorry for the random tag I know you don't know me but I remember u replying to my older posts and being super active and during my spiral I seen a lot of your messages from back a few years ago. Saw you had this happen to you. Did it ever happen again? Did you figure out some 'safe guards' to prevent this? Or did you maybe decide to switch away from Lantus altogether.?

Basically not really a question Im just spiralling and going crazy with worry here now that I know that there's a possibility of something ugly like this happening and Im just curious if there are ways to make sure it doesn't happen..

Thanks

EllieM said:

Hi @Quinapril I'm sorry you're stressing out.

Basically I had a lantus low at least once, possibly twice, and I "fixed" it by splitting my dose so that I took half a dose in the morning and half in the evening, which reduced the risk significantly. I also tried to wait twently minutes after injecting my night time dose before going to sleep. After that change in routine I didn't have another occurrence. And though it was scary it didn't put me into a coma because I was able to keep knocking back the glucose until my bg went up. (Probably my scariest hypo ever was when we were away on holiday and I accidentally injected bolus instead of lantus, and then found we didn't have as much sugar with us as I feared that I might need. No lantus low involved, and I survived without a trip to A&E).

I was on lantus for ten to fifteen years so it wasn't exactly a common occurrence, but I generally found that lantus became less reliable for me (in the sense that it sometimes also acted unpredicatably slowly) so when my clinic offered me a pump two years ago I accepted and have been very happy since then. But I still have lantus as my emergency insulin for if my pump breaks and would use it then.

And the thing is, hypos are unpleasant but if you have carb by your bed you should be able to deal with them, specially with the advent of cgms.

So I personally wouldn't worry about lantus/glargine until I found I was getting issues with it....

Good luck

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Thank you for the advice.

I will definitely be keeping a bottle of cola or something nearby the bed just in case. And I think Ill switch to 4mm needles instead of my 6 mm ones just for more peace of mind.

I do think that I should switch the basal too eventually. Life is just a bit hectic right now and I feel like I want stuff to be more stable before I make such a (big?) change.

I do notice that my basal tends to work okay within the first 16-18 hours and then kind of start working less towards the evening. So maybe splitting the dose would ease this issue over as well.

Now about splitting it. How did you go about? I would want to try it but I want to make sure its safe and I dont do something stupid.
Is it kind of like say I inject 13 units of basal at 10 pm or so, so I move
1 unit over to 10 am and then
2 units 10 am - 11 units 10 pm; then
3 units 10 am - 9 units 10 pm

Is that how I should go about splitting it or is there a better way?

Antje77 said:

Hi @Quinapril , while a Lantus Low is possible with any of the insulin glargines, you seem to have used your basaglar without issue for years. There is no reason to suddenly expect trouble if it never happened before.

However, if the fear affects your mental health this much, it's as good a reason as physical health to see if you can switch to a different insulin.
You mentioned your Lantus not being effective for the full 24 hours, Tresiba may be a good substitute for you, it has a flatter action profile and a longer duration. Very stable for me.

I did have a Lantus Low once, but that happened only weeks after starting Lantus, many years ago, and it was the reason I switched to Tresiba. I'm fat by the way, and I injected in fatty tissue when it happened. Even fatty tissue has capillaries you can hit so I don't think it matters much if you're thin or fat.

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Thats the funny part haha. It never did affect my mental health at all. I never knew a sudden drop like that was possible. But now that I know I started worrying about it quite a bit.
I guess you are right. I calculated and I guess I injected Basaglar between 1000 and 2000 times or so without any issues so I guess it is unlikely that something will go wrong.

Just the knowing you know? That it's actually possible and completely random makes me anxious. I guess for now I will measure my bg every time like 10 mins after I inject the basal to see if anything shady is going on.

But I'll research and talk to my doc about Tresiba I think.

EllieM said:

I have to be careful what I say because forum rules don't allow us to give dosing or medical advice. Basically when I am changing timings of doses because of time changes or whatever (I travel quite a bit) I work on the principal that it's better to have too little basal in my system and do correction doses of bolus to catch me up.

I personally find my life much easier now my team have moved me on to a pump, but that is quite a big change that you may or may not want to consider and may or may not be eligible for.

As a long term T1 yes hypos can be scary, but I don't think it's good for your mental health to obsess over them. If you still have hypo awareness (can be an issue for long term T1s or if you have too many hypos) then you are very very unlikely to get into trouble as long as you always have sugar with you.

Having said that, I understand and empathise with your anxiety. For me, hypos were always the worst part of being T1, and before my pump I just had to learn to live with them....

Are you getting a lot of hypos at the moment?

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I never realized this was so strict regarding u know the "medical advice". Cause I don't know how it is in ya'll guys countries but over here if I ask doctor about some bloog control strategy he will usually be somewhere along the lines "Well you should carefully try and see it how works out for you" well as long as it's not some stupid idea haha. So its like yeah man.. I could have thought of that myself too lol.

But yeah I barely ever get hypos (3 knocks on wood) lately tbh. I guess it's somewhat of an indication of a problem in itself. Because I follow my CGM obsessively and when I see a sudden strong down arrow I start to try and catch the drop with sugary stuff almost immediately even if the glucose isn't even that low yet.

Sooooo.. I guess my fear of hypos kinda makes me keep my glucose higher baseline.

Well plus I recently had some not so fun issues with alcohol. Just problems in life causing me to abuse it for a while. So I am damned sure that it doesn't help my control. But I am getting this thing under control and am very serious about it.