Lantus 24h Basal Test

[Loakie]

I am on 3 units of Lantus in the morning (breastfeeding is reducing my basal requirements) and have completed fasting basal tests. I found that for most of the time my glucose levels remained stable within +/- 1.7mmol/l but there were 2 periods where they dropped more than this. Overnight I dropped a little further but dawn phenomenon and foot to floor brought it up again. The main problem seems to be a Lantus peak from 3-7h post injection where I dropped by 4.2mmol/l. I have to watch out for hypos during this time. Interested to hear the thoughts of others.

 

[Bloden]

Hi there @Loakie. I used to take Lantus (now on Tresiba) and found my BG would usually dip at jab +3 hours or +6 hours. I was taking it before bed, so the pesky lows would happen overnight. My endo suggested taking it during the day, but I couldn’t face the threat of lows while I was up and about, so I asked about other basal insulins and ended up choosing Tresiba. I also realised that Lantus was only lasting for about 16 hours, which left me with no basal coverage for approx 8 hours, eek! So, it was deffo time for a change.🙂

 

[Loakie]

@Bloden I was taking it at night for years but would drop too much during the night so switched to morning. My fasting pre breakfast levels are similar so it seems to last 24h. It's not fun watching for hypos in the day. How do you find Tresiba?

 

[Bloden]

I really like Tresiba because it has a flatter profile than Lantus and goes the full 24 hours. The only problem is that a dose change takes 2 days to register, eg I lowered my dose on Wed night this week, and still had fasting hypos Thurs and Fri - I should be okay from now on.

 

[Amity Island]

@Bloden I was taking it at night for years but would drop too much during the night so switched to morning. My fasting pre breakfast levels are similar so it seems to last 24h. It's not fun watching for hypos in the day. How do you find Tresiba?

Hi Loakie,

Lantus for me was running a bit short. I switched from Lantus to Tresiba Degludec a couple of years ago. It's been really reliable for me. Keeps my basal readings flat. Best thing, being able to take it whenever I like each day. It's like magic, no need to be strict about taking at a set time every day. It's almost a 48hr insulin which can overlap without any problems. Only proviso on switching to Tresiba is what dose to go onto. I struggled with it initially as doctor put me on a lower dose to the lantus. Which caused major problems, I was so short on basal dose, I was correcting with humalog every 8 hrs which was draining. I went private as a result, consultant upped dose to same as lantus (19u) never looked back since. There are other basal insulins also available.

Other options include a twice daily basal, which I didn't want to try as it means even more restrictions on each day, with having to take it twice at set times. But this can allow for splitting the amounts on day and night, where one might not need as much in one half of the day as the other half of the day, this can resolve some issues.

I think some members on here @Inka @trophywench may offer an alternative opinion of trying an insulin pump, which is something I've never tried and no very little about, but they do say a pump can be tweaked to be more in harmony with a persons specific basal needs and used for boluses as well.

Other options are to snack at times before an expected drop in blood sugars, a free meal if you like.

Lot's of things to think about and discuss with your diabetes team or DSN.

 

[trophywench]

Well hang on - I liked 2 x Levemir very much for about 10 years, the fact you could assess within approx 12 hours of making any change and didn't hang about to surprise you suddenly after years sitting inactive in your body OMG the sudden unannounced hypos like Lantus did, forced my hand - can't spend the foreseeable future wondering if and when, when you have a normal job! and a normal life.

14u Lev in a morning, 4u at night, but had to bring that forward from bedtime to approx 9.30 pm, to get decent coverage/ no hypos in the early hours. No dramas and didn't make that much difference TBH what time I had each dose, except temporarily that day/night as Levemir isn't 'violent' in how it releases in the body. no huge peaks in its delivery everything that much more gradual. They hadn't invented Tresiba by then so pretty clueless how that might have suited me, but my logic said that if swapping Lantus to 2 x Levemir saved multiple Novorapid correction doses every day, I was still better off - and I was.

Bit the bullet and swapped to a pump in 2011 - not dead easy to begin with getting my head round it and I was in tears some days but my husband knows me too B well, cos he said he knew I wouldn't be able to cope before I had it and why didn't I just ring the DSN up and tell her I didn't want it or put it in the bin outside and just send the money back to the CCG then? I replied saying Well I'm tempted! thinking You barsteward! I'm intelligent whatever you think - so I'll prove it - and you can stick your £&^%$%ing opinion where the sun don't shine! And then put my sensible head back on, and sorted it. After 6 months if that, no way Pedro would I have gone back to jabbing.

Still happily pumping and on my 3rd pump now. Oh and currently on 11u per day total basal, been dropping every year since 2011.

 

[Amity Island]

14u Lev in a morning, 4u at night, but had to bring that forward from bedtime to approx 9.30 pm, to get decent coverage/ no hypos in the early hours. No dramas and didn't make that much difference TBH what time I had each dose, except temporarily that day/night as Levemir isn't 'violent' in how it releases in the body. no huge peaks in its delivery everything that much more gradual. They hadn't invented Tresiba by then so pretty clueless how that might have suited me, but my logic said that if swapping Lantus to 2 x Levemir saved multiple Novorapid correction doses every day, I was still better off - and I was.

TW,

Just curious about the levemir.

Are the timings really strict or is there a bit of slack between taking the 2 doses?

 

[trophywench]

Definitely quite a bit of slack @Amity Island - I certainly didn't get up at 7am and drive to work at weekends or on holiday. If we eg went out for a meal so I missed 9.30pm, I just jabbed it when we got home and if my BG was a bit high by that time I could always have a correction - but mostly at said eating establishment I'd have had a drink (or 3 or 4) so I'd just flop into bed and start again tomorrow when I got up again.

Have you ever consulted the Levemir dosing graph, first assume whatever total daily dose you might be on, easiest to use the same daily dose as right now of whatever you are on now) and split that up into the two doses you think you'll take (assume first off half am and half pm cos until you try it you won't be able to tell accurately) then calculate the actual dosage per kg of you - then follow the line left to right, to estimate how much of 24 hrs the dose will last at an active level. It does have a peak after X hrs of jabbing. (the Y axis of the graph) (I always have to expand the screen resolution up to about 300% before I start in order to follow the line.)

Levemir – detail « Diabetes Support Information Exchange (diabetes-support.org.uk)

 

[Loakie]

Hi @Amity Island

I'm currently having to snack before lunch, reduce my lunch bolus and have no pre bolus to manage the Lantus peak.

I am interested in Tresiba and Levemir. It's difficult to know which would suit me best.

A DSN did mention a pump to me 1.5 years ago but my consultant said I wasn't eligible because I was still honeymooning. I'm not sure if I am or not because it was when I became vegan that my insulin sensitivity increased. I would like to change basal insulin and keep trying MDI.

 

[rebrascora]

I think the choice between split dose Levemir and Tresiba would come down to whether your basal needs are similar day and night and whether you have a fairly routine lifestyle or if it is variable. Tresiba trickles out a steady amount of basal insulin day and night, so if you need a lot less during the night, like myself and @trophywench, then it might cause you to hypo during the night or be high during the day depending upon the dose. Levemir gives you the opportunity to adjust your dose half daily to accommodate changes in activity or differences in day/night requirements etc. So for me I normally take 16 units in the morning and anywhere from 0-8 at night..... If I have had an active day or done exercise I always need less during the night. Timing is pretty flexible for me with Levemir and is usually bed time and waking up, so 11pm ish and 7am ish. I don't find any benefit in splitting it exactly 12 hours apart as you are supposed to, so that is just for convenience for me.

 

[trophywench]

Ah well @rebrascora - that's where you and I are/were both wrong! I do not need less insulin at night - from c. mid evening to c. 1 or 2am - I need A Lot of insulin.

Didn't discover this until I had a pump ......

 

[rebrascora]

Ah well @rebrascora - that's where you and I are/were both wrong! I do not need less insulin at night - from c. mid evening to c. 1 or 2am - I need A Lot of insulin.

Didn't discover this until I had a pump ......

Interesting! All I know at the moment is that I need pretty much none between 3am and 5am!

 

[Loakie]

Those surprise hypos @trophywench are another reason I'd like to change basal. Also that when my Lantus injection site bleeds quite a bit I notice a sudden drop in glucose levels shortly after.

It's difficult for me to see from the Levemir graph because my basal dose is 3u and I'm 58kg. I'd be needing a half unit pen certainly!

 

[rebrascora]

Those surprise hypos @trophywench are another reason I'd like to change basal. Also that when my Lantus injection site bleeds quite a bit I notice a sudden drop in glucose levels shortly after.

It's difficult for me to see from the Levemir graph because my basal dose is 3u and I'm 58kg. I'd be needing a half unit pen certainly!

Can't believe you don't have a half unit pen already, especially with such low basal needs.

 

[Loakie]

@rebrascora my days are very routine. I do drop a bit further overnight briefly before dawn phenomenon kicks in. Then I have foot to floor that takes my fasting levels to 6.5-9.5, typically in the 7s.

I have a Novopen Echo for my Novorapid but only recently discovered that they are available for Lantus. I was on 8u and 11u when I was given single unit pens. But when i phoned for help because 1u was too strong i was told to eat 30-40g of carbs uncovered. It's certainly not ideal having to increase/decrease doses by 50%!

 

[grovesy]

@rebrascora my days are very routine. I do drop a bit further overnight briefly before dawn phenomenon kicks in. Then I have foot to floor that takes my fasting levels to 6.5-9.5, typically in the 7s.

I have a Novopen Echo for my Novorapid but only recently discovered that they are available for Lantus. I was on 8u and 11u when I was given single unit pens. But when i phoned for help because 1u was too strong i was told to eat 30-40g of carbs uncovered. It's certainly not ideal having to increase/decrease doses by 50%!

Is this the breast feeding affecting your requirements?

 

[Bloden]

I'm currently having to snack before lunch, reduce my lunch bolus and have no pre bolus to manage the Lantus peak.

Lantus is a right pain, IMHO of course!

As for choosing between Tresiba and Levemir, I think other Tresiba users (@Kaylz eg) would agree that Tresiba’s slowness to react to a dose change is a pain if you’re someone who’s active and whose routine isn’t set in stone. I’m hoping to get a pump once things get back to near-normal, cos I can see how Tresiba lets me down because of my random routine and random bursts of activity.

 

[Kaylz]

Oh yes it is a royal PITA! And as it's so long and basal needs aren't the same the amount of biscuits I require to see me through the night is getting ridiculous! xx

 

[Loakie]

Is this the breast feeding affecting your requirements?

Breastfeeding is reducing my basal requirements but my levels remain fairly steady and I do not need to snack for it. Prepregnancy I was taking 3-6u of Lantus depending on where i was in my menstrual cycle.

 

[Loakie]

Lantus is a right pain, IMHO of course!

As for choosing between Tresiba and Levemir, I think other Tresiba users (@Kaylz eg) would agree that Tresiba’s slowness to react to a dose change is a pain if you’re someone who’s active and whose routine isn’t set in stone. I’m hoping to get a pump once things get back to near-normal, cos I can see how Tresiba lets me down because of my random routine and random bursts of activity.

My routine is much the same at the moment. My basal dose does need adjusted every so often though. Hopefully my diabetes clinic will change my insulin.