Change insulin times

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Kaz84

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Type 2
So I’ve been on lantus for quite a while the diabetes clinic set my dose. I take 10 units with my dinner at 12-1pm and 12 units with my tea about 7-7.30pm. My blood sugar is still a little high now my doctor has told me to up my insulin but change the time so at dinner at 12 and before bed at 11.30pm. my blood sugar is now sky high before bed between 18-20. Mmol. Before this I was usually 12-14 mmol. She said to leave more time because I was double dosing but now my levels are worse. Should I stick it out a few weeks see if it settles or just take my higher dose with my tea as I feel that it works better keeping me more level.
 
What are your levels like before tea and what are you eating for tea? Have you tried not eating and tea and testing instead (basal test) to find out if the problem is your lantus or your tea?
 
I eat more for tea which is why my insulin is slightly higher. My levels are normal before I eat.
 
That seems an unusual regime @Kaz84 Have you tried using a bolus/meal/fast insulin instead or in addition? Is it possible you’re actually Type 1? Has that been ruled out?

12-14 before bed is still high. What was your last HbA1c?
 
I have to ask why are you using Lantus in the way you are?
Lantus is a background (basal) insulin and not a bolus for meals. You should be on Lantus once a day and having a bolus insulin (quick acting) for injecting before meals.
 
Mainly because I have low appetite and I don’t eat breakfast so I was put on lantus. I felt it was working well the way I’ve been talking it. The dosage was set by the clinic. I did have a test they said I was still type 2. My last hba1c was 70 that’s why the doctor is changing the dosage.
 
Kaz84 said:
Mainly because I have low appetite and I don’t eat breakfast so I was put on lantus. I felt it was working well the way I’ve been talking it. The dosage was set by the clinic. I did have a test they said I was still type 2. My last hba1c was 70 that’s why the doctor is changing the dosage.
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The insulin you have is not designed to cope with food hence why your A1c is high. With a bolus (quick acting) you can adjust your insulin to match how much food you eat so it does not matter how much or how little you eat.
 
I think they was happy with my levels but I got my appetite back slowly so my levels have gone slightly higher. I am going to go back to my original times but on the higher dose. I felt that worked really well for me.
 
It seems a very strange regime to be on as your HbA1C is high and even before the change in timings your levels were much higher than desirable.
What sort of meals are you having?
 
I don’t eat healthy at all. I’m underweight and eat whatever I want. Chips, pasta, chicken x I’ve been honest with what I eat when I’m telling them. Because I don’t really eat a lot I just don’t eat healthy. I do really crave sweet stuff.
 
They have talked about changing the insulin but never have. I think they might see how I go with the new dose and maybe change it. The clinic was meant to do a review a few weeks ago but was cancelled. But had my bloods done for it. That’s why the doctor has rang me and changed it. I should get another appointment from the clinic soon. I reckon they will change my insulin.
 
In theory you have a long life ahead of you but only if you get a suitable insulin regime to cope with those high carb foods you are having.
With a proper basal /bolus approach to insulin then you could be having those foods with perhaps some more healthy additions without having such high blood glucose levels.
You should press your diabetic team for something more beneficial and if they will not then ask for referral to a specialist clinic.
 
Others have talked about basal insulin and said Lantus is not to be used with food.
However, I think it is worth explaining what this means
There are a number of different types of insulin. For now, I will focus on fast and slow acting.
Fast acting lasts for about 4 hours with a peak around 30 to 60 minutes. This works well with converting the sugar from the food we eat into energy.
Slow acting last 12 to 24 hours (some last even longer). Ideally, it has no peak - it gives out body a steady dose of insulin over the life of the dose. This is the basal/background insulin which is used to work with the glucose that is dripped from our liver throughout the day and night.
Lantus is a slow acting insulin. So, taking it with meals will have little effect on the carbs from the food.
Some people find they cope find with only slow acting but it is spaced out evenly throughout the day. If you take it less than12 hi ours apart, you are doubling up your dose for some time and having no insulin at other times of the day (before your lunchtime dose).
So, you may have seen better evening numbers with your old regime because you had twice as much active insulin in your body. However, your morning numbers would be extra high because you had none.

Those of use with Type 1 use both types of insulin. This gives us the background and the flexibility to eat when we want.
 
Kaz84 said:
Mainly because I have low appetite and I don’t eat breakfast so I was put on lantus. I felt it was working well the way I’ve been talking it. The dosage was set by the clinic. I did have a test they said I was still type 2. My last hba1c was 70 that’s why the doctor is changing the dosage.
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With bolus/meal insulin, you don’t have to eat breakfast if you don’t want to. You just omit the bolus if you don’t eat. Lantus is a basal/background insulin and it’s job is to keep your blood sugar ok in the absence of food.

Even if you are Type 2, I think you’d get better control and more flexibility on a basal/bolus regime. As an example, you may just be able to take one dose of Lantus and two doses of bolus insulin. It looks like your Lantus is being used to cover food and that’s not what it’s for. If you were to take enough Lantus to cover your meals, you could go hypo during the night or at other times.

If I were you, I’d push for a bolus insulin. I’d also check what tests they did to diagnose you as Type 2.
 
Kaz84 said:
They have talked about changing the insulin but never have. I think they might see how I go with the new dose and maybe change it. The clinic was meant to do a review a few weeks ago but was cancelled. But had my bloods done for it. That’s why the doctor has rang me and changed it. I should get another appointment from the clinic soon. I reckon they will change my insulin.
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What’s this diabetes clinic you’re talking about? Is it a hospital diabetes clinic with Diabetes Specialist Nurses, or is it just a diabetes ‘expert’ nurse at your GP surgery?
 
Many people regardless of type feel hugely better once they have the correct regime to suit their lifestyle and will be much more positive about their future.
 
Thank you everyone for your advice. Next time they contact me I will ask about a different type of insulin. It should be in 4 weeks time. I think they will change it anyway
 
Inka said:
What’s this diabetes clinic you’re talking about? Is it a hospital diabetes clinic with Diabetes Specialist Nurses, or is it just a diabetes ‘expert’ nurse at your GP surgery?
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It’s just a diabetes clinic with specialists. It’s my doctors who have just changed the dose. But I’m expecting to hear from the clinic soon too. I could email them they are usually really good at getting back to me but thought I’d try the new dose and see how I get on.
 
My levels in the morning, before dinner and before tea are usually pretty good. It’s before bed my levels are high.
 
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