Lantus

[Janet]

Hello

I hav'nt posted for some time but read regularly with interest. My son has been on Lantus since August 2010. He has his injection in the evening. We were told that this will give him a level read for 24hrs. (Bolus before meals.)

To be honest I am not that impressed. He could either be really low during the night and need checking several times then high during the day then the next 24hrs it's the opposite, high at night low during the day.

We started carb counting when he was on Insulatard twice a day to prepare and seemed to be doing OK. What I dont understand is we are doing the same carb counting with the same meals and measures.

We wondered should we try giving him his Lantus in the morning?

Also we were told not to Bolus at morning snack but my son is always quite high at lunchtime.

I would be interested in your thoughts.

Thanks Janet

 

[Robster65]

Hi Janet. I can only give you an adult's perspective on Lantus, but it should be very similar.

I've been on Lantus for many years but recently split my dose on the DSN's advice. I inject slightly more in the morning than I do at teatime and it keeps me fairly stable for the 24hrs. It is designed as a 24hr insulin but rarely acheives this. It can be as short as 12 hours effective time in some people I believe.

Also, if he is high before lunch, have you tried cutting out the mid-morning snack or at least reducing it ? I remember having snacks when I was on twice a day injections but dropped them once I swapped to MDI.

It may be worth discussing with your DSN/consultant about the snacks and also about splitting the lantus dose or maybe swapping to levemir.

Rob

 

[Janet]

Thanks Rob

I think the Lantus split may be a good idea I will ask our specialist at our next appointment. We were never told that it sometimes is only effective for a 12hr period. At what times do you take your injections?

Not sure am able to convince my 10yr old not to have a morning snack though. I'ts boring enough to have to have fruit or a sugar free biscuit when your friends have chocolate. I try to stick to 10g!

 

[MeanMom]

My daughter is on MDI and always has a mid morning snack of 15 carbs or less which she does not inject for (we have been told not to). She is quite often high(ish) at lunch time but it it a question of balance imo. K has her breakfast at 6.45 - lunch at school is 12.30. I challenge any person to manage that long without eating - even with a big breakfast of slow acting carbs. In an ideal world perhaps they should inject for the snack a unit or two. But they also need to have a social life and interact with their friends. If you have to go test and inject during your 15 min break it doesn't leave much time for your friends!

By the way K is on Levimir, not Lantus - it doesnt seem to last any longer but in my experience there are less night time lows. Just a thought. We dont split the dose yet as the lunch time 'high' is the only real problem we are having (touches large plank of wood) but I think that day may not be far off.

 

[Robster65]

I inject before breakfast at same time as the humalog and again at teatime with the humalog. I use thighs and buttocks for the lantus and arms and abdomen for humalog. I think the average duration cited is something like 18 hours but there is a considerable tail-off period, especially with smaller doses, so it does vary a lot. Some get away with the full 24 hours.

I agree with both of you that quality of life is a big factor in diabetes. The compromise has to be found for each individual and it is hard for younger children. I was diagnosed at 13 and was on 2 jabs a day until I was in my late 20s (I think). I used to have a mini mars bar at mid-morning at school. Maybe not ideal but it was nice and I'm still alive with all faculties (just).

I know when I have an early start and eat at maybe 7am, that lunchtime seems a long time coming. If you can work out a way to maybe up the lantus/levemir to cover the snack without any hypos later on, maybe it will cure the highs. Best of luck. 🙂

Rob

 

[Adrienne]

Hiya

My daughter was on Lantus and NR when she was about 4 when it first came out until about nearly 7 when she started pumping. She was put on Lantus at night first. Well that lasted 3 days. We had the same pattern as you Janet, hypo all night, high all day. So we swapped to the morning and left it at that.

Lantus tends to work for about 16 to 22 hours (22 if you are very lucky) and levemir tends to work for about 14 to 18 hours (18 if very lucky). Most people (talking about kids here) end up having to split the levemir but not many split the Lantus although there are a few (including a few adults on here as well). Generally though the Lantus seems ok.

We used to give the Lantus at about 8 am when having NR for breakfast to start with but then used to give it when she woke up a bit earlier than the NR.

You can never get it totally right with Lantus. In basic terms when you inject it, it stays in a little pool where it is (probably not quite like that but easier to explain) and it slow releases a bit throughout the day. However there are lots of variables and it may release a bit quicker one day than the next or slower or even in bigger bits or lesser bits. There are small peaks and troughs, it is not as flat as it was presumed it would be.

So my thoughts are to swap to the morning first before spliting. See if that works. You may find out that levels will be too high in the morning so may need to split it eventually.

Re mid morning snack. The new thinking these days is that no mid meal snacks are actually needed on MDI. However some people (talking about children here again) find they do need a mid morning snack as if they don't they will be hypo by lunch time. My daughter did need about 15 carbs at snack time or by 12 she would be in the 2's even if she was spiking at mid morning. However some find they do not need a snack at all.

I think you firstly need to find out if a snack is needed and at what levels, ie all levels or just say under 15.0 or something. You can then do a deal. If your son still wants a carby snack and he is over your limit, he has to choose. If he has a snack he has to have an injection to cover it or he has a protein only based snack which could well alter his levels a bit but not to the extent of the carb so ie pepperami, cheese string, hard boiled egg etc etc.

It is all about choice and making those decision.

I hope you get this sorted out.

🙂