Night hypo on one unit of lantus

[Northerner]

The other night I was 5.0 before bed, so I took my one unit of lantus and went to bed. I know this may seem rash to a lot of you, but really my levels are so stable overnight and have been for months, if not years, so as long as my novorapid has completely expired then I wouldn't expect to drop any lower.

However, that night I woke up at around 1 am - well, I say 'woke up' but I hadn't really been sleeping, just dozing - and felt I needed the loo. I was sweating but didn't feel any other symptoms, but when I got back to bed I thought I may as well test - I was 3.0! 😱 The novorapid was well expired by now - at least 8 hours since injecting - so that single unit of lantus must have been the culprit! There's nowhere I can go from there, except to cut out the lantus altogether, which I admit I'm tempted to try and see what happens. I have a consultant's appointment coming up in a month or so, so will ask him about it.

Last night I was 4.1 before bed so I had a Belvita biscuit and my lantus. No dramas, and I woke at 5.5. Sorely tempted to give the lantus a miss tonight!

 

[novorapidboi26]

I say go for it, if you feel you need that 1 unit in the morning you could always inject then............

Its amazing that just 1 unit has an effect on you, really is..........😱

 

[Robster65]

Unlikely you'll go badly hyper, so as NR says, give it a try and see what happens.

I've had some strange effects in recent months, due to extra activity now and then, but totally out of proportion to the expected adjustments.

It's times like this a pump seems more attractive. 🙄

Rob

 

[Northerner]

I say go for it, if you feel you need that 1 unit in the morning you could always inject then............

Its amazing that just 1 unit has an effect on you, really is..........😱

The only difficulty with that is that I would end up with an overlapping dose, since it can't be split, so I would effectively be left with something like 35% extra lantus after injecting my bedtime dose 😱 And as you say, if one unit does have an effect, then that increase might not be a good idea! Oh for a half-unit lantus pen! 🙄

As you say Rob, I doubt if I would go seriously hyper, my own pancreas just has to be trickling something out!

 

[lucy123]

Sorry I don't understand any of it Alan - but I do want to wish you all the best in getting things sorted.

Terrific in managing the run this morning as well. Normally when I go hypo I tend to feel sorry for myself for a while afterwards.

Hope you get things sorted.🙂

 

[novorapidboi26]

Is there any chance your liver could be releasing its glucose quicker than the average man and therefore being catered for by the quicker insulin..........?

Just a wild thought really.......😱

 

[everydayupsanddowns]

The only difficulty with that is that I would end up with an overlapping dose, since it can't be split, so I would effectively be left with something like 35% extra lantus after injecting my bedtime dose 😱 And as you say, if one unit does have an effect, then that increase might not be a good idea! Oh for a half-unit lantus pen! 🙄

As you say Rob, I doubt if I would go seriously hyper, my own pancreas just has to be trickling something out!

I suppose as a first step you could move your 1u of Lantus to breakfast time. That way it would be on the 'fade' part of its cycle in the early hours rather than its mini-peak coinciding with the likely drop-off of cortisol/adrenaline overnight?

Some folks who start on pumps (and I was one) find levels alter after about a week and it has been suggested to me that this might be a sort of 'residual' Lantus effect. Not something that obeys the usual dose profile but more connnected with the general 'three days to settle' behaviour that many people observe.

 

[MeanMom]

Alan - that's a real pain in the bum!

Can't remember if you've tried Levemir or not? We find K often needs to vary her basal by a unit up or down at the moment (hormones🙄) and with the change having an 'immediate'(same night) effect with Levemir we have more flexibility.

Otherwise you really need a half unit pen - are they not available on Lantus or do they just not give you one? Can you get yourself one?

More questions than answers I'm afraid, but sending you empathy vibes from K - she's been hypo quite a few nights lately<props eyelids up with matchsticks>

 

[everydayupsanddowns]

Meanmon - nope there are just *no* half unit pens at all for Lantus (guess the real money is in T2 insulin use with typically larger doses).

The only option would be a half-unit syringe, which is hardly ideal 🙄

 

[Northerner]

Thanks MM, I'm afraid Mike is correct - no half unit lantus pen exists I don't really want to change insulins when I'm only on one unit anyway. I'm actually wondering if the 'residual effect' of a lantus dose (which certainly does exist) might mean I only need to inject my one unit every other day?

It's interesting that I still need a relatively large amount of novorapid - currently between 20-25 units a day - so I'm not like a lot of people who just need tiny doses of insulin per se, I just don't need much basal (if any!)

I hope K's levels settle soon 🙂

 

[Robster65]

Meanmon - nope there are just *no* half unit pens at all for Lantus (guess the real money is in T2 insulin use with typically larger doses).

The only option would be a half-unit syringe, which is hardly ideal 🙄

The half unit syringe idea would be useful as an experiment though. Nowt wrong with a syringe. Just a bit more of a faff at bedtime.

And I like the idea of the liver thing. That could explain things. If the liver was varying its output, it would indeed have the same end result.

Alan, over to you !! 🙂

Rob

 

[Robster65]

Thanks MM, I'm afraid Mike is correct - no half unit lantus pen exists I don't really want to change insulins when I'm only on one unit anyway. I'm actually wondering if the 'residual effect' of a lantus dose (which certainly does exist) might mean I only need to inject my one unit every other day?

It's interesting that I still need a relatively large amount of novorapid - currently between 20-25 units a day - so I'm not like a lot of people who just need tiny doses of insulin per se, I just don't need much basal (if any!)

I hope K's levels settle soon 🙂

Have you tried adjusting your NR down and your lantus up (I'm sure you have but I had to ask)?

I was on a very different ratio of humalog to lantus before the DSN got me to readjust. And I was very sceptical. But it did work.

Rob

 

[Northerner]

Have you tried adjusting your NR down and your lantus up (I'm sure you have but I had to ask)?

I was on a very different ratio of humalog to lantus before the DSN got me to readjust. And I was very sceptical. But it did work.

Rob

I'd definitely be hypoing through the night, as upping the lantus would currently mean a 100% increase in dose. My ratios change a great deal as the day progresses - I can be having the same NR for a big meal and pudding in the evening as for a single slice of Burgen in the morning. 😱 Also, my fasting periods between meals (which are often more than 6 hours apart) will usually show fairly low, occasionally hypo, levels, so an increase in lantus would probably make this more likely.

Think I'll see what sort of level I'm at before bed before making a decision...watch this space! 🙂

 

[Flutterby]

Like Rob, I had to make the same changes recently - I've increased my morning Levemir from 8 to 12 which is a huge jump for me and reduced my humalog. Totally sceptical but tried it as a last resort and it worked! Not saying it would for you Northy but just in agreement with Rob that strange things do happen!

 

[Robster65]

I was hypoing about 2-3am and we put down to humalog lagging. Not sure how but it did seem to coincide with larger humalog doses at evening meal (which was about 5.30pm).

When I dropped the humalog ratios and upped the lantus, it all seemed to settle into a better pattern. As Flutterby said, it might be very different for you as a late onset and with your running but the lantus dose vs. effect does seem to raise a lot of questions unless you are producing random squirts of insulin still (which I know you've suspected for a long time).🙂

Rob

 

[trophywench]

How exceptionally weird ! - but - how interesting ! LOL

Have you had a C-peptide test recently? And/or could you borrow a CGM?

I go along with 'risking' your Lantus in a morning, instead of at night (not both LOL) and/or a change to Levemir cos it just is so much more immediate. Plus you can use Lev cartridges, in a Novopen whatever they are that gives half units, pen.

 

[Northerner]

How exceptionally weird ! - but - how interesting ! LOL

Have you had a C-peptide test recently? And/or could you borrow a CGM?

I go along with 'risking' your Lantus in a morning, instead of at night (not both LOL) and/or a change to Levemir cos it just is so much more immediate. Plus you can use Lev cartridges, in a Novopen whatever they are that gives half units, pen.

They won't pay for a test because they say there's no clinical requirement as my control is excellent - but I would like to know, perhaps I can persuade my consultant in the interests of expanding the collective knowledge about weird diabetics?

I suppose I'm a bit reluctant to change because lantus injections before bed is all I've ever known and it does seem to work very well. The night hypo was a very rare occurrence - can't actually remember the last time I had one - so I might just 'forget' to inject tonight and see what happens. If I'm above 7 in the morning I'll know it was a bad idea! 😱

 

[HelenM]

Did you do any running that morning... Sunday Long run? I normally have post exercise lows about 5 hours later but it occasionally it seems to happen many hours after.
That dose though is tiny,you couldn't have got that low with the older lantus pens.
I don't know if I've mentioned this graph of the progression of LADA on here before.
It suggests that the loss of beta cell mass is more like a downhill roller coaster rather than a slide. It is only a model as no-one really knows but it rang a lot of bells with me. ... http://care.diabetesjournals.org/content/24/8/1460/F1.expansion.html

Looking at it now it may be that the of the progression of T1 given there is wrong According to some recent research that would be an intial decline followed by a flattening out with some cells remaining in many people.

 

[Medusa]

i was thinking running too.... sometimes i have a hypo seemingly for no reason but turns out to be a while after exercise due to muscle still burning energy for a while after stopping running

 

[Northerner]

Did you do any running that morning... Sunday Long run? I normally have post exercise lows about 5 hours later but it occasionally it seems to happen many hours after.
That dose though is tiny,you couldn't have got that low with the older lantus pens.
I don't know if I've mentioned this graph of the progression of LADA on here before.
It suggests that the loss of beta cell mass is more like a downhill roller coaster rather than a slide. It is only a model as no-one really knows but it rang a lot of bells with me. ... http://care.diabetesjournals.org/content/24/8/1460/F1.expansion.html

Looking at it now it may be that the of the progression of T1 given there is wrong According to some recent research that would be an intial decline followed by a flattening out with some cells remaining in many people.

I don't think it was related to running, although obviously you can never rule anything out - I didn't experience anything like this when training for the Bath Half earlier in the year and I've been running for years now with diabetes and can predict the effects fairly accurately usually.

My guess is that my life with diabetes has gone like this:

Rot begins summer, 2006, begin losing weight for no apparent reason
Over next two years, feeling lethargic, drinking gallons of milk, beer and cider (not in the same glass! 😉)
Catch stomach virus, ailing pancreas can't cope, end up in hospital and diagnosed, summer 2008.
Supported by insulin, gradually recover, pancreas and beta cell function also recover to some degree.
Summer 2009, lantus has dropped from 20 to 10 units.
Summer 2011, lantus now around 4 units
Autumn 2011, lantus now 1 unit

It would seem that my pancreas is producing practically all the insulin I need to cover the action of my liver. How long will this go on, who knows? Will it get even better? Who knows!

I suspect that if I hadn't caught the virus, but had gone to the GP about the other symptoms I would have been diagnosed Type 2, or maybe LADA if they knew about it, and possibly have gone down the oral meds route until my pancreas totally gave out. Just my speculation, of course!