Lantus in the MORNING instead of EVENING

[khicktx]

I recently read on here somewhere that Lantus is usually given at bedtime because it lasts 18-24 hours and that by the time it is dwindling the dinner injection is given kind of as the bridge between the first Lantus injection and the next one the following evening. Thus making a steady regimen. However I quite frequently fail to give myself injections at dinner. I am just careless sometimes. But my Lantus peaks around 3 or 4 every morning, and depending on the night before I may experience a mild/mildly severe low. Has it ever been suggested to take Lantus in the AM? My thought is this:

If I took Lantus in the A.M. (Aprox 6:30 or so) my peak would be about 5 or 6 hours later. This would be my lunch time.

I could use a sliding scale determined at lunch.

If I forgot the dinner shot, the Lantus would still be working.

And I could still test at bedtime and bolus if needed.

I see it this way because at least then I would have some insulin in my system at dinner, rather than the tiny amount of Lantus left, there would be a bit more (since I would be taking it about 8 & 1/2 hours later).

Anyone have any suggestions or comments tomy thoughts?

[Forum-vol-wak]

I  am not a phycan, but i would highly suggest that you dcusss this change with your  endocronolgist as you might have to do this over several days as lantus is a 24 hr insurlin.  The  other is that lantus really doies not have a peak so it should not  effect  your luch time injuection.

[KevinHarney]

First of all, yes many people take Lantus in the morning instead of the evening for just that reason.

However the switch is a pretty complicated one.  I would suggest that it be accomplished with your Dr. but the Vol is wrong in that Lantus does not have a peak.  It does have a peak at about 4-6 hours but it is not a large peak.  This peak does effect many users in the middle of the night.

The easiest suggestion is to make sure that you test at dinner.  You really need to be doing this regardless of whether you are on Lantus or not.  Skipping doses is has a really bad effect on your levels as you will tend to over compensate at bedtime for what you missed at dinner and had several hours of highs in between.  Giving you a yo-yo effect in your sugars.

Also, if you are taking Lantus and bolus at night before bed because you missed your dinner then you are in fact taking a double dose of insulin and they are kicking in at peak near the same times.  Your bolus will peak a couple hours after bedtime and then your levels will be correct and then your Lantus will be peaking right after that.  This is why you are getting lows.  Additionally, you should NOT be mixing the two Insulins in the same syringe.

I believe that the switch from evening Lantus to moring Lantus is generally made in the following manner but you should REALLY see a Dr. to do it correctly.  Generally I think they change it over a long period of time by taking 1 less unit at night and then taking 1 unit in the morning and the following day take 1 less unit at night and 2 in the morning etc.  I have never done the switch so I am not the best person to advise on it but that is what I understand.  With some people just taking a few units in the morning is enough to even it out but in my opinion that defeats the purpose of 1 shot a day !!!  If I were to switch I would ask my Dr. if I could skip 1 dose of Lantus and just start on a new schedule.  In other words I would skip 1 evening dose and not take another dose until the following morning 36 hours later.  This would seem to be the easiest to me but you would have to bolus a lot that one day to compensate.  Like I said see the Dr. this can be really complicated.

Long answer to a short question.  Hope it helps some.

[JDRF-VOL-SG]

I am one who did the switch from night Lantus to morning Lantus and it is done exactly as described by Kevin, except that I recommend waiting TWO days between each 1-unit change in order to let things stabilize before making the next switch. Many of us who are prone to night lows do this. When doing the switch, many end up taking a "split dose" meaning that some insulin is taken in the morning and some at night, totally the same total that you are currently taking. Each person's ideal split dosage is different, so you watch when making the switch to see when you achieve perfect glucose levels at both morning and night and stop making changes when that happens and stays the norm. In my case, I have an identical twin, also a type 1 diabetic. Our lifestyles are different, and our split doses of Lantus are different. In my case, I need most of my Lantus in the morning and only 2 units at night to see me through the night. My twin on the other hand, splits her dosage more half and half.

And yes, I agree that there is a peak in the action of Lantus somewhere between 4-5 hours, usually. Some people notice it more than others. I notice it a great deal and have to feed it when it happens. But it still is much better than the old NPH insulin with its horrible peak actions that could get dangerous.

[khicktx]

I knew about the peak...I experience it, so there is no saying that it doesn't exist.

As for the other, I wouldn't change it without professional advice, I just wanted to know if it'd been done and how.

So thank you very much for your insight. I appreciate your thoroughness!