Taking Lantus at 5am Vs Taking Lantus at 7am

[DanGoku28]

Hello,

I need some insight experience from other diabetic Type 1 people to see this is an issue.

So I have been diabetic since October 2022 and I'm 37 years old. So recently my Lantus keeps increasing from the recommendation from the diabetic nurse to the diabetic consultant in one of the hospitals in Kent where I go to.

My Lantus went from 16 to 18 to 20 and now its increased to 22.

I take my diabetes seriously but according to the data on my Freestyle Libre 2 the hospital in Kent are not satisfied with my overall result. My results are 44% which they are concerned of.

So I work nights in my local supermarket job and when I was speaking to the person from the hospital telephone consultation I explained that my blood improves at work. But when I have a day off and I have to switch my body clock around for example I got to bed at 10pm and wake up at 7am, my blood sky rockets to 20mmml/L or even 23mmml/L.

I took my lantus 7am at the same time. Sometimes my blood improves throughout the day and sometimes randomly it decides not to. So I thought what happens if I took my lantus at 5am. I tried this for about 2 weeks and I did notice my blood was getting better. So my blood at 5am would be 19mmm/L, took Lantus at 5am. By 7am it would be 12mmm/L. And throught out the day I took Novorapid for my breakfast at 7am blood improves at 8mmm/L by 12pm and by 1pm I have my Novorapid by lunch. My blood would spike at 4pm by 15 and I have a snack with Novorapid. Dinner at 7pm and so on. At 8pm blood would be 6.

Well the telephone consultation nurse didn't agree with me at all when I took Lantus at 5am because she didn't like the idea of my when my blood would drop from 20 at 5am to 12 at 7am because after 7am I took Novorapid and had my breakfast.

So by listening to her advice today I took my Lantus at 7am and throughout the day my blood has been high as 23 at 7am - 15 by 6pm knowing I have to go to work on my first night and change my body clock around. I did the telephone consultation nurse that I work nights but they just seem to brush it under the carpet and completely just not take my perspective of my working life.

So if I'm wrong taking my Lantus at 5am on my days off please could you guys give me feedback.

 

[Leadinglights]

Hopefully someone will be along to give you some words of wisdom. It is challenging enough for people who work shift or unusual work patterns to adjust for night to days let alone having Type 1.
The timings people use when they have regular hours will likely not work to well for you so your may have to do some experimenting to find the right regime.
It sounds as if your diabetic team are non too helpful.

 

[rebrascora]

Hi.

Firstly I want to congratulate you for taking the initiative and doing some experimenting on yourself. Good diabetes management is all about figuring out what works best for your body and your lifestyle, with the important consideration of keeping yourself safe, particularly from risk of hypos.
Being up in the 20s regularly is not good for your long term health so it is important to find a solution and sometimes changing the time that you take your basal insulin is the answer. My concern in this situation is how disruptive waking at 5am is for you. Are you able to get back to sleep without any problem or are you losing 2 hours sleep? As someone who used to work rotating shifts for a lot of years, I know how important sleep is both to your physical and mental wellbeing but it will also impact your BG levels. That said being in the 20s most of the night will be impacting the quality of your sleep and needs to be dealt with and sometimes the answer is not just to keep increasing the dose, but adjusting when you take it, so I think your adjustment is absolutely relevant and by the sound of it, clearly working. I very much doubt there is any risk of hypo over those 2 hours, which should be the nurse's main concern, especially as Lantus builds to a peak of activity about 5 hours after injection. Obviously if your levels were lower at 5am, then you might be risking a hypo and ultimately you probably need to be addressing why your levels are that high overnight. It may well be that the Lantus is running out at a time when your body would normally be active working a shift, so you are working/burning off the glucose without needing so much insulin on work days, but on your days off, you are sleeping during that period and therefore the lull in Lantus before your next injection is having more impact and levels are rising.
Ultimately, the answer would probably be to have an insulin pump and have different basal profiles for work days and days off, but I think your experiment has shown to be an effective option for now..... IF.... it doesn't cause you too much sleep disruption AND you consider what your levels are before injecting and be prepared to defer the Lantus injection if you wake up at 5am and your levels are say 7 or 8 rather than the usual mid teens or above.

I appreciate that the nurse is probably looking at the fact that your levels are dropping a lot through the night and ideally they would want basal to hold you steady, but for 2 or even 3 hours before you wake up, I don't think it is a valid concern provided that you take your levels into consideration at 5am before you inject.

Ultimately, it is your diabetes and you manage it in the best way possible for you with the tools that you have. If you were hypoing or getting close to hypoing, then I would say her concerns are valid, but not when levels have still not quite come down into range when you wake up.

Out of curiosity, what is your BG like at bedtime and do you usually have a meal right before you go to bed? I know I used to do that simply because that was the only time I could fit a meal in. Not ideal but that is life. Another option might be to adjust your meal ratio for that meal (if you have one) but to my mind that is far more risky that injecting your basal a couple of hours earlier in the morning.

 

[everydayupsanddowns]

So I thought what happens if I took my lantus at 5am. I tried this for about 2 weeks and I did notice my blood was getting better. So my blood at 5am would be 19mmm/L, took Lantus at 5am. By 7am it would be 12mmm/L. And throught out the day I took Novorapid for my breakfast at 7am blood improves at 8mmm/L by 12pm and by 1pm I have my Novorapid by lunch. My blood would spike at 4pm by 15 and I have a snack with Novorapid. Dinner at 7pm and so on. At 8pm blood would be 6.

Welcome to the forum @DanGoku28

Sorry to hear you are having a bit of a runaround with your Lantus timings, and your shift patterns.

No one here is qualified to give you and medical advice, we can only share our own experiences, and the sorts of things we have found over the years through our own experimentation - good to hear you are chatting this through with your nurse too.

How repeatable was the sort of pattern you describe? Are you often in double figures through much of the night?

Lantus isn’t really meant to drop your BG levels like that. It is supposed to be trickling away in the background, and just mopping up glucose released by the liver 24/7 rather than dealing with food, or actively reducing your BG levels. Additionally it takes about an hour to get going - so personally I’d not be expecting very much difference with a 24hour insulin taken a couple of hours different one day to another.

This makes me wonder whether Something Else might be happening. Were you staying up after your 5am start? Or were you dozing for the couple of hours?

It’s an unusual one for sure!

 

[SimonP]

Welcome too 🙂

I couldn't work out whether you're also taking a correction dose of bolus to bring those high BG levels down? As @everydayupsanddowns says the bolus is to keep your BG flat in the absence of food rather than to correct high BG levels.

My second thought that is perhaps you could look to split your basal dose such that it fits in roughly with your shift patterns, and you can then twiddle each individual dose so that you have more coverage when you're not working.

I find going to work also drops my BG vs WFH or putting my feet up at the weekend, I try to deal with this by doing some exercise, but a potential alternative would be to take more basal for those days when I'm not doing so much.

 

[Inka]

I too was unsure if you took a correction dose of fast-acting insulin when you woke up @DanGoku28 ? I’ve never worked nights regularly but I have worked the odd night. Because working one night is unusual for my body, I find I go high and need substantially more insulin than usual. I believe this is my body putting out stress hormones because of the unusual situation. For you, it seems to be the opposite way around: your body thinks it’s normal to sleep during the day so you getting up in the morning could be causing the rise.

The obvious answer is a pump because then you can have different basal patterns for work and non-work days/nights. You could also consider trying a twice daily basal, which would give you more flexibility.