Lantus - decreasing

[mum2westiesGill]

Monday 12/11/2012
Fasting 0827 2.2
Hypo check 0845 4.1
Bef bfast 1159 8.6
Bef lnch 1631 5.9
Bef dinnr 2003 6.2
Hypo 2254 3.8
Bed 2317 6.7

Tuesday 13/11/2012
Hypo 0929 2.3
Hypo check 0949 4.5
Bef bfast 1124 7.9
Bef lnch 1554 8.4
Bef dinnr 2017 5.5
Bed 2336 4.6

Wednesday 14/11/2012
Hypo 0748 2.4
Hypo check 0806 4.6
Bef bfast 1020 7.1
Af bf 1244 12.3
Bef lnch 1413 8.0
Bed dinnr 1851 6.9
Hypo 2251 2.6

Thursday 15/11/2012
Night 0245 3.0
Hypo 0712 2.2
Hypo check 0729 4.1
Hypo 1030 3.4
Bef bfast 1048 6.1
Hypo 1649 2.1
Hypo check 1702 3.1
Bef dinnr 2018 6.8
Hypo 2322 3.8
Bed 0000 6.1

Friday 16/11/2012
Hypo 0920 2.6
Hypo check 0938 4.7
Bef bfast 1143 9.2
Bef lunch 1547 7.3
Bef dinnr 2045 6.4
Bed 2317 5.2

Saturday 17/11/2012
Hypo 0515 1.8
Hypo check 0530 3.1
Hypo check 0646 5.7
Hypo 0959 2.9
Bef bfast 1026 4.4
Bef lunch 1438 4.4
Hypo 2121 2.3
Bef dinnr 2154 3.0
Bed 0029 8.7

Sunday 18/11/2012
Hypo 1000 2.8
Afbf 1214 14.4
Bef lunch 1539 14.8
Bef dinnr 1928 12.4
Bed 2316 7.1

Monday 19/11/2012
Night 0358 6.5
Hypo 0850 2.4
Hypo check 0907 3.2
Hypo check 0925 6.4
Bef bfast 1045 11.7
Afbf 1312 15.4
Bef lunch 1606 6.4

I'm having hypos all over the place ie waking up to them plus having them during the day.

One week ago on Monday evening 12/11/2012 I reduced my lantus (BI) by 6u so from 42u to 36u (& on a say so from my DSN).
I decreased it again last night by 2u so from 36u to 34u.

I can't help thinking I should've maybe done it by 4u. I know lantus should be left for 3 / 4 days / 1 week before making any more changes. Is it too late after just 1 night to be reducing it once more then stick with this change for the next few days?

 

[m1dnc]

I would leave the Lantus dose alone for a few days to see how it settles. When I switched to a pump earlier this year, it took 4/5 days for all the Lantus to clear my system, so it was certainly persistent with me.

Looking at your results, I'm wondering if you might be overdoing it with your dinner short acting dose and then going to bed with falling BGs. Perhaps you should be using a different carb ratio (assuming you're carb counting) for dinner i.e. a lower insulin/carb ratio then.

 

[mum2westiesGill]

I would leave the Lantus dose alone for a few days to see how it settles. When I switched to a pump earlier this year, it took 4/5 days for all the Lantus to clear my system, so it was certainly persistent with me.

Looking at your results, I'm wondering if you might be overdoing it with your dinner short acting dose and then going to bed with falling BGs. Perhaps you should be using a different carb ratio (assuming you're carb counting) for dinner i.e. a lower insulin/carb ratio then.

Hi m1dnc,

Thank you for taking time to look at my results. Yes I am carb counting. Atm for my dinner short acting dose ratio I'm doing 1:10 (one unit of insulin/every 10g carbs). So a lower ratio would be 0.5:10 (half a unit of insulin/every 10g carbs) - is this correct please?

 

[everydayupsanddowns]

Atm for my dinner short acting dose ratio I'm doing 1:10 (one unit of insulin/every 10g carbs). So a lower ratio would be 0.5:10 (half a unit of insulin/every 10g carbs) - is this correct please?

Well you wouldn't have to jump straight down to 0.5u:10g, as long as you don't mind fishing your phone out of your pocket (assuming it has a calculator).

You could go 0.9u:10g. As an example:

Work out total carbs in eve meal = 57g
Calculate number of 'lots' of 10g CHO = 5.7
Each of those needs 0.9u = 5.7 x 0.9
Total insulin = 5.13u
Round to nearest half unit = 5u

That way you have more flexibility and don't have to make such big changes. Hope that made sense!

 

[m1dnc]

Hi m1dnc,

Thank you for taking time to look at my results. Yes I am carb counting. Atm for my dinner short acting dose ratio I'm doing 1:10 (one unit of insulin/every 10g carbs). So a lower ratio would be 0.5:10 (half a unit of insulin/every 10g carbs) - is this correct please?

That might be a bit drastic to halve your ratio in one go. Why not try 1:15 ( which is another way of saying 0.75:1). If that is not enough you could reduce it again. On the other hand, if you find you're running too high, you can tweak it to say 1:12. In any event, you should try any change for a few days before trying something different, and only make one change at a time.

Btw, have you ever thought of a pump? It is just the thing for dealing with swinging levels like you've been having, and the ability to make small tweaks is amazing.

 

[m1dnc]

( which is another way of saying 0.75:1).

ooops 1:15 should equate to 0.67:10. Sorry for any confusion, but Mike has it right.

 

[everydayupsanddowns]

Alternatively you could ask your DSN for some of the 'smart' meters (Accu-Chek Expert or Insulinx) which allow you to plug in a variety of ratios for different times of day. You tell the meter how many carbs you will be eating and it suggests a dose.

Sounds like one of those would be a real help. I had the Expert and loved it.

M

 

[mum2westiesGill]

One week ago on Monday evening 12/11/2012 I reduced my lantus (BI) by 6u so from 42u to 36u (& on a say so from my DSN).
I decreased it again last night by 2u so from 36u to 34u.

I can't help thinking I should've maybe done it by 4u. I know lantus should be left for 3 / 4 days / 1 week before making any more changes. Is it too late after just 1 night to be reducing it once more then stick with this change for the next few days?

Right okay I did actually phone my DSN & she confirmed that it's not too late to reduce it (BI / lantus) again tonight (after already reducing it last night) by another 2u so from 34u to 32u (in total from 36u to 32u). I'm also going to start taking it much earlier in the evening. I usually take it about 11:00pm or within an hour either side. Then I'm going to wait 4/5 days / 1 week to see what changes it brings 😱.

 

[trophywench]

Urgh, Gill, Have you done overnight testing? - in other words OK you are hypo when you wake up. But what time did the dip start? Half an hour before or has it been gradually falling since 3 am?

 

[bev]

Hi Gill,

I have asked you before on a previous thread whether you have tried a CGM - but no reply.🙂 Have you tried a CGM? Does your clinic use them? It would be much easier to work out what is going on rather than testing at random times as its difficult to build up a picture of what is going on.🙂Bev