Switch to intermediate acting insulin or bolus at dinner?

[NotBeyonce]

So my lantus works for 18 hours. I wake up with decent fasting numbers and then I take tablets (metformin XR 2000 mg + gliclizide MR 120 mg) with breakfast. I find that my best blood sugar levels around lunch time.

Today at lunch:
Pre- Prandial - 5.6 mmol/L
2 hours post - 6.3 mmol/L


Dinner:
Pre-Prandial - 8.0 mmol/L
2 hours post - 9.7 mmol/L

Between lunch and dinner I only had water. I feel by dinner time my basal has worn off and my tablets are not at their peaks.

So the 8 and 9.7 are not extremely high numbers, but my A1C is over 10% so I'm expected to have tighter controls. I am supposed to have <6.0 mmol/L fasting and pre-prandial, and <8.0 mmol/L post meals until my A1C lowers to under 7%.

I haven't taken my bedtime yet, but I assume it will be around 11. That's what I've been averaging lately.

I'm just wondering is it better to switch to a intermediate acting and do 2x daily basis injections or stick with my lantus and do a bolus just for dinner? I want some ideas before I present a suggestion to my diabetic nurse and endocrinologist.

Extra Facts:
I'm 5'3'', 130 lbs, take 20 units of Lantus to achieve fasting in the mid 5s. Previously averaging fastings in 8-11 range and post prandials up to 15 when on metformin and gliclizide, post prandials up to 20 on metformin alone. I eat max 100g of carbs per (including carbs from fiber ... I don't calculate net carbs. A carb is a carb to me). I do not experience hypos.

 

[Simon84]

*Bump*

 

[Tophat1900]

I wouldn't be happy with those dinner time numbers, but that's me. I would be taking a small bolus untill I reached the levels I wanted to be at. What you need to do for you is probably consult your doctor about this. Tell them you're at not happy with those dinner readings.

 

[catapillar]

Lantus lasts about 18 hours, so it could well be running out by dinner time. Many people get around this by splitting their lantus and taking a shot am and pm.

I'm not sure how applicable basal testing would be to a type 2 on basal only, where it may be designed to cover food, but here's a guide on basal testing - https://mysugr.com/basal-rate-testing/ - that could be worth doing to see if you need to consider splitting your lantus.

 

[Mep]

yeh I find lantus does wear off too. I'm guessing you've already made sure you aren't eating too many carbs with your meal at night. Depending on how long you've had diabetes, it may be worth asking your doc to check what your pancreas is doing (they can do c-peptide blood test to check that). If you aren't producing insulin you need yourself you probably would be better using bolus insulin with your meals also. I tend to use more bolus with my dinner because my sugars are usually higher from 5 pm onwards. I inject 8.30 pm so yeh the lantus definitely doesn't last the full 24 hours like they claim it should.

 

[NotBeyonce]

I wouldn't be happy with those dinner time numbers, but that's me. I would be taking a small bolus untill I reached the levels I wanted to be at. What you need to do for you is probably consult your doctor about this. Tell them you're at not happy with those dinner readings.

Yes, I am not either. My goal pre meals is 5.9 or lower. My goal post meals are 7.9 or lower. My team agrees with this goal 'cause I had a dramatic spike in my A1C.

I was just curious as to what is the better option. I read that bolusing for type 2s is not recommended until the daily insulin is at 0.5/kg. Is this correct? That's too high a basal dose, as it would be 30 units and I assume that will put me into severe hypos. So, I thought maybe switching to intermediate insulin that I take every 12 hours may be better.

 

[NotBeyonce]

Lantus lasts about 18 hours, so it could well be running out by dinner time. Many people get around this by splitting their lantus and taking a shot am and pm.

I'm not sure how applicable basal testing would be to a type 2 on basal only, where it may be designed to cover food, but here's a guide on basal testing - https://mysugr.com/basal-rate-testing/ - that could be worth doing to see if you need to consider splitting your lantus.

Will an overlap of "insulin dosages" cause an issue? Is there a potential for hypos?

Thanks for the link. I will research that and may try to do a basal test over the weekend.

 

[NotBeyonce]

yeh I find lantus does wear off too. I'm guessing you've already made sure you aren't eating too many carbs with your meal at night. Depending on how long you've had diabetes, it may be worth asking your doc to check what your pancreas is doing (they can do c-peptide blood test to check that). If you aren't producing insulin you need yourself you probably would be better using bolus insulin with your meals also. I tend to use more bolus with my dinner because my sugars are usually higher from 5 pm onwards. I inject 8.30 pm so yeh the lantus definitely doesn't last the full 24 hours like they claim it should.

I did not eat a high carb meal as my post-prandial numbers from dinner only went up 1.7 mmol/L. Also, my lunch wasn't too fatty or high in protein to give a delayed spike.

Yes, I will getting my c-peptide test done. I will get the requisition when I see my doctor later next month.

 

[NotBeyonce]

Spoke to my nurse today. Apparently after reviewing my more recent numbers, I'm really close to having control of my diabetes, so she doesn't think bolusing is needed. She advised I could switch to Tresbia or do a second smaller dosage of Lantus in the am. She also wants me to do a slight increase in my basal right now.