BG dropping 10mmol/L overnight

[Vix]

Right, I am beyond frustrated that my diabetes team have changed my lantus from morning to night and then I haven't been able to get hold of them for 3 weeks (an official complaint will be going in this week) but... I now do my lantus at 10pm and it drops my sugars by between 5-10mmol/L every night!! Surely this means that unless I go to bed high I will have a hypo in the night?? Was 15.4 at bedtime last night and 4.9 waking this morning 😱 so I'm tempted to go back to my morning lantus as they are offering me no suport whatsoever so I just feel like following my instinct... I don't think I'm doing too much lantus as it's going high after lunchtime, anywhere from 12-20! Anyone else had similar problems with night doses of lantus?

xx

 

[sacol4940]

I used to take my lantus at night but this never happened to me...

Hope you get something sorted

 

[Cleo]

hi vix
have you tried splitting the dose 50:50 morning and night?. Like you said, its def. not right that you need to be quite high before bed in order to avoid a night time hypo. The whole point about good glycemic control is surely to have *as little* fluctuation as possible?!?
when are you seeing your team next?, is it possible for you to change hospitals??
C.

 

[Akasha]

Before I had my pump, I was on Lantus.
Originally told to have it prior to bed and would have the same problems (Normally waking up in the early hours on a 2.something)

My DSN at the time said that despite what is said about long acting not having a peak, it had been noticed that Lantus had a peak at around 5 hours post injecting.

I had swapped my Lantus to 10 in the morning, and dropped my dinnertime ratio's to account for the peak.

Hope this info helps, and hope your hosp get back to you soon

 

[everydayupsanddowns]

Right, I am beyond frustrated that my diabetes team have changed my lantus from morning to night and then I haven't been able to get hold of them for 3 weeks (an official complaint will be going in this week) but... I now do my lantus at 10pm and it drops my sugars by between 5-10mmol/L every night!! Surely this means that unless I go to bed high I will have a hypo in the night?? Was 15.4 at bedtime last night and 4.9 waking this morning 😱 so I'm tempted to go back to my morning lantus as they are offering me no suport whatsoever so I just feel like following my instinct... I don't think I'm doing too much lantus as it's going high after lunchtime, anywhere from 12-20! Anyone else had similar problems with night doses of lantus?

xx

Two questions...

1. Why was it suggested that you move Lantus to the evening? (were you having some sort of problem that this was supposed to solve?)

2. How many times have you seen this sort of drop? (Have you done a set or two of tests every couple of hours overnight midnight... 2am... 4am... 6am... to watch what happens?)

I moved my Lantus to the morning precisely to avoid overnight/waking hypos. Lantus seems to have a mini 'peak' for many people at around 5hrs after injection and this was co-inciding with my 3am drop-off in cortisol production (and BG dip).

Taking Lantus at night basically meant that I had the most basal working when I needed the least. Splits didn't work so well for me (though I know they do for some).

The only thing you can do with MDI basals is to keep fasting-testing them overnight and during the day until you find the best fit for you. Took me about 8 months to work through all the options and try a few expdriments, but my control was much the better for it once I knew what system worked best for me and only had to occasionally tweak the dose.

 

[Vix]

thanks everyone

@cleo - I have literally just changed hospitals are we are at pre-conception stage so need to be at nearest hospital and also it's the hospital we would have antenatal care at. I agree though, I don't want any fluctuation really!! My next appointment is not until 21 May at the antenatal clinic

@akasha - thanks, I was injecting in the morning (which I prefer) and still had night hypos so it seemed ludicrous for me to change to night doses but I did as my consultant asked as I want to improve my control and will try almost anything but then I literally can't speak to anyone at my diabetes clinic about it... every time I call I get told a message will be passed on and no-one calls me back (3 weeks and counting now since I changed)

@mike - To be honest the consultant was stuck in her ways and said it should only ever be done at night and insisted that I stopped doing it in the morning, despite me raising my (logical in my head) concerns that I was having night hypos and it would surely make it worse!! I have done a few tests at 2am and they have been anywhere between 8-5. I was/am of the same opinion that if injecting at night I will have the most insulin when I need the least, but frustratingly I can't get anyone to speak to me about it which is a pain to be honest given that I am trying everything requested of them and they can't be bothered to give me 5 mins to help!!! I have done some basal tests in the morning and they aren't good, they go up from 4-6 waking to about 12-14 at lunch but when I have my breakfast (same everyday) and my usual bolus then they go from 4-6 to 5-8 which seems to be better so I'm not sure if I could be getting a liver dump if hungry? Not done a lunch fast yet as needed a few days of normal eating to allow me to concentrate on my massive workload at the moment.

I will keep trying, just feeling really isolated and unsupported by my diabetes team

xx

 

[Redkite]

Right, I am beyond frustrated that my diabetes team have changed my lantus from morning to night and then I haven't been able to get hold of them for 3 weeks (an official complaint will be going in this week) but... I now do my lantus at 10pm and it drops my sugars by between 5-10mmol/L every night!! Surely this means that unless I go to bed high I will have a hypo in the night?? Was 15.4 at bedtime last night and 4.9 waking this morning 😱 so I'm tempted to go back to my morning lantus as they are offering me no suport whatsoever so I just feel like following my instinct... I don't think I'm doing too much lantus as it's going high after lunchtime, anywhere from 12-20! Anyone else had similar problems with night doses of lantus?

xx

This is exactly what used to happen with my son when he was on Lantus. He'd have his Lantus at 8pm, and would need to be 16+ to avoid being hypo by morning. Then by 3-4pm, his levels would start rising because there was hardly any basal left. Switching it to the morning would have meant hypos in the middle of the day and high waking levels. I wanted to split the dose but our team said that was inappropriate for children (it isn't, we have since found).

I'd recommend you look into moving hospitals to find a more supportive clinic team! Splitting your Lantus dose is likely to help you (but what split to use would need advice, which you aren't getting from your team!). And lastly, have you considered a pump? It's such a wonderful tool for being able to tailor your own personal basal profile, mimicking the action of a healthy pancreas. My son is able to spend the entire night with BG's in range - totally impossible on MDI.

 

[everydayupsanddowns]

@mike - To be honest the consultant was stuck in her ways and said it should only ever be done at night and insisted that I stopped doing it in the morning, despite me raising my (logical in my head) concerns that I was having night hypos and it would surely make it worse!!

OK, so here's a quote from the Drs Prescribing information on Sanofi's US site (my emphasis):

DOSAGE AND ADMINISTRATION
The starting dose should be individualized based on the type of diabetes and whether the patient is insulin-na?ve (2.1, 2.2, 2.3)

Administer subcutaneously once daily at any time of day, but at the same time every day. (2.1)

http://products.sanofi.us/lantus/lantus.html

Even the UK Patient Information Leaflet (inside each box) says:

Frequency of administration
You need one injection of Lantus every day, at the same time of the day.

without any mention that it *has* to one particular time.


Not exactly unclear is it?! 🙄

 

[Lauras87]

Hey vix

I always dropped in the night & as you know I'm now on a split dose instead of taking the whole lot at night.

Maybe that might help?

Maybe your DSN & my DSN are on holiday together hence we can't speak to them?

 

[Vix]

thanks @mike - I might print that and take it to my next appointment 😉 and they can't just change it to suit them and not me, give me no support and expect me to do what they say! I think I'll go back to morning tomorrow...

@laura - I think my DSN is on an eternal holiday 😉 So maybe they have eloped together! Funny that we're both in the same area as well!

xx

 

[Vix]

@redkite my brother is also a diabetic and the next nearest hospital to me and his team are just as bad as mine so i don't think that's a viable solution as I'd still have bad care and have to travel further, which is especially problematic as we are in pre-conception stage and I don't want to travel further to a hospital! I might just go and camp out in the diabetes clinic until someone speaks to me!!! A lot of people tell me to go on the pump but I really don't want to for various reasons so am willing to try everything else first

xx

 

[everydayupsanddowns]

A lot of people tell me to go on the pump but I really don't want to for various reasons so am willing to try everything else first.

I think I know exactly how you are feeling. Or at least, my own version of it. Whether a pump is right for you is something you have to decide for yourself, but just to say that I've been there too. I wrote this at the time: Changes, uncertainty and what to do next.

 

[Vix]

Interesting indeed Mike, I read the post about you not wanting a pump and the line that resolutes most with me is 'In addition to all this I'd have to be attached to it. All the time. 24 hours a day.' Plus we are desperately wanting to try for a family, so the time taken faffing about with a pump would put that back yet further I feel... I'm just not ready for a pump yet, never say never but at the moment I don't want a constant reminder and pump attached to me 24/7 xx

 

[Vix]

having said that can it be any worse than now??? My sugars gone from 7.2 at lunch to 17.8 now and I'm in tears yet again with this sodding disease xx

 

[everydayupsanddowns]

having said that can it be any worse than now??? My sugars gone from 7.2 at lunch to 17.8 now and I'm in tears yet again with this sodding disease xx

Sounds like you are thinking it though very carefully. And you are absolutely right there are no 'easy' answers. This post by Alison (a member here whose current pregnancy blog posts you might find interesting too) was one of the ones that made me think it was worth consideration: http://www.shootuporputup.co.uk/2010/06/what-made-the-difference/

Having said that, it still took me a good 2 years of 'no' before I had come to a point where I thought it was at least worth asking the question. If you are not there yet then you are absolutely right to stay with MDI. Going on to a pump does involve work, but I *do* find it the best way of managing my D. Oh and yes, after a very short while my fear of attachment did indeed come to nothing.

Good luck with your decision, and hope your levels settle a bit in the meantime.

Incidentally... do you use, or have you been offered a 'smart meter' (InsulinX or Expert) that can help to fine-tune MDI doses by taking the donkey work out of bolus calculation/micro correction?

 

[Redkite]

@redkite my brother is also a diabetic and the next nearest hospital to me and his team are just as bad as mine so i don't think that's a viable solution as I'd still have bad care and have to travel further, which is especially problematic as we are in pre-conception stage and I don't want to travel further to a hospital! I might just go and camp out in the diabetes clinic until someone speaks to me!!! A lot of people tell me to go on the pump but I really don't want to for various reasons so am willing to try everything else first

xx

Totally understand what you're saying re pump and hospital. We moved hospitals from West Herts to London which is a bit more hassle in terms of time and cost for the train journey, BUT absolutely worth it in terms of the care received. And there is always someone to answer queries by phone or email, whereas with our old team weeks would go by with no response! But if you will be needing to go back and forth a lot for pre-conception and ante natal care I can understand your reasoning. If only all teams were equally high quality!

On the pump front, we had to fight for nearly 2 years to get my son's pump, yet the first night he went to bed with it attached to him I felt really sad, and the bottle of celebratory champagne stayed unopened in the fridge. He personally never minded being attached to something, and I didn't feel sad long as it was an absolute godsend in improving his d management.

Hopefully you will get smoother BGs across the 24 hours if you split your Lantus, as I do sympathise with those horrid afternoon rises.

 

[Lauras87]

having said that can it be any worse than now??? My sugars gone from 7.2 at lunch to 17.8 now and I'm in tears yet again with this sodding disease xx

*hug* it's no fun it is?

I had some chocolate earlier that I haven't had since I became diabetic & I'm up at 15.1 even tho I had insulin for it

I want Chinese, beer, ice cream & sod the diabetes

 

[Vix]

@Mike - I'm defintely thinking about it but I feel it will take a lot of persuasion before it's a yes... but like I said, never say never 😉 Thanks for the link, another one to add to my read list. I've never been offered a 'smart meter' but if I EVER get hold of my DSN I'll add it to my list, as I obviously need something to help me out if my medical team won't!!

@redkite - it's a real shame there is such a difference in hospitals, guess it's the postcode lottery again! What makes it upset me more is that I'm back at the hospital where I was originally diagnosed and my team were amazing then, my DSN is still there but she's paediatrics so I can't have her as my DSN now... was wondering whether to speak to her if I could actually get reception to put me through as I'm getting angrier by the day about it.

@laura - hugs much needed 😉 thanks! I am so tempted to go and eat some ice-cream right now, as trying so hard doesn't seem to make a bit of difference - I feel like I might as well be eating chocolate given what my sugars are doing!!

xx