The Lantus Saga part 500

[KookyCat]

I'm getting a better grip of what the Lantus or my body is up to, so I wanted to know if this mirrors anyone else's experience or if I'm actually going slightly insane now 🙄

As far as I can tell I am having six hourly peaks in Lantus activity. I've identified this by playing with the timing of the injection. This happened accidentally really because the reduced dose of Lantus the consultant recommended had me going too high in the morning because it was clearly running out. When I was injecting at 7:30am I knew I was having some peak activity of some sort at 7:30pm because any physical activity made me hypo and I struggled to get my blood sugar to stay stable, and another peak at 1:30am which was my special hypo time. In order to counteract the pre breakfast peak on the much reduced dose I started injecting at 5:30am. This resulted in much lower readings which is good but a slight hypo before lunch at around 11:30am and then much much higher readings at the two hour post lunch point, but a dive into the fours at 5:30pm so I can't correct the lunchtime peak by adjusting the ratio because that makes the 5:30pm slot a hypo rather than a low four. My special hypo time is now 11:30pm it seems so if I'm having one that's when it happens. I have deduced that previously I was having a Lantus peak at around 1:30pm which was helping keep the post lunch reading down. It's like clockwork every six hours, it's quite freaky. So have I lost my sanity? Could it actually be peaking every six hours...it's like Groundhog Day 😱

 

[Pumper_Sue]

There's probably no peeks or troughs in the lantus at all.
It's your own basal needs that lantus can not match. So shout for a pump 🙂
Just as an example for you my basal needs from 7 PM until midnight are 0.025 of a unit yet at 10 AM until midday I need 2.35 units.

 

[KookyCat]

I do wonder if it's this bag of bones that just has weird patterns, but it's so hard to tell, I know I need practically no insulin in the evening that one is obvious, I think I get dawn phenomena at about midday to 3pm 🙄 I'm keeping at the pump issue, but it's a bit like head, have you met Brick wall? Oh you have, well a second and third introduction won't do any harm 🙂

 

[Bloden]

There's probably no peeks or troughs in the lantus at all.

That's a really interesting comment Sue. I hadn't thought of that.

I'm having fun and games with my Lantus too. 🙄 I did my first ever daytime basal test today (no lunch, etc.) and found that my BGs stayed pretty steady, so the dose is OK. BUT the past few weeks I have had 1 or 2 hypos a night. Last night I overdid my snack so I could have a full night's sleep! At bedtime my BG was 13.7 and this morning's fasting BG was 5.5.

I'm trying to work out a better time to inject it! (10pm at the mo). That reminds me - must read your Basal Basal Basal thread in more depth.

Sorry I can't offer any advice Kookycat. I'm just starting over after 4 years off the rails, and everything's new. 🙂

 

[Robin]

I found Sues comment thought provoking as well. is it the Lantus or is it the body? I used to take mine at bedtime, and often hypoed at 2am. I'm sure there is a documented peak in Lantus activity after four or five hours. I now take it at 6pm, so it peaks before bed, and brings down my evening readings. I still need an extra Bolus unit at teatime,though, to allow for the Lantus getting off to a slow start. I also find it runs out about an hour before 6pm, sometimes, but not consistently. But this may be because I tend to me more active gardening or something in the afternoons ,so this could help keep the Bgs down. I know when I first started on Lantus, I took it at breakfast, and had a problem with dawn phenomenon, til I Worked out it wasn't that, but was the Lantus running out before breakfast. I still get a rise as soon as I get out of bed, but I can deal with this by eating breakfast and bolusing a bit extra. I find I have to work out the best compromise I can with the Lantus, Kooky Cat, it sounds like your body and the Lantus are determined to slug it out over 15 rounds.

 

[Bloden]

My body's similar to yours Robin - I can't take Lantus before midday because it doesn't cover my dawn phenomenon. So I've been thinking about taking it around 6pm, but I'd have to inject at work, and I'd probably forget! Thanks for the info...more cud for this cow to chew!🙄

 

[Amberzak]

I agree with Sue. I'm on levemir and constantly have problems. Consultant said right away 'the problem with multiple injections is that the basal insulin is a constant, but the body rarely needs a constant.

 

[Northerner]

I can't really add anything, since I abandoned The Stinging One three years ago, but when I was on it I definitely used to get a peak after about 3 hours. My story with lantus, though, was just constantly reducing it until I couldn't reduce it any more - I wish more people could do that!

Sue makes an excellent point about it not really being the lantus, but the body's own cycle of liver glucose release and insulin sensitivity, which is very individual and impossible to fine-tune on a once- or twice-a-day basal: you might get somewhere near if you are lucky, and you can adjust your bolus doses to compensate when necessary, but it really is a sledgehammer to crack a nut, unfortunately.

 

[Robin]

I keep telling myself that if I'm doing the best job with the tools provided, I can't expect anything more, and I shouldn't get stressed about odd readings. But I like to be in control, and it doesn't stop me banging my head on the wall when It all goes horribly wrong. Take last night, I discovered I was 15.2 before bed. How could I possibly have miscalculated my Bolus to that extent? I weighed the rice, Oh yes, I had a couple of extra crackers with my cheese, oh wait, I had a piece of milk chocolate....and another bit because the packet was nearly finished ( and this was my husband's chocolate, I usually stick to 90% dark). So it was all my fault! How could I have been so stupid! (Fortunately my maths is better than my willpower and a correction of two and a half units brought me out at 5.4 this morning.) But then again, last week, I went to bed on a reading of 8.2, no short acting left on board, what I'd usually do if I've had a glass of wine, and woke up to a 2.3 at 2am. And that was in no way due to Pilot Error. I guess I'll keep on with the Body versus Insulin battle til they find a cure (10years, is it? ha ha)

 

[Robin]

Sorry, that last post did turn into a bit of a whinge. What I'm trying to say I suppose, is that for some of us, coping with our insulin is a bit like wrestling an octopus, just when you think you've got all the tentacles under control....

 

[KookyCat]

Well folks ive wrestled this octopus as much as I can with logic and sheer bloody mindedness, so if it takes another turn its on its own . I just wish the difference in requirement wasn't quite so ridiculous, my lunch ratio is 1:15 and should really be more like 1:13 to avoid that peakiness after lunch, but my evening ratio is 1:40 and even that doesn't give me a peak 😱 that's one heck of a leap, and very annoying because I don't want to eat carbs in the evening (never have), carbs seem very alluring at lunch time though, clearly ive got bad karma 🙄

I can't take the basal at night because that's a complete disaster all round but the crack of dawn is a stretch even for me, but hey it seems to work. Last night I went to bed at 5.3 woke to a 5.4 so it's stable, when they say you should go to bed on a 7 I laugh, coz seriously if you can get my blood sugar up there at night I'll give you a medal. At lunch time on the other hand, an egg can make my blood sugar crack an 8 (not kidding, eggs actually make my blood sugar go a bit bonkers).

I go through waves of emotion on the whole pump issue though, would rather not on the one hand but I need something better than I've got....then there's the whole anti pump attitude at the clinic, good grief they don't make it easy do they. Onwards and upwards I say, oh and ive decided the freestyle Libra is a must even if I can't afford to use it all the time. I can't solve this problem or prove it exists without one I don't think. Sorry this has got very rambling and long, I think I've got spring fever because the sun is shining

 

[Robin]

I really don't think it's possible NOT to have long rants! I'm with you on eggs, I have to treat them like carbs, and also cottage cheese for some reason. I don't know whether it's because eating pure protein on its own makes the body treat it like carbs or what. I also don't really want a pump. I think I would find it even more frustrating, because just as Id got it set up perfectly....things would change and I'd be back to square one. I agree, getting a Libre is tempting, just to use occasionally to get a complete snapshot of what goes on over the whole 24 hr period. k always think, the more data I've got to work with, the more likely I am to produce a meaningful result.

 

[Sally71]

There's probably no peeks or troughs in the lantus at all.
It's your own basal needs that lantus can not match. So shout for a pump 🙂
Just as an example for you my basal needs from 7 PM until midnight are 0.025 of a unit yet at 10 AM until midday I need 2.35 units.

How different we all are - my daughter is completely the other way around - her highest requirement is 6pm until midnight (currently 1.15 but rising continually) and her lowest is 0.15 mid afternoon (used to be mid morning but has recently changed for some reason!).

So the chances of any long-acting insulin working perfectly for anyone are probably very small!

And to those of you who are unsure about pumps - IF YOU GET THE CHANCE, TRY ONE. It is fab just to be able to do tiny tweaks - e.g. If you are getting hypos at the same time every day you can do a minor adjustment for the few hours previously which should stop the hypos without interfering with what goes on the rest of the day. Yes it's hard work and hard not to become obsessive sometimes, but I get the impression that some of you have that problem with MDI anyway. If our pump broke and we had to go back to MDI I would not have a clue and my daughter's BGs would probably be yo-yoing all over the place!

 

[Robin]

Something just occurred to me about quick acting insulin, and needing different ratios at different times of day. I need more in the morning, but I think this is because I get a liver dump as soon as I get out of bed, not because I'm less sensitive to the insulin. So. The way I calculate my morning Bolus is this. 1:10 for what I'm going to eat, then chuck in an extra unit for my liver. If I did it by changing the ratio, (say 1:8) then on the days when I had a low carb breakfast, say 10g, and bolused, say one and a half units instead of one, I still wouldn't be getting enough to cope with what my liver has thrown out, and if I had a carb fest of 40g, and bolused 5 units instead of 4, I'd get too much and be hypo by lunch.
Does that make sense? Another octopus tentacle to grapple with!

 

[heasandford]

Can I add another thread to this as wel, please?
Doing basal testing seems to show that I have got exactly the right levels of insulin supplied by my pump - straight line, as shown by both Libre and glucose meter testing. However if I eat breakfast more than an hour later than usual I always get a peak, regardless of what I eat! Why? As we all know, our bodies do sometimes seem to react differently to what is predicted!

 

[everydayupsanddowns]

Something just occurred to me about quick acting insulin, and needing different ratios at different times of day. I need more in the morning, but I think this is because I get a liver dump as soon as I get out of bed, not because I'm less sensitive to the insulin. So. The way I calculate my morning Bolus is this. 1:10 for what I'm going to eat, then chuck in an extra unit for my liver. If I did it by changing the ratio, (say 1:8) then on the days when I had a low carb breakfast, say 10g, and bolused, say one and a half units instead of one, I still wouldn't be getting enough to cope with what my liver has thrown out, and if I had a carb fest of 40g, and bolused 5 units instead of 4, I'd get too much and be hypo by lunch.
Does that make sense? Another octopus tentacle to grapple with!

Pretty much exactly how I deal with it. Except that I have a different response at weekends, so I eat one standard breakfast Mon-Fri and a different one sat-Sun. Only way I've managed any kind of consistency!

Can I add another thread to this as wel, please?
Doing basal testing seems to show that I have got exactly the right levels of insulin supplied by my pump - straight line, as shown by both Libre and glucose meter testing. However if I eat breakfast more than an hour later than usual I always get a peak, regardless of what I eat! Why? As we all know, our bodies do sometimes seem to react differently to what is predicted!

I have seen people commenting (often T2s who seem to have a clearer picture of DP because they can't rescure some days with extra insulin and have to rely more on body activity/patterns) that if they don't eat within x hours/minutes of rising their liver is more likely to wade in and 'help out'. And once it has started it can be tricky to switch it off! Could that be happening for you too?

 

[heasandford]

that if they don't eat within x hours/minutes of rising their liver is more likely to wade in and 'help out'. And once it has started it can be tricky to switch it off! Could that be happening for you too?

not so much eating within time of rising, more if I have a lie-in! It has been good to see that other people seem to have learnt to deal with similar effects, I appreciate the suggestions

Sadly, trying to deal with that effect today seemed to have the wrong result when I went for a walk after lunch. Despite having less insulin (lunch) and switched off pump, I went low and struggled getting it back up. This was well over 5 hours after the morning dose, I do seem to have 'leftover' effects? - eg turned off liver in the morning so it doesn't want to come back on in the afternoon?? Story of my life...!

 

[KookyCat]

My liver is a bit shy sometimes, it appears keen to correct a hypo at night (for which I am eternally grateful) but very shy of correcting in the morning. That said I had a cracking hypo today three hours after lunch a rather lovely 2.2 which I didn't feel at all (worrying) I only caught the blighter because I realised I hadn't done my 2 hour reading and I'm keeping an eye on highs after lunch currently. Now I wonder if I'm taking too much bolus at lunch and the sudden peaks are actually rebounds which is new and exciting 🙄 I also seem to have acquired a new hypo symptom, namely intense stomach cramps but not sure if that was the coffee I practically inhaled because I find sugar in coffee easier to stomach (pardon the pun) than anything sugary. 30g of carb later I managed to crack a five and stay there. Seriously Patty is having a proper little paddy today.

I have to stick to a pretty rigid breakfast and dinner time or I go high/low although lunch is more flexible. My theory is my body likes regular injections of food or she starts to feed herself 😱

 

[heasandford]

Yes, I like the idea of insulin providing the flexibility to eat 'whatever and whenever' but it really isn't like that is it? And when you think you might have cracked one issue, it all changes!
I think I'm into 'spring hypos' - after every meal, within 2-5 hours after eating - with or without a high spike! Beginning to feel I'm out of control at the moment - just as well I keep reading everyone else's trials and tests, keep it in perspective!

 

[Northerner]

Yes, I like the idea of insulin providing the flexibility to eat 'whatever and whenever' but it really isn't like that is it? And when you think you might have cracked one issue, it all changes! ...

I think that not everyone realises this, that there is much more to it than just counting the carbs and injecting the insulin for whatever and whenever you want to eat. I sometimes wonder if this is stressed enough in training courses, as I have known some people - pump people in particular, since it is even easier - just bolus and eat. Until we get ultra-rapid acting insulins, there will always be a lag whilst the insulin gets working, which can lead to spikes and lows and a worse A1c than necessary. You really need to understand your own body's reactions, in addition to the formulae and ratios.