Lantus

[chezpez]

I've mentioned before about having mild hypos through the night it's always around 3am4am even when ive gone to bed at a level 9 or 10 Unless a eat a snack before bed I usually drop into 3's.
Takes too long to get advice from DN , even though I've asked in the past, and said I would have to accept to go to bed on a higher sugar level! .
I've split lantus in the past one at 6am and 10pm.
I'm thinking of having majority of lantus in the day and a few units for night. Can you spilt it 12 hours apart. I.E 6-7am then 6-7pm . As in therory the daytime one should run out by 2am - 3am, at 20 hours
I'm I making it too complicated, any advice?.
Thanks

 

[Cheyne]

It was recomended I take a look at the lantus timeline graph to pin point when to inject the insulin. I moved from after evening meal time to after lunch and it has given me more stable results. I still get sudden hyper spikes which we don't know why, but after being refused rapid acting insulin there is not a lot I can do. I suspect my hypers are from the autonomic polyneuropathy I dealing with.

 

[chezpez]

It was recomended I take a look at the lantus timeline graph to pin point when to inject the insulin. I moved from after evening meal time to after lunch and it has given me more stable results. I still get sudden hyper spikes which we don't know why, but after being refused rapid acting insulin there is not a lot I can do. I suspect my hypers are from the autonomic polyneuropathy I dealing with.

Thanks, funnily enough I've been thinking about moving to lunchtime. I've not done that time before, I was wondering why they suggest only morning and bedtime?

 

[rebrascora]

I think morning or bedtime is to enable there to be sufficient insulin to deal with Dawn Phenomenon or Foot on the Floor because the liver probably releases more glucose at this period of the day than at any other time and of course your Lantus is there to deal with the glucose released from the liver. Taking it at lunchtime is probably least likely to provide good cover in the morning. That said we are all different and I always encourage people to experiment for themselves to see what works for their body. Some of us also supplement our basal with a bi of fast acting insulin in the morning as soon as we wake up to tackle Foot on the Floor. For me, 1.5-2 units of FIasp is needed on top of my breakfast bolus to deal with it. I am however lucky that I don't get DP, just FOTF so I can use my fast acting to deal with it. If your liver starts pumping out glucose at 3am every morning then it would be a pain waking up and having to jab bolus insulin to tackle it or having high readings every morning if you didn't, so adjusting your basal to give you maximum activity at the times that you need it is important.

As regards splitting doses, I use Levemir and I need lots in the morning (currently 24units) before I get out of bed and just 2 or 3 units at bedtime. During the depths of winter I find I have to bring the evening dose forwards to about 7pm otherwise my levels climb towards bedtime and I need a correction when I get into bed as well as my bedtime Levemir, and it isn't ideal going to sleep with active Fiasp in my system.

 

[Austin Mini]

I inject Lantus just before bed around 10pm. I do my test and add 4 to the test result ie if my test is a 9 I add 4 and inject 13 units of Lantus. I have never had a nighttime Hypo with Lantus and when I test around 7am the following day my readings is usually a 6 or 7.
I have been doing this for over ten years and it suits me just fine but for you you will have to try and see what happens. Good luck

Moderator note: This member clarifies his personal approach here https://forum.diabetes.org.uk/boards/threads/lantus.112450/#post-1355498

 

[helli]

I always assumed the suggestion to take it at night or in the morning was just to find a consistent time of day and an activity (going to bed, eating evening meal, eating breakfast) as a reminder to add Lantus injection to your daily routine.

Lantus can be split 12 hours apart - this will not mean that each dose lasts 12 hours. It will still last the same length of time of about 20 hours for each dose so there will be an overlap. But you do not have to take the same dose morning and night. If your basal needs are less during the night, you can take a smaller dose in the evening.
Levemir is a little more flexible because it lasts about 12 hours for most people.

 

[rebrascora]

@Austin Mini That is an interesting approach. Was it something you were advised to do or worked it out for yourself? I do something a bit similar if I wake up high in the morning but with my bolus insulin Fiasp. If I wake up on 8 I inject 8 units of Fiasp. If I wake up on 13, I inject 13 units. 2 units of that is to deal with FOTF, 4 units is to deal with my breakfast and the remainder is correction. The higher above 10 I am the bigger correction I need because Fiasp gets a bit wimpish when it is faced with a BG mountain to climb, so I have to get progressively heavier handed with it.

I definitely would not recommend such an approach to anyone else though. Insulin works in different ways for different people, so your or my approach might cause a massive hypo for another person.

 

[Austin Mini]

@Austin Mini That is an interesting approach. Was it something you were advised to do or worked it out for yourself? I do something a bit similar if I wake up high in the morning but with my bolus insulin Fiasp. If I wake up on 8 I inject 8 units of Fiasp. If I wake up on 13, I inject 13 units. 2 units of that is to deal with FOTF, 4 units is to deal with my breakfast and the remainder is correction. The higher above 10 I am the bigger correction I need because Fiasp gets a bit wimpish when it is faced with a BG mountain to climb, so I have to get progressively heavier handed with it.

I definitely would not recommend such an approach to anyone else though. Insulin works in different ways for different people, so your or my approach might cause a massive hypo for another person.

I was prescribed (at my request) Lantus just before we went to New Zealand on holiday in 2014. I worked it out for myself and have yet to have a nighttime Hypo in ten years. By the way, Lantus and me get on very well it’s such a good insulin.

 

[rebrascora]

I always assumed the suggestion to take it at night or in the morning was just to find a consistent time of day and an activity (going to bed, eating evening meal, eating breakfast) as a reminder to add Lantus injection to your daily routine.

Lantus can be split 12 hours apart - this will not mean that each dose lasts 12 hours. It will still last the same length of time of about 20 hours for each dose so there will be an overlap. But you do not have to take the same dose morning and night. If your basal needs are less during the night, you can take a smaller dose in the evening.
Levemir is a little more flexible because it lasts about 12 hours for most people.

Actually, Levemir acts over about 16-20 hours for most people if the 3D profile of activity is anything to go by. Only those on really small doses will find it only lasts 12-16hours. It does significantly tail off though for the last few hours.

 

[Lucyr]

I inject Lantus just before bed around 10pm. I do my test and add 4 to the test result ie if my test is a 9 I add 4 and inject 13 units of Lantus. I have never had a nighttime Hypo with Lantus and when I test around 7am the following day my readings is usually a 6 or 7.
I have been doing this for over ten years and it suits me just fine but for you you will have to try and see what happens. Good luck

Your posts over this forum today are shocking, I’m pretty concerned that you don’t understand how basal insulin works, and you don’t know how to treat hypos safely. It’s such a dangerous combination. You really need to brush up on basics before you cause yourself serious harm.

 

[Austin Mini]

Your posts over this forum today are shocking, I’m pretty concerned that you don’t understand how basal insulin works, and you don’t know how to treat hypos safely. It’s such a dangerous combination. You really need to brush up on basics before you cause yourself serious harm.

Thank you, I have lived with type 1 since 1987 my diabetic specialist says she wishes everyone with type 1 was like me. Are you a diabetic specialist Lucyr?
Ps I very very rarely get a hypo

 

[Lucyr]

Thank you, I have lived with type 1 since 1987 my diabetic specialist says she wishes everyone with type 1 was like me. Are you a diabetic specialist Lucyr?
Ps I very very rarely get a hypo

You don’t need to be a diabetic specialist to know that Lantus isn’t used to correct high blood sugars. It’s one of the first things you learn. You should consider doing a diabetes course such as the online Bertie course or the Dafne course. Honestly, I’m just concerned you’re going to accidentally kill yourself by correcting a high bg with Lantus.

 

[Inka]

I inject Lantus just before bed around 10pm. I do my test and add 4 to the test result ie if my test is a 9 I add 4 and inject 13 units of Lantus. I have never had a nighttime Hypo with Lantus and when I test around 7am the following day my readings is usually a 6 or 7.
I have been doing this for over ten years and it suits me just fine but for you you will have to try and see what happens. Good luck

Why do you add 4 @Austin Mini ? It seems a precise figure, so I wondered where you got the 4 from?

If, say, your bedtime blood sugar was 14, you’d add 4 so inject 18 units of Lantus; if your bedtime blood sugar was 5, you’d add 4 and inject 9 units of Lantus, right - so half the dose you’d have for a blood sugar of 14. So, some of your 18 units of Lantus are correcting your high blood sugar. I’m wondering why you don’t use your fast-acting insulin to do the correction? Fast-acting is faster and also more predictable in its release, and its duration of action is shorter.

 

[Cheyne]

Thanks, funnily enough I've been thinking about moving to lunchtime. I've not done that time before, I was wondering why they suggest only morning and bedtime?

Hi,
I switched to after lunch for the full injection on the bases that 4 hours after injection is the strongest response Lantus has. Then it drops as quick, slightly, and holds until a smaller high just before ending, 24 hours later.
By injecting at 1pm each day I'm ready for the unusually high spike in Bg I get after evening meal which is less than 50 carbs and no measurable sugars. Fortunately I don't get hypo's, only hyper's. Don't experience the morning drop and never did. So far working out well for me. I neither know or care what my diabetic team thinks. Decided to go it alone after they refused to give me fast acting insulin to curb the 19 point highs I have been getting after looking at food. I've been able to control them to around 12's which can't be bad by using the lantus response to counter the highs I get. Most of the day I'm in the high 5's to 9 range.
Cheers

 

[chezpez]

Thanks for all your help , I think I will start with lantus lunchtime injection. See if helps

 

[Austin Mini]

Why do you add 4 @Austin Mini ? It seems a precise figure, so I wondered where you got the 4 from?

If, say, your bedtime blood sugar was 14, you’d add 4 so inject 18 units of Lantus; if your bedtime blood sugar was 5, you’d add 4 and inject 9 units of Lantus, right - so half the dose you’d have for a blood sugar of 14. So, some of your 18 units of Lantus are correcting your high blood sugar. I’m wondering why you don’t use your fast-acting insulin to do the correction? Fast-acting is faster and also more predictable in its release, and its duration of action is shorter.

I regard a test of 6 being the normal hence add 4 to the 6 and I inject 10 units of Lantus.
With a reading of 14 (very rare) I would inject 2 units of Humalog and 10 units of Lantus.
This has worked very well for years and it suits me just fine, however it may not suit yourselves.
My normal before bed readings are between a 6 and a 10 If I had a 14 I should have put 2 Humalog (to bring me back to 6 then 10 Lantus. I’m sorry for the confusion.

 

[Kol]

I've mentioned before about having mild hypos through the night it's always around 3am4am even when ive gone to bed at a level 9 or 10 Unless a eat a snack before bed I usually drop into 3's.
Takes too long to get advice from DN , even though I've asked in the past, and said I would have to accept to go to bed on a higher sugar level! .
I've split lantus in the past one at 6am and 10pm.
I'm thinking of having majority of lantus in the day and a few units for night. Can you spilt it 12 hours apart. I.E 6-7am then 6-7pm . As in therory the daytime one should run out by 2am - 3am, at 20 hours
I'm I making it too complicated, any advice?.
Thanks

I split mine breakfast / dinner with no problems, more flexible than just one injection per day.
If you drop too low overnight slowly reduce evening dose until you don’t 🙂

 

[everydayupsanddowns]

I regard a test of 6 being the normal hence add 4 to the 6 and I inject 10 units of Lantus.
With a reading of 14 (very rare) I would inject 2 units of Humalog and 10 units of Lantus.
This has worked very well for years and it suits me just fine, however it may not suit yourselves.
My normal before bed readings are between a 6 and a 10 If I had a 14 I should have put 2 Humalog (to bring me back to 6 then 10 Lantus. I’m sorry for the confusion.

Ah OK, I too was a little surprised at your description of your “adding 4” and seeming to use Lantus to correct high bedtime levels (with that increased dose then working overtime throughout the next 20-24 hours long after the high BG had come down, but it looks like your system is a lot more nuanced and subtle than it first appeared.

Glad you have found a system that works for you, and gives you such great results 🙂

 

[everydayupsanddowns]

Thanks for all your help , I think I will start with lantus lunchtime injection. See if helps

Ah Lantus! The Marmite of insulins. As you can see it suits some people really well, while others find the little bump in activity at 4-5 hours after injection something of a challenge overnight.

I had years of intermittent nighttime hypos that in retrospect I can see were made much more likely by my injecting Lantus at bedtime. I tries splitting it, but that didn’t work in my case. My ‘best fit’ was simply to switch to taking it at breakfast time.

Hope the switch to lunchtime lantus works well for you @chezpez

 

[helli]

My ‘best fit’ was simply to switch to taking it at breakfast time.

Yep, Lantus definitely is a marmite insulin.
I took it from day 1 on MDI until I got a pump.
My biggest issue with it was that it did not last the full 24 hours.
Like you, I tried splitting it but never got the right ratio.
A morning dose did not work for me because it was running out at about the same time as my DP kicked in.
In the end I chose to take it with my evening meal. This is always at least 4 hours before I go to bed so I was alert for that 4/5 hour kick and I could "fill in" the 2 hours when Lantus run out with fast acting insulin.