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Problems with Lantus and sporadics hypoglycemia
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Problems with Lantus and sporadics hypoglycemia

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.
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Avatar_n_tn
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
Avatar_n_tn
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
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Avatar_m_tn
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.

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Avatar_n_tn
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.
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Avatar_n_tn
Thanks for the replys.  Every bit helps!
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Avatar_n_tn
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
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Avatar_f_tn
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
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Avatar_n_tn
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
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Avatar_n_tn
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.
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Avatar_m_tn
I have been using Lantus for a few months. I too have had a couple of bad low sugar episodes... But not from Lantus, but from mistaking my Humalog pen for my Lantus pen. They are not exactly easy to tell apart when you are tired (I take it at night). I was taking 16 units, so imagine the same of Humalog! Wow! Cram those glucose tabs!!!

On a pump now (or rather the pod) for the past couple days. Harder to goof up.
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Avatar_f_tn
I have had diabetes for 18 years now and have happily had an insulin pump for the past 9 years.  However, I often switch over to shot therapy during the summer because it is more condusive for summer sports and activites.  I have had approximately 10 serious hypoglycemic reactions while on lantus over the past 3 summers.  All of them are early morning, like you mentioned.  Now while I am on Lantus, I only give myself half of the amout of insulin I normally would for dinner, I have a snack before any activies I have a high protein snack before bed, and I stay away from any alcoholic beverage.  With this routine, I typically wake up with a blood sugar ranging from 120-150.  I live on my own and would rather wake up with a slightly higher blood sugar, than end up in a coma.  If lantus is something you are really concerned with I would highly recommend an insulin pump.  My insulin pump is my savior.  I only wish it was more water friendly!  Best of luck.
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Avatar_m_tn
I've been taking Lantus for a few months now with good results. I did however have an incident recently that took me to the ER. When I injected the Lantus into my ab, I was immediately able to taste it. I went to bed and woke up about an hour later with a blood sugar of 36. My daughter panicked and called 911. I was told in the ER that I had a common insulin reaction. It wasn't until the next day when I saw my  family doctor that I found out that I did indeed hit a vein. Between the small bruise I had at the injection site and the taste in my mouth when I injected it my Dr was able to confirm that I hit a vein. There really should be more information posted about this. I now know that if I'm able to taste the Lantus, I should consume some sugar as well as protein right away.
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Avatar_f_tn
I have been using Lantus for a few years now, and last night was the 2nd time I experienced hypoglycemia.  (It's scarey!)  But, I learned something new from this sight...the risk of hitting a vein!  I did bleed last night which happens occasionally but I didn't know why.  I will now take better precautions but, in the meantime, I have my saltines and honey on the cupboard just in case I need them tonight!
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Avatar_m_tn
I' had Type-1 for 49 years, and have been using Lantus since it was approved in the US.  I, too, have had sudden-onset hypoglycemia after injecting Lantus.  It happened only three times, always after having bleed-back at the injection site.  As other have said, it's truly scary (particularly when driving), and it took a lot of carbs to counteract.  It seemed as though the entire Lantus dose took effect immediately (like a fast-acting insulin).  After the third incident, I began to split my Lantus dose, taking half in the morning and half in the evening.  I've had no problems since - but if I do, I know that I'll be dealing with the effects of only half as much insulin.  I do like using Lantus - especially the (usually) flat action, without a peak in the middle of the day.  It make life (especially meal scheduling) much easier.  Who knows, maybe one of the new insulins in the approval pipeline (e.g., Tresiba) may not have this problem.

BH
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Avatar_m_tn
I am type 2 on insulin, I take lantus and have had several times around 12-4am where my sugar suddenly drops.  It has dropped 75 in just two hours.  I start freaking out.  It won't go down all day until late at night.  The doctor says it doesn't peak but why this sudden drop?  I rather take a small dose of Humalog at night.  I know that my Humalog would stop after about four hours and didn't have to worry about it overnight.
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Avatar_f_tn
I have experienced sudden hypoglycemic episodes within minutes of injecting Lantus. I always aspirate and none of these times have I injected into a capillary. My sugar crashes and I go into hypoglycemia fast.This has happened 6 times in the last couple months. Never had it happen before and I've been on insulin since 1985. I am currently using Lantus (one dose in the morning only).  Since these incidents I have started dividing up my dose into two or three injections in the morning. And for the record there have been other times in the past that I have accidentally injected into a capillary and the reaction is immediate and I can tell the difference from what I am now experiencing. My Dr's have no explanation.So now I am afraid to take my insulin as I never know what will happen. When the treatment becomes more dangerous than the disease it is time to search for an alternative. Anybody out there having this issue with Lantus???
Linda R
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