Problems with Lantus and sporadics hypoglycemia

[Kenai]

Hello.  I am T1 since Oct 2004, and switched to Lantus in Feb.  Most of my BG numbers are very good (A1Cs 6.0 and 5.5), but since switching to Lantus, I have experienced 5 episodes of sudden and extreme drops in BG.  They happen late morning, not related to breakfast, novolog dose or exercise.  My BG is usually above 150 when it starts, and I must consume 150-200 grams of carbs (as juice or gel) to get it to stabilize, usually in 20-30 mins.  I have read on other sites of people having similar unexplained problems with lantus, longtime T1s that describe the feeling as being like a big spurt of insulin from the pancreas but they are long past a possible honeymoon phase.  All conclude it's haywire absorbtion.  I take one bedtime dose, do not mix, and always use a new syringe. Does anyone have experience with this or know of more detailed info on Lantus absorbtion and stability?  Thanks.

[JDRF-Team-ES]

Sounds scary.  I am a Type I also, but  have never taken Lantus, so can't help you on the sudden Blood sugar drop.  I'm on a pump which seems to prevent some of those extremes.  It may be time for a visit to your doctor with a possible adjustment in your dosage of either the Lantus or the Novolog.  It sounds like they may both be kicking in full speed at the same time.  Your A1C's sound great so you are certainly doing everything you are supposed to do.  Hope you can get this issue worked out soon.  Perhaps some other folks on Lantus ave some other suggestions.  Good Luck!
Es

[Markie]

kenai,

Don't be too quick to blame the Lantus. If you have only been T1 since October last year, you are probably still producing some insulin. And it is not unusual for intermittent spurts of endogenous insulin to occur as the honeymoon period proceeds.

So your sudden drops in bg could have nothing to do with the insulin you are injecting. In which case you will just have to live with them until your honeymoon period is over.  

I have been T1 for 28 years, so I am totally dependent on injected insulin. I have been on Lantus for about a year now. Variability in absorption/action is minimal and I am very happy with the results.

Cheers,

Mark

[Larry68]

Hi Kenai,

Most people have good experience with Lantus, and a low as you describe so long after taking the injection would not seem to be releated to this insulin.Two important things to keep in mind about this insulin, however:

1. It must be allowed to crystalize after injection, as it obtains it's slow release by the slow dissolution of the crystals over 20-24 hours.

2. Injection into a vein will cause rapid hypoglycemia, as all the insulin is immediately available to the body.

I do not see any connection between these cautions and your problem, unless something interfered with the crystalization under the skin, but keep them in mind.

I used Lantus for about a year prior to reverting back to NPH because of two severe reactins I had after hitting a vein in my leg and later in my abdomen. I have been type 1 over 40 years, but these reactions were a new and very frightning experience.

[JDRF-Team-LRS]

Hi Kenai,
While none of us is a physician here, we all have lots of experience.

From what you've written, you see a definite pattern to your lows -- late morning.  I am thus suspicious of your morning shot to cover breakfast potentially coinciding with your sputtering, spurting pancreas that's giving its all to try to cover breakfast carbs, just to collide with your Novolog.

As you may know, the tail for Novolog lasts about 5 hours.  Many folks assume it's much shorter than that.

In addition to the other suggestions, I'd encourage you & your team to focus on (1) your insulin:carb ratio in the morning (many of us long-timers do need more insulin to cover a given amount of carbo in the morning; you may not) and (2) your insulin sensitivity ratio -- that is, how many points will a unit of insulin drop your BG.  Armed with those 2 numbers, your morning BG and the carbos in your breakfast, "in theory" you can compute just the right dose to cover those carbos without your crashing.

Altho' you say the low is not related to your Novolog, the timing (late morning) suggests to me that it is at least partly related to it.  The good news in all this is that you have detected a PATTERN.  Patterns are easier to troubleshoot than random events, so take heart & keep patient.

My final comment is that if you're taking 150-200 gm of carbos and NOT ending up with an enormously high BG later, then your dose of something must be waaay too high.  Most of us have been taught to treat with ~15gm of glucose (quicker than juice, etc.) and wait 15-20 to test again.  Your sugar intake is about 10 times greater than one would expect to treat a "simple" low.  OTOH, if your pancrease is responding (albeit late) to a high carb breakfast (for example), you might be getting your injected insulin plus a healthy dose of your own insulin.

Do review your results and the suggestions here with your team.

[Kenai]

Thanks for the replys.  Every bit helps!

[jana270]

I know this is an old posting,but interested to know how you're getting on with the lantus following the unexplained hypos.  I came off it for same reason, and it made me ill-loads of other symptoms too.  Are you still on it and are you still having unexplained hypos, or any other problems?
Jus

[Jodi1968]

I too experience severe low blood sugar after hitting a vein with Lantus.  Never had this with my Humulin N and I am thiniking of insisting on switching back to my old iinsullin at bedtime.

While my dad and brother love this insulin, it is not working for me.

Jodi

[Lys206]

Bravo Jodi!

After 5 years of strange sudden hypos I have been working with a Nutrition Trainer from Element Nutrition in Montreal.... I have a pedometer, track all my meals and intake with a digital recorder and anaylze results weekly with my Dietician. One day I injected and bled. Within two hours I was at the most bizzare low - 2.1mml- an extreme low for me.... two hours later I was low again. I had two more hypos each one less extreme than the last until 7p.m. If it wasn't for other bloggers talking about this "intra venous" effect and also if I hadn't been on a medical leave for other reasons, I would never have made this connection. Lantus makers Sanofi Aventis have been reported to Health Canada and I encourage all users to report this effect to both doctors and other pertinant government agencies. It is not clear in the side effects how dangerous this effect can be. Be very careful how you inject this insulin.

Lys

[Gord37]

I ,too, have had severe lows after injecting my Lantus.  I have tried to reduce the intervenus effect by splitting the amount injected into two equal amount at different sites, and pinching the fat well up.  Seems to help.  My doctor says it is impossibble to hit a vein when injecting into fat, but fairly frequently I get a bleed out and I think that means that  I hit a vein.