New Lantus user with quirky BG results

[tumtum]

I have just started using Lantus and am having a hard time controlling BGs.  Does anyone have any anecdotal experiences with it?  First, there is the 22 hour duration.  If I take it at bedtime, I find that getting control of dinnertime BG is very difficult - I have to use 3-4 x the normal dose of insulin to get on top of it until it is time to take the Lantus.  Then, I have a perfect fasting and control one day and it starts slowly eroding so that in 3 days I am dealing with BG's in the 200's. Also, I can count the carbs and compensate perfectly one day and then the next when I eat a load of carbs, they will be controlled up until the end of the dose (5 hours) and then the BG goes up.  This week I have had a cold and have not exercised as I usually do, but even so, I had a perfect day or two and the rest are a little irrational.  Does anyone know what the keys to good, consistent control are with this product?  My doctor merely generalized by saying I would need to find my dose with Lantus by increasing a couple of units every few days for high fasting BG.  Thanks for any light you can shed.

[JDRF-Team-LRS]

Hi again Tumtum,

I'm not a Lantus user, but I've read a fair amount (from other users) so I hope I can be of some help.  Since Lantus is commonly used today, I hope others will chime in with their tips 'n' tricks, too.  The process of finetuning can be so frustrating.



As I'm sure you know a cold or flu can wreack havoc on our control in very unpredictable ways.  Even with a well-honed routine during healthy times, our control often cannot be tight during those times.



Nonetheless, here are some thoughts.  Yes, I've read that many users find Lantus wears off in less than 24 hours.  I'm not sure how long you've been using Lantus for, but a general "finetuning" rule of thumb is to make a change & then observe the results for 3 days, recording the good & the bad & the ugly that comes with it.  Especially with a long-active insulin, it is not possible to make a judgment based on one 24-hour period.  This is especially true when we're out of our normal routine.



Your comment that you can cover carbs well for the 5 hours duration of your meal shots and then your BG begins to climb suggests to me (I'm not a physician, so pls check this with your doc) that your dosage of Lantus is not yet right -- at least not yet right at that time of day.  Before adjusting your dose, I'd recommend noting when you take your various shots and your bg results at various times.  Study 3 days' worth of data.  What pattern(s) do you see?



The catch-22 with fine-tuning our dosage is that we must respond to a *pattern* or we'll spend the rest of our lives chasing individual numbers.  If you're finding that you're high in mid-afternoons or early evenings on a regular basis, then you may want to discuss changing the TIMING of your Lantus.



Changing routines is stressful, illness is stressful, blood sugar swings are stressful.  As you know, all these stressors also make it tougher of many of us to maintain good control and can make us insulin resistant.



One more consideration for you & your endo.  Some DMers have reported that a split dose (some in the morning & some in the evening) gives them better coverage than having the full dose once per day.  The only scientific research study I saw reporting on this found no difference.  So, it may be that in large groups of folks it'll make no difference overall while for specific individuals it may be very helpful.



From your msgs, I can tell that you're committed to maintaining excellent control and you deserve a lotta credit for that.  It feels so bad to work so hard and not get predictable good results yet.  



Stay tuned for input from Lantus-users and do let us know how your troubleshooting goes.  I'd like to learn what works for you and I'm sure that many others would, too.

[Markie]

I had the same problem with Lantus not lasting a full 24 hours. And a shot taken before bed would run out some time after supper the next day. Having the shot in the morning meant that I  would have a high fasting bg the next morning.



Many users find that splitting the Lantus dose between morning and evening shots helps. But this assumes that you have a constant need for basal insulin over a the 24 cycle. I have a much greater need for insulin from 3am to 11am because of the Dawn Phenomenon. So just using Lantus wasn't enough.



After splitting the Lantus dose, I still found that my morning blood sugars were too high. I now inject 8 units of Lantus when I get up in the morning, and 8 units of NPH before going to bed at night. It peaks when I have the greatest need for basal insulin - from after midnite to before lunch the next day. This regimen keeps things on a pretty even keel.



Lantus is good in that its action is reliable and consistent. But you need to experiment with different regimen variations to find the one that works best for you.



Cheers,



Mark

[T C]

I switched to lantus 2 yrs. ago. I take 24 units at 2 am before the 3 am phenomenin, where everyones GL rises. Also take novalog if needed on sliding scale around or after lunch, usually a few units like 3. I switched from humalin l and humolog. Even thou i hate the reactions from fast acting insulin. Lantus works ok i guess, was worried at first about hitting blood on an injection due to it's a 24 hr. insulin.



Thomas

[Imediject]

I've had Type I diabetes for 41 and have done great on Lente/Regular - until Lente was discontinued this summer.  I switched to Lantus/Humalog about six weeks ago, and I will be the first one to stand up and say that the fine tuning of the doseage takes time and patience.  I learned during the first week that 1) in my case Lantus only lasts about 18 hours, 2) it has a definite peak for me at about 5 hours after injection.  And I also learned that for me an unrefrigerated vial keeps its full strength for about two weeks, so it's now in the refrig between injections.  I warm it up in my hand or even under my arm for a few minutes before injections to keep the injection comfortable and the chance of thermal shock to the tissue down.  



So, I'm currently getting the best results from taking around 2/3 of my dose at 8 AM, and the other third at dinner around 6 PM.  I count carbs and cover them with Humalog, which is working well.  I still need to do some fine tuning on the 6 PM dose though.  My BG is fine all evening, then drops a little around 2 AM, and then will do a slow rise -- so I'm upping the evening dose 1 unit every 4 days until I see things even out.  



One thing for certain is that Lantus is a very individual basal insulin.  I think everyone has to work out what is best for them, but hearing what works for others sometimes gives us ideas on how to deal with our own problems we have.  There's a book out called "Using Insulin" that talks a lot about Lantus, and I think their statistics are that about a third of those using it need split doses.  Others combine types of basal insulins such as taking Lantus at one time of the day, and NPH at another to cover the gap that happens when the Lantus loses it's strength. And dose varies greatly as well.  I've heard some folks mention that they're on tiny amounts of Lantus, and I've also heard of one individual that was on 880 units each day.  Yep, that's not a typo -- 880!  So, everyone has to find their comfort zone that works best for them.  I've found that with the Lantus I'm currently taking about 25% less basal insulin than I was with the Lente, but that may change as I regulate my evening doses further.



I think what makes this even more frustrating is that I'm a nurse educator, and with umpteen years of a medical background, Lantus has stumped me as much as it has anyone. :-)  It's a tricky insulin to work with, but I've heard many people mention that once they get to the right amount, the results are well worth the effort.  



My thoughts are with you -- and please know that you're not alone when it comes to "Lantus Frustration".  :-)  Just take it one day at a time, and keep a good Log Book so you can look back over patterns that form.  



Bonnie

[Imediject]

Oops -- Sorry about the second post, but I forget to mention something to you about the carb problem you're having.  Carbs are definitely not all created equal.  Everyone seems to have a different sensitivity, but mine is pasta.  If I eat what is considered a normal serving in a meal, it's digested more slowly that what the carb coverage with Humalog allows. I usually end up doing a correction bolus of a couple units of Humalog something like six hours after the meal to get my readings down to normal.  Some people have problems with potatoes, others with white flour breads -- so you'll have to discover what carbs you're sensitive to and keep an eye out for higher than normal readings if you eat them.  You could also raise your carb bolus by a unit or so, but just make sure you don't overdo and end up with a low BG in two hours, followed by a high once the carbs are digested.  



Bonnie

[T C]

I was wondering about the multible lantus injections you mentioned. I take at 2 a.m. 24 untis of lantis, with also novalog i have, ehich i don't take due to everytime i check glucose its in range. Let me know what you feel about lantus in multible times. I'm stumpted on my sugar it's 50 one minute, then 300 next. I'm type 1 uncontrolled. I used to be 185 lbs., lost wieght down to 113 lbs. Then diagnosed(1997). Since then unable to find a regiment to sustain levels. I had a red dot on front leg other side of calf, now grew to a one dollar bill size from ankle up. Doctor sent me to derm. but they said I needed a nerologist, never went.



thomas

[Imediject]

Thomas - when Lantus first came on the market, it was advertised to be a 24 hour coverage insulin...all you needed to do is take it once a day at bedtime.  Over time though, patients and their physicians have been doing a lot of work together to make adjustments that suite each individuals needs.  Some people do very well on one injection of Lantus a day (with fast acting insulin to cover meals).  Some find it works best for them with split doses.  And some find it works best combined with another type of basal insulin.  The place to find what works best for you is with your doctor, a diabetes educator, or someone in the medical profession that knows you and what your needs are.  I'm finding Lantus to be very tricky to work with -- and yes, I do get frustrated when I do everything right but still have problems.  But I do believe time and patience will work out the rough spots.  My advice -- give your doctor a call and see if he will sit down with you and go over the BG/insulins logs you keep.  He might be able to see patterns that he can help you correct with just a few minor adjustments.    



Bonnie

[tumtum]

Thanks, everyone, for the great responses!  I no longer feel alone in this thing.  I am enjoying being able to ignore pre-set lunchtimes which have always been a real problem in my line of work (and play) due to the exigencies and emergencies that are unforeseeable and urgent in nature.  This aspect of Lantus is great.  During the day the carbs are pretty easy to compensate for with Humalog. However, this new ease is, for the first time, making me think seriously about a pump.  



If a pump could take battering like falling off horses and could accomodate heavy, sweaty and twisty exercise such as in the gym, skiing, Yoga twisting, etc. that would be a real plus.  Has anyone compared these two things besides possibly a huge cost associated with the pump?  When I first heard of the pump I was way too active in the wilderness/mountains/snow to think seriously of using something like that and you had to test just as many times a day as the other way, and I was taking my time adjusting mentally to the idea of being a diabetic, so that was as much consideration as I gave it -- 20 years ago.  Humalog is great but now I am becoming a human pin cushion!  My lifestyle is much more limited now, but still I question how both Lantus and a pump would work in strenuous physical activity.  When you actually physically contort your body and organs, producing sometimes surprisingly strong physiological results (in Yoga), is the pump able to stay put and handle the rush, so to speak, safely?  I think I would be able to predict Lantus better than the pump just because of lack of experience/knowledge with the pump.  



Anyway, I am willing to give this Lantus more time to work out since not having to think about it until bedtime is a great load off and if I can experiment with that special nighttime lapse time period awhile using intermediate insulins or Humalog maybe.  Does anyone just take a small snack and some Humalog?  I think I will discover some workable routine -- or my doctor will!  Thank you again!  This posting board is a great tool - I rarely meet or talk with insulin dependent diabetics.