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Extreme Highs and Lows Experience Overnight
I have been diagnosed with Type 1 Diabetes for the last 4 years. I thought I was doing a reasonable job controlling my diabetes with my 3 month average around 7.1. About a month ago, my doctor changed my long acting insulin from Novolin NPH to Lantus. This completely threw me off and I ended up being woken up by paramedics 3 times in 1 week. My blood sugar would be normal before bed and then by morning it had gone to 1.8. When I would eat a snack before bed to keep my blood sugar from dropping, I would go high - 13.0-15.0 on average. My doctor has now switched me back to my Novolin NPH and I am still having a hard time getting back on track. I go to bed high, and wake up high. I test at 3 in the morning and I am high, but coming down. At this point, I'm at the end of my rope. I live on my own, so going so low I can't wake up is terrible because my parents, co-workers, or neighbors have to be inconvenienced and come to my rescue. Can anyone offer any advice or suggestions how to keep my blood sugards from going really high and really low? I can't seem to find the happy medium and stay there. It's like a yo-yo going up and down. Thanks for any help.
Ive found levemir to be much better than lantus. on lantus I was crashing in the night, had to eat a 30 carb snack otherwise id crash-you get the picture. I just switched to levemir, I go to bed at about 100, wake up at 140 (lil higher than i want) but ill just up the dose 2 units. But seriously, levemir is much more stable than lantus. Its long acting like lantus, but Ive found there isnt any werid peaks and im more even.
A quick update! I have gone back on the Lantus and started taking it in the morning. I took it on Sat. morning and by Sunday morning, I was almost normal - 11.2 when I woke up. I then took it Sunday morning and this morning I was 7.7, so I am quietly optimistic that this may be what I need. I also feel better during the day because the control is better between meals with the Lantus as opposed to the NPH. I will continue with thsi routine and hope that it continues to work for me. Keep your fingers crossed!
On your question about possibly going low at night if you take Lantus in the am ... it might happen, but if you detect that pattern you can likely treat it with a small amount of Lantus at night. The very dangerous risk of going too low overnight is avoided.
Some docs are not well-trained on pumps and don't have easy access to folks who do; for that reason, they may be reluctant to put a patient on it. Other times, docs may be concerned about an individual's discipline and troubleshooting and our understanding of carbo counting, insulin:carbo ratios, insulin duration, etc. If the endo has no patients on a pump, then it's likely an issue that's not about you as an individual.
Do you have access to certified diabetes educators (CDE) in your area? CDEs are an important member of diabetes care team and are often certified pump trainers, too.
My endo isn't very knowledgeable about pumping but trusts the enormous amount of personal research I do and also trusts the CDE I work with for training & trouble-shooting. Pump reps from teh manufacturers are usually CDEs and some are pumpers themselves. I've read from others that the reps have come to their home to get 'em going.
Good luck. I hope you'll keep in touch as you navigate this troubleshooting. I'm also sure you'll get to the balance you're striving for.
Some docs are not well-trained on pumps and don't have easy access to folks who do; for that reason, they may be reluctant to put a patient on it. Other times, docs may be concerned about an individual's discipline and troubleshooting and our understanding of carbo counting, insulin:carbo ratios, insulin duration, etc. If the endo has no patients on a pump, then it's likely an issue that's not about you as an individual.
Do you have access to certified diabetes educators (CDE) in your area? CDEs are an important member of diabetes care team and are often certified pump trainers, too.
My endo isn't very knowledgeable about pumping but trusts the enormous amount of personal research I do and also trusts the CDE I work with for training & trouble-shooting. Pump reps from teh manufacturers are usually CDEs and some are pumpers themselves. I've read from others that the reps have come to their home to get 'em going.
Good luck. I hope you'll keep in touch as you navigate this troubleshooting. I'm also sure you'll get to the balance you're striving for.
Thank you for all your advice! I was taking the Lantus at night, usually around 10:00 and while I was basically "normal" before bed, I would either crash, or go high. So I tried the 3am readings and those were even wierd - some were high, some were normal. So, at that point, I had been on Lantus for 2 weeks, my doctor decided that it was not working for me and that I should switch back to NPH.
With each meal, and actually any snack I have, I take NovoRapid. That basically works fine and I do not have any problems with that. I just can't seem to get my overnight and morning readings to be normal.
If I take the Lantus in the morning - are the effects not wearing off by the middle of the night so I may still go high?
I have also asked my doctor if the pump is a better solution for me. For whatever reason, she will not entertain that idea for me and I can't get it out of her why. Whether it is the cost, or if it just won't work for me. But at this point, she is telling me to figure out what and how much insulin I need with the current stuff.
If I lived in an area where doctors were plentiful and available to take on new patients, I would certainly do that. Unfortunately, there are very few doctors available and those that do specialize in diabetes are not taking on new patients. So I'm stuck with who I have.
Thanks again for all the help! Nice to know I'm not alone.
With each meal, and actually any snack I have, I take NovoRapid. That basically works fine and I do not have any problems with that. I just can't seem to get my overnight and morning readings to be normal.
If I take the Lantus in the morning - are the effects not wearing off by the middle of the night so I may still go high?
I have also asked my doctor if the pump is a better solution for me. For whatever reason, she will not entertain that idea for me and I can't get it out of her why. Whether it is the cost, or if it just won't work for me. But at this point, she is telling me to figure out what and how much insulin I need with the current stuff.
If I lived in an area where doctors were plentiful and available to take on new patients, I would certainly do that. Unfortunately, there are very few doctors available and those that do specialize in diabetes are not taking on new patients. So I'm stuck with who I have.
Thanks again for all the help! Nice to know I'm not alone.
I'm with LRS on the CDE and the pump issue. Making the decision to go on a pump was not an easy one for me, but once I made the decision, it really changed my quality of life. I have also had experience with docs who weren't familiar with a particular regimen or insulin and insisted that I stay with what they knew and were comfortable with. Patients today have to be educated consumers and if you decide you want to go back on the lantus or try the pump, you just have to find the right resources to help you. The CDE is a great way to start. They may even have some connections to some of those doctors who aren't taking any new patients. Good Luck to you!
Great input from ES. I'm also not a physician, and am also a long time diabetic.
I have read about folks taking their Lantus shot in the morning or at night or a partial dose at each time. If you were taking the Lantus in the morning and "crashing" overnight, then talk to your doc about taking it at night instead -- then the timing of any drops would be while you're wide awake and able to test & treat. If you had been taking it at night (which is what I'm guessing, given the timing of your "drop"), then shift to the morning.
While Lantus is not supposed to have a peak, I have read many folks' reports similar to yours. If you do give Lantus another try, remember that it may take a day or two for things to level out as the NPH moves out of the bloodstream and the Lantus builds up. Watch carefully for lows that might occur because of overlapping doses.
Which short acting insulin are you using for meals? Some are very short (Novolog/Humalog) and Regular lasts a bit longer.
If you can possible standardize your meals for a few days, you might be able to figure out what's going on. Ideally, as you do the switch and attempt to get good control again with Lantus, avoid high-fat/high carbo- combinations since those types of meals can wreak havoc on blood sugar for 8 hours or more.
I'm sure you know that you are very fortunate to have pals & family who can help you out. None of us likes to need others' help and yet it's an important safety net when we do need it. My guess is that you're also "there for them," when their needs dictate.
I have read about folks taking their Lantus shot in the morning or at night or a partial dose at each time. If you were taking the Lantus in the morning and "crashing" overnight, then talk to your doc about taking it at night instead -- then the timing of any drops would be while you're wide awake and able to test & treat. If you had been taking it at night (which is what I'm guessing, given the timing of your "drop"), then shift to the morning.
While Lantus is not supposed to have a peak, I have read many folks' reports similar to yours. If you do give Lantus another try, remember that it may take a day or two for things to level out as the NPH moves out of the bloodstream and the Lantus builds up. Watch carefully for lows that might occur because of overlapping doses.
Which short acting insulin are you using for meals? Some are very short (Novolog/Humalog) and Regular lasts a bit longer.
If you can possible standardize your meals for a few days, you might be able to figure out what's going on. Ideally, as you do the switch and attempt to get good control again with Lantus, avoid high-fat/high carbo- combinations since those types of meals can wreak havoc on blood sugar for 8 hours or more.
I'm sure you know that you are very fortunate to have pals & family who can help you out. None of us likes to need others' help and yet it's an important safety net when we do need it. My guess is that you're also "there for them," when their needs dictate.
I am so sorry about what you are experiencing. This is the nightmare of all insulin dependent diabetics, going low in the middle of the night and not being able to wake up. I am not a doctor, so my advice comes from 40 years of experience with Type I Diabetes. There will always be some swings with daibetes. There are so many variables; food, exercise, hormones,stress, illness, etc. Many of these can't be controlled. The goal is to try to get your blood sugars within some comfortable range and then modify your insulin for the inevitable swings.
I was on NPH for many years and found it to be a very lifestyle restricting insulin becuase of its very distinct timing. Your schedule has to correspond to the insulin's schedule and I really didn't like that. The Lantus is a much longer acting insulin without the drastic peaks which can give you a lot more flexibility. I don't know how long you were on the Lantus before you switched back to the NPH, but your blood sugar swings may not have been totally related to the insulin, since you are still having problems on the NPH. My own preference would be to go back on the Lantus and give it another try. Perhaps eating a smaller snack or taking a littl less Lantus might do the trick. It does take a while to figure out the right dosage for you when you begin any new routine. Ultimately, the Lantus should be able to give you better control and more lifestyle flexibility. I'm assuming that you take regualr insulin at mealtimes in conjunction with the Lantus. Of course, you would have to discuss this with your doctor.
If you do change back, you may want to err on the side of keeping those night time snacks until you have a better sense of how and when the insulin works for you. I trust you are seeing an Endocrinologist who has had lots of experience with diabetics on insulin. It's important that your doctor specifically have experience using Lantus since adjusting every insulin is a little different.
The hardest thing about having diabetes is that it is impossible to achieve perfection, even when you do everything "right". I do encourage you to go back to your doctor and see if he has any more suggestions for adjusting your insulin. For some of us, the best option has been the pump. But it is not for everyone and you should be able to get good control with insulin.
The most important thing is to not despair. Having diabetes is really hard and when things don't go well, it can be really frustraing. Just remember, you are doing the best you can, not everything is within your control and most importantly, tomorrow is a new day and a new opportunity. Lots of luck to you.
Es
I was on NPH for many years and found it to be a very lifestyle restricting insulin becuase of its very distinct timing. Your schedule has to correspond to the insulin's schedule and I really didn't like that. The Lantus is a much longer acting insulin without the drastic peaks which can give you a lot more flexibility. I don't know how long you were on the Lantus before you switched back to the NPH, but your blood sugar swings may not have been totally related to the insulin, since you are still having problems on the NPH. My own preference would be to go back on the Lantus and give it another try. Perhaps eating a smaller snack or taking a littl less Lantus might do the trick. It does take a while to figure out the right dosage for you when you begin any new routine. Ultimately, the Lantus should be able to give you better control and more lifestyle flexibility. I'm assuming that you take regualr insulin at mealtimes in conjunction with the Lantus. Of course, you would have to discuss this with your doctor.
If you do change back, you may want to err on the side of keeping those night time snacks until you have a better sense of how and when the insulin works for you. I trust you are seeing an Endocrinologist who has had lots of experience with diabetics on insulin. It's important that your doctor specifically have experience using Lantus since adjusting every insulin is a little different.
The hardest thing about having diabetes is that it is impossible to achieve perfection, even when you do everything "right". I do encourage you to go back to your doctor and see if he has any more suggestions for adjusting your insulin. For some of us, the best option has been the pump. But it is not for everyone and you should be able to get good control with insulin.
The most important thing is to not despair. Having diabetes is really hard and when things don't go well, it can be really frustraing. Just remember, you are doing the best you can, not everything is within your control and most importantly, tomorrow is a new day and a new opportunity. Lots of luck to you.
Es
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