Type 1 sudden Lantus effectiveness??

[slaxxfb]

as a bit of history: last night i had a hypo at 9.30pm. was 65 mg/dl (3.61 mmol), had a cup of milk.
this morning, FBG at 9.15am was 116 (6.4). i'm trying to get into IF so only injected Lantus 8u (as per daily/most effective dosage as per basal test). but for some reason i was feeling rather off at that moment - shallow breathing, fast heartbeat, a little lightheaded. decided to eat half a pear and go through my morning prep. the feeling did not go away and by around 10.45am i was sure that it was a hypo with worsening symptoms: eyesight is getting affected (blind spots), very shaky, panicky/blanking thoughts. immediately had a cup of sugared coffee (nothing else at hand that's faster.)
by 12nn BG is at 202 (11.22) which honestly i'm okay with, i know it's because of the coffee. i can get it down and control it from there.

so questions:
1. what just happened?? i don't think Lantus works this fast or this strongly? this is the first time this has happened. any thoughts?
2. if i understand correctly, the liver should be continuously producing glucose at a steady rate, and my basal is nicely matched to this rate as per basal tests. is there any time that the liver stops producing glucose? (leading to unexpected hypos)

any sharing/info/insights would be much appreciated.

 

[kitedoc]

Hi @slaxxfb, From my own experience and knowledge, not as medical opinion or advice:
To anyone who has tried it, hypos are a risk with IF. If you think about it we usually fast from say, 10 pm to 7 am, sometimes shorter, some things longer. If you are on insulin by injection why fast longer than this?
Apart from the BSL readings with times of 9.30 pm and 9.15 am, there is scant other information.
Did you have an evening meal with some bolus (short-acting insulin)?
What did you eat in the morning and how much insulin did you take for that?
If you felt off at about 10.45am did you check you BSL?
Coffee stimulates the liver to release glucose as does a low BSL. The sugar in the coffee is broken down the glucose and fructose and the glucose will contribute to the resultant BSL.
We diabetics may not store glucose in our livers as efficiently as non-diabetics so we cannot necessarily rely on liver stores to keep us from hypos developing. We cannot assume that the liver is feeding in glucose when BSLS are in range or high.
Other factors might be: insulin sensitivity increase related to exercise; Lantus or other insulin injected accidentally into a muscle will be absorbed more quickly and lower BSLs more quickly; insulin sensitivity may increase in the first ? 12 months after diagnosis of T1D and commencement on insulin (honeymoon period).
I hope the above helps. Good Luck.

 

[slaxxfb]

hello @kitedoc , thanks for the reply, very informative to me.
i wanted to try IF to keep my BSL stable for most of the day, plus a bit of weight maintenance. it's also the reason why i did basal testing, and currently studying my ICR. i'm hoping to be stable enough to do 16:8 fasts, but if something like this happens often i might just cut the fast altogether.
(yesterday) 6.30pm BSL 141 (7.8) - 4u bolus but i guess a banana cannot substitute for 1/2 cup of rice, thus the...
(yesterday) 9.30pm BSL 65 (3.61) - hypo, had a cup of milk
(today) 9.15am BSL 116 (6.4) - breakfast was only coffee+creamer and half a pear, only injected basal 8u Lantus as was already feeling weird.
10.45am did not check BSL, the symptoms were strong already, just had the sugared/3in1 coffee (26g carb)
12nn BSL 202 (11.22)

i think you have 2 points that most fit what happened today: 1, when i injected Lantus this morning i might have hit a muscle/vein, as the puncture had bled. 2, the uncertainty of liver function on sugar storage and production. i had been wary about this since reading about IF, since my sugar has always fluctuated. this might just spell the end of IF for me...

again, thank you so much for your reply. it's the sort of information that lets me know what i should be looking out for next, besides what is happening at the moment.

 

[Deleted Account]

@kitedoc is very wise - I agree with his comments.
I just wanted to add I would not be treating a hypo based on what I feel. For me, I need a finger prick test unless there is absolutely no way to test (e.g. my meter was broken).
When we are adjusting our daily pattern by, for example, IF, there could be something else at play which gives us those feelings.
But test as soon as you get those feelings: don't wait as the hypo could get worse.

I would also keep some hypo treatments close at had at all times. My dextrose are in the same bag as my meter.
But, if you forgot, pure sugar may be better than coffee which could have had fat with the milk/cream that would slow down the carbs.

 

[kitedoc]

@kitedoc is very wise - I agree with his comments.
I just wanted to add I would not be treating a hypo based on what I feel. For me, I need a finger prick test unless there is absolutely no way to test (e.g. my meter was broken).
When we are adjusting our daily pattern by, for example, IF, there could be something else at play which gives us those feelings.
But test as soon as you get those feelings: don't wait as the hypo could get worse.

I would also keep some hypo treatments close at had at all times. My dextrose are in the same bag as my meter.
But, if you forgot, pure sugar may be better than coffee which could have had fat with the milk/cream that would slow down the carbs.

Thank you @helensaramay, If wisdom can be leaned from lots of mistakes and mistooks I must have found some.
All faults are mine to have and try to amend. I have yet to fine a remedy for my foot in mouth disease however!!
We all have knowledge, experience and wisdom, if only we knew when to use them !! Best Wishes!!

 

[kitedoc]

hello @kitedoc , thanks for the reply, very informative to me.
i wanted to try IF to keep my BSL stable for most of the day, plus a bit of weight maintenance. it's also the reason why i did basal testing, and currently studying my ICR. i'm hoping to be stable enough to do 16:8 fasts, but if something like this happens often i might just cut the fast altogether.
(yesterday) 6.30pm BSL 141 (7.8) - 4u bolus but i guess a banana cannot substitute for 1/2 cup of rice, thus the...
(yesterday) 9.30pm BSL 65 (3.61) - hypo, had a cup of milk
(today) 9.15am BSL 116 (6.4) - breakfast was only coffee+creamer and half a pear, only injected basal 8u Lantus as was already feeling weird.
10.45am did not check BSL, the symptoms were strong already, just had the sugared/3in1 coffee (26g carb)
12nn BSL 202 (11.22)

i think you have 2 points that most fit what happened today: 1, when i injected Lantus this morning i might have hit a muscle/vein, as the puncture had bled. 2, the uncertainty of liver function on sugar storage and production. i had been wary about this since reading about IF, since my sugar has always fluctuated. this might just spell the end of IF for me...

again, thank you so much for your reply. it's the sort of information that lets me know what i should be looking out for next, besides what is happening at the moment.

I am glad it is of help. As you know though not everything can always be explained ! We all still have times when all the right moves led to mini- disaster and all the wrong ones end up a success!! Add in the influence of intercurrent illness, stress, weather and season and one has plenty of excuses !!!

 

[slaxxfb]

@kitedoc is very wise - I agree with his comments.
I just wanted to add I would not be treating a hypo based on what I feel. For me, I need a finger prick test unless there is absolutely no way to test (e.g. my meter was broken).
When we are adjusting our daily pattern by, for example, IF, there could be something else at play which gives us those feelings.
But test as soon as you get those feelings: don't wait as the hypo could get worse.

I would also keep some hypo treatments close at had at all times. My dextrose are in the same bag as my meter.
But, if you forgot, pure sugar may be better than coffee which could have had fat with the milk/cream that would slow down the carbs.

I will keep these in mind, thank you. I really got scared earlier because i've had a hypo in the range 1~2mmol and it was traumatic, i didn't want it happening again. But you are right, there might have been other factors at play. I will be more vigilant next time.

 

[alphabeta]

@kitedoc is very wise - I agree with his comments.
I just wanted to add I would not be treating a hypo based on what I feel. For me, I need a finger prick test unless there is absolutely no way to test (e.g. my meter was broken).
When we are adjusting our daily pattern by, for example, IF, there could be something else at play which gives us those feelings.
But test as soon as you get those feelings: don't wait as the hypo could get worse.

I would also keep some hypo treatments close at had at all times. My dextrose are in the same bag as my meter.
But, if you forgot, pure sugar may be better than coffee which could have had fat with the milk/cream that would slow down the carbs.

Allow me to add one point
Did you expose your pen to temperatures exceeding 20-25 degrees? In this case your Lantus will act like fast acting insulin because by essence Lantus is merely short acting insulin molecules joined together. Heat can destroy that bond between molecules so be careful.

 

[slaxxfb]

Allow me to add one point
Did you expose your pen to temperatures exceeding 20-25 degrees? In this case your Lantus will act like fast acting insulin because by essence Lantus is merely short acting insulin molecules joined together. Heat can destroy that bond between molecules so be careful.

It didn't get exposed to heat, but thanks for the tip, didn't know about that :O

 

[tim2000s]

Allow me to add one point
Did you expose your pen to temperatures exceeding 20-25 degrees? In this case your Lantus will act like fast acting insulin because by essence Lantus is merely short acting insulin molecules joined together. Heat can destroy that bond between molecules so be careful.

This is completely wrong. This is not how Lantus works.

The way Lantus and NPH insulin work is to form a precipitate (essentially they crystallise) in the subcutaneous fat. Heat doesn't affect that. If you hit muscle rather than fat it can work as a fast acting insulin, but heat doesn't cause that change.

Read more here: https://www.diabettech.com/diabetes/lantus-lethal-or-lifesaver-doc-gbdoc/
and here: https://www.diabettech.com/lantus/h...hy-you-should-try-tresiba-if-youre-on-lantus/

 

[alphabeta]

This is completely wrong. This is not how Lantus works.

The way Lantus and NPH insulin work is to form a precipitate (essentially they crystallise) in the subcutaneous fat. Heat doesn't affect that. If you hit muscle rather than fat it can work as a fast acting insulin, but heat doesn't cause that change.

Read more here: https://www.diabettech.com/diabetes/lantus-lethal-or-lifesaver-doc-gbdoc/
and here: https://www.diabettech.com/lantus/h...hy-you-should-try-tresiba-if-youre-on-lantus/

Umm what I said is not wrong at all... I agree with the crystallization part, and to add, those molecules start dissociating slowly in a steady rate thus providing 24-hour coverage. It happened to me and I created a thread here explaining what happened and what I experienced and it was all resolved by simply opening a pen from the refrigerator that was not exposed to heat. Yes Lantus if spoiled by heat can act like fast acting insulin, I did experience this myself, I had 10 mmol/l drop within 2 hours at 10 units. Now i am at 15 units and I drop by a maximum of 3 mmol/l

 

[tim2000s]

@alphabeta, with all due respect, the modifications made to the lantus molecular structure are designed to make it soluble in a solution of pH 4, which means that when you inject it you feel the sting, and it forms the precipitate. Other than that, it is not designed as a series of short acting insulin molecules joined together that come unbound.

There have studies done to look into the effects of heat on unfolding of insulin molecules, and what they have shown is that without Zinc present, you need to get to 70 degrees celsius before non-zinc containing insulin unfolds (effectively moving from hexamer to monomer, which is how Lantus is broken down from the precipitate), and when zinc is present (as it is in Lantus) it's more like 87 degrees celsius. Or in other words, at under 30 degrees, there is no way that the molecular structure is going to breakdown without something else going on. If the crystallization is unable to occur, then the body starts to act on breaking the structure down more quickly.

With Lantus, almost every issue where it becomes faster acting (it effectively acts as a regular human insulin, like Actrapid or Humulin R), is where it has been unable to create the "pool" in the subcutaneous fat. It is not about the temperature to which the insulin reaches whilst the vial is in use.

 

[alphabeta]

@alphabeta, with all due respect, the modifications made to the lantus molecular structure are designed to make it soluble in a solution of pH 4, which means that when you inject it you feel the sting, and it forms the precipitate. Other than that, it is not designed as a series of short acting insulin molecules joined together that come unbound.

There have studies done to look into the effects of heat on unfolding of insulin molecules, and what they have shown is that without Zinc present, you need to get to 70 degrees celsius before non-zinc containing insulin unfolds (effectively moving from hexamer to monomer, which is how Lantus is broken down from the precipitate), and when zinc is present (as it is in Lantus) it's more like 87 degrees celsius. Or in other words, at under 30 degrees, there is no way that the molecular structure is going to breakdown without something else going on. If the crystallization is unable to occur, then the body starts to act on breaking the structure down more quickly.

With Lantus, almost every issue where it becomes faster acting (it effectively acts as a regular human insulin, like Actrapid or Humulin R), is where it has been unable to create the "pool" in the subcutaneous fat. It is not about the temperature to which the insulin reaches whilst the vial is in use.

With all due respect, there is no way possible I had injected since April till 25th August and not even once having Lantus pooled properly... I came to such a conclusion after 2 points:
Another member here reported hypo with Lantus after pen being exposed to 37 degrees.
After I changed to a new pen and always kept it refrigerated, these drops simply stopped completely!
Now through the course of 4 months I examined every other variable such as dose, food, injection site, needle length and it all turned out to be a negative. If Lantus spoils at 87 degrees, then why it always should be kept below 28°C according to Sanofi? I am 100% sure and confident of what I am saying because I lived this dilemma for 4 months which was on the expense of my health and my weight.

 

[slaxxfb]

i haven't had an expired Lantus yet as it's only used once a day, then back into the fridge, so i wouldn't be of help on this topic.

however, with Apidra, they're not as sensitive to heat as i presumed them to be, having accidentally left mine for 3days in a garage (the Philippines' running temp can go from 32-45 degC depending on season), and it didn't spoil. however, it did spoil within the day when i accidentally used a syringe for Lantus on an Apidra pen. gelled up, all of it.