Well, I never thought I’d say this, but it’s a great week to be a person with Type 1 diabetes. With all of the bad news surrounding the Type 2 drug Avandia (rosiglitazone), it’s a relief to know I don’t have to worry about it. I recommended you read my colleague Tara’s blog entry (“Type 2 Drug Avandia Linked to Increased Risk of Heart Attacks”) for the full story.
That’s one of the first times in my life I’ve referred to someone as a colleague. What can I say? It’s just not a word in my describe-a-friend/coworker vocabulary.
While all of the controversy surrounds Avandia, I’m way over in Type 1 land contemplating whether or not to lower my daily dose of Lantus (insulin glargine). I’ve just started a brand new bottle of Lantus and I’ve been taking my normal 15 units in the morning and then eating a rather normal breakfast and lunch, but I’m still going low in the midmorning and early afternoon. This happened Monday after eating Brussels sprouts and whole-wheat pasta for lunch and only taking one unit of rapid-acting NovoLog (insulin aspart) to help out the Lantus.
I’ve known for a while that my body is sensitive to insulin, but lately it’s been a little more sensitive than usual. I took 13 units of Lantus yesterday and my blood glucose was 86 mg/dl before lunch.
I often wonder how much of an adjustment two units of Lantus is. While I’m very much locked in on an insulin-to-carbohydrate ratio with my NovoLog, it’s a bit tricky to judge how much the longer-lasting insulins affect your blood glucose. Is there a chart for your Lantus dose? I seem to remember something from when I was diagnosed. I wonder what Google will tell me to do.
I realize that Lantus doesn’t have a true peak the way some of the other insulins do, but sometimes it sure feels like it’s working.
Last night I had dinner with some friends at a great Italian place in Greenwich Village called Maremma. I took one unit of NovoLog for the few bites of bread and the polenta served with my entrée. Over the span of the meal I had a salad, two braised short ribs, a bite of sausage, a small side of polenta, and two glasses of red wine. I took my insulin right at the table and I think everyone was right in the middle of conversation and never noticed my sly little stabbing before dinner. I often feel pretty slick when this happens, though it is very unlikely anyone would ever say something if they did witness me shooting up. The other side of the coin is those who worry too much. I wonder if anyone who knows I have diabetes ever thinks “I haven’t seen him take his insulin, and those potatoes are really high-carb!”
Back to the story—when I got home an hour after dinner, my blood glucose was 81 mg/dl. I had a few bites of granola with a small glass of milk before going to bed. I often find it a little frustrating when I go low at night because the last thing I feel like doing after eating a big meal is eating more right before I go to sleep. Not that 81 is a really dangerous blood glucose level, but I prefer a small snack before bed if I’m in the 80’s. While it’s great to be in tight control of your blood glucose, sometimes a piece of fruit or a small glass of orange juice is not really what I’m looking for to put me to sleep. Especially if I’ve already brushed my teeth.
All right, I think I’ll search YouTube for Lantus and see what comes up.
I also take lantus once a day but I take it at about 10:30 PM before I go to bed. IF my BG is less than 100 I only take 8 units, if greater than 100 I take 9 units. However I notice that it seems to cause a dip in my BG about 7 hours later. My A1c run about 6.3%. I do take humalog before each meal and I do test at the same time. In your article you mentioned a very large meal with 2 glasses of wine, the sugar in wine will push your bg up but the alcohol will tend to lower, wine is trickey for diabetics and not a good choice. Hope this info helps
Posted by bernie Spector | May 30, 2007 at 2:56 pmWhen I was on Lantus I was all over the place and I stopped taking it after a couple weeks of numbers from 3 to 23 and back in one day, I am in Canada and use the other units of measure. However, when I was trying to regulate my BG my nurse was playing more with my Rapid/Bolus (NovoRapid in Canada, I think it the same as your Novolog)than the Lantus. Later when I went back to NPH she continued that way, my basal rates rarely changed.
Although you seem to take very little Rapid insulin compared to me- I have a units/grams of carb ratio and I would take 7 units per meal on average- you may not have the room to play with your Boluses like I do.
I was assimilated last fall and use a pump now and I have reduced my daily insulin intake by almost 60%!! I still adjust my boluses more than my basal rates. I have a different ratio fo evey meal. I don’t bottom out nearly as much as before.
Good luck with your adjustments
Posted by Joelle | Jun 01, 2007 at 11:42 amI’m Type 2, but thankfully I never took oral meds. My Dr and I elected to start me on insulin right away instead. Now I believe that is best, instead of using insulin as last resort.
I take 40 units of Lantus every morning. I bolus ONLY if I hit 150+. My pancreas does still work and usually all I need is the Lantus, so my pancreas doesn’t OVERwork.
Studies that I’ve read show that Europeans treat this way, with insulin from the beginning, and they tend to have fewer complications later than Americans, who start with oral meds alone.
I think our Drs need to rethink this strategy. How many people have had heart attacks due to the mindset that insulin is a last resort medication?
Posted by Ephrenia | Jun 02, 2007 at 10:35 amWhoops. I forgot where I was originally headed with my first post. :-)
Andy, I’ve been taking Lantus for about 2 years now. One thing I’ve noticed is that I have to reduce my dose in the summer months. Does the heat make me more sensitive? Do I eat less? Do I drink more water? (Yes to that one for sure) I don’t know the reason, maybe some of all three? But whatever does it, I have to wtch for the changeover and reduce the dosage, then in the cooler months it has to go back up.
Posted by Ephrenia | Jun 02, 2007 at 10:52 amI’ve taken Lantus for at least 6 years. I was told to take all the Lantus at dinner. My problem was that I would “bottom out” at night but be high mid morning. The solution was to take 10 units at dinner and 3 units at breakfast. That has worked much better for me. I didn’t come up with the solution on my own but was told to do that by a nurse who is also a diabetes educator and my endocrinologist agreed that was the best method.
I still take novolog at mealtimes and I do carb count.
Betsy
Posted by Betsy Hardin | Jun 05, 2007 at 2:56 pmHi Andy- I am another person in Type 1 land. I take Novolog on a sliding scale and take Lantus at 9:00 p.m. the opposite of you.
Posted by Simons | Jun 09, 2007 at 5:50 pmYou made the commet that you are very insulin sensitive- so am I. Often times a half a unit change is all that I need.
But my bs’ can just go wild sometimes and I never willunderstand what makes that.
Oh, I have been type 1, insulin dependent for 64 years.
I am new to blogging.
Simons
Hi ther! I am new to the blogging thing too AND I am new to Lantus. Unfortunately I do not have insurance and even les $$ so I depend on what I can (I know this sounds terrible) ’scrounge’ up! I get a lot of my stuff from my Diabetes educator (what a God send!) and then in the building I live in there is a gentleman with type II who always has an abundance of insulin. Ok, back to my initial thought, since I am new to the lantus (formerly an NPH gal) so I am unsure on amount. I have been taking 15-17 in the am and my quick acting (Novolog now) on a sliding scale and so far it has been working ok. I haven’t had the best Ha1C #’s and I am working to get those down but I feel I am on the right path. I have been Type I since age 16 (will be 39 in a couple of weeks) and I have always kinda been all over the chart. Since I have been seeing my educator (under the table) things have been turning around and it is the first time I have really counted insulin:carb. Thanks 4 being here! Steffi
Posted by SteffiOr68 | Jul 17, 2007 at 6:24 amI am just a newly diagnosed diabetic, type 1, and am taking 7 units of lantus in the evening and take about 4-6 units of humolog before each meal. Since I was having a problem bottoming out around 10pm unless I ate a large supper, I will take the recommendation of some of the blogs I read about splitting my lantus dose between supper and breakfast. My bs run low unless I get too much carbs of the wrong kind.
Galen
Posted by Galen | Jul 04, 2008 at 12:19 pmHi I too am taking Lantus and Humalog. I do not have insurance and it is VERY hard to get control on my diabetes and I also seem to have BP problems with it spiking pretty high I am fairly young (i think anyway) I will be 31 in Nov. And know that I have to get a handle on my health. Can someone please tell me how to do the insulin/carb ratio. And give any advice that may help me get control. I avg really HIGH BG readings.
Thanks, Angie
Posted by angiep010 | Aug 06, 2008 at 8:51 amHi Angie,
Dietitian and diabetes educator Amy Campbell actually just responded to another reader’s questions about insulin-to-carbohydrate ratios in the comments thread at “Carb Counting.” You may want to go check it out for some guidance on how to use these ratios. Hope it helps!
Posted by Tara Dairman, Web Editor | Aug 06, 2008 at 9:33 amI’ve been in Diabetes “hell” since 2006, and found a happy medium about two years ago. then my health care ran out and I have been without my insulin for over a year now. I am on disability and will be getting my medicare starting next month, so I am going to be on an insulin roller coaster starting next month. I have not been to the dr. since March ‘08 when my funds ran out and don’t have a clue where to start on the search for what will work for me now. I was on a huge dosage of Lantus at bedtime and also Novolog before meals. By huge, I mean like 240 units. I was also doing about 30 units of Novolog pre-meals. I don’t know what will work for me now after so long. I always thought that was too much Lantus but the doctor and pharmacist said to take whatever worked for me and those were the levels I got results with. Should I seek a second opinion on the meds? They are the only two insulins that ever seemed to work for me, except before I was diagnosed and was thought to be gestational diabetic when I got pregnant in 2002. I was on different insulins then and got good results but after my pregnancy I took a turn and refused to acknowledge my condition. Lantus and Novolog were prescribed in 2007 and worked after trying orals and some other injectible meds with poor results. What do you suggest, anyone? I am looking for any and all opinions from others who have experience with these insulins. Thanks!
Posted by Candice | May 17, 2009 at 10:26 pmP.S. MY A1C levels were fantastic while on these dosages… never above a 4.6 in a year. Think these dosages were good or bad in the long term? I am afraid they were causing other underlying problems like my super advanced proliferative retinopathy in both eyes. Any ideas? Have felt better after being off of these meds for a year than I felt while on them and lost all of the weight they caused me to gain, as well. My eyes are fine after three eye surgeries and no more retinopathy issues since the last surgury in 2008… before my medical coverage ran out and I stopped all the meds. ANY IDEAS?
Posted by Candice | May 17, 2009 at 10:32 pmMy husband has been a diabetic since 1965. He is 85yrs old. Originally he was taking NPH, but in 2005 doctor put him on Lantus. He had an episode in 1992 (diabetic coma)where he bottomed out about 5am to below 40. He did make it, consequently he has had a fear of this happening for years. The doctor had him take the Lantus in the a.m. because he understood about the fear. Since then he has become a kidney transplant (has it for 12yrs), has HBP, High cholest. Takes 14 kinds of pills that add up to 20 a day. He now has bad dementia with terrible short term memory loss and night sleep anxieties. He is on the exelon patch and shortly will be on Namenda for combination theory. He has been hospitalized twice within 2 mos.as he his body is having fluid retention in lungs and legs. He weighs 156lbs..6ft tall…While in the hospital they took him off Lantus, which gave him very high BS. Could not get staff to understand he only reacts to the Lantus. Originally he took 13-17 units, but slowly have increased to 17-25 as his BS fluctuates, either low all day, or high all day. Watch all his foods carefully…Yesterday a.m was 91-85-102-136 (snack) low day…next day 80-72-145-128-212..30 day avg on meter reads 137…Have lowered his dosage to 22 units. Wonder if I should go back to 13-17…He has a very good appetite and eats well. Portion controlled. When he was in rehab for a week, all foods were carb controlled and his sugars were off the wall with Novolog. One days his readings were 139-279-297-324….Needless to say I pulled him out of rehab because they had no understanding of transplant meds. It has been an unbelievable turn of events in our lives. I guess I have not come to any point with you and maybe just needed to type out some of my feelings.
Posted by Roses | Jun 20, 2009 at 11:48 amHe has not heart problems..echo card..heart spec. has a very strong heart as they thought it was a heart problem when retention began. We have home care now and I try to get him to exercise other days, but very difficult as he could sleep all day if I allowed it. Thanks for listening…because there is so much more I could go on forever on this posting..with errors made in hospital and rehab center…
I would say that if 13 units had you running at 86 then you should more than likely stick to that and if you realize that you are running higher after meals then take like 1.5 with meals. the reason that the lantus seems as if it has peaks is because at different time of the day there is more or less glucose being broken down. for instance during the day my basal rates are a 1 unit/hr and at about 2 in the morning they are .6 units/hr. so it is natural that you will feel “peaks” because you cannot fine tune the lantus like you can a pump, and even on pumps it varies from day to day. but good luck with everything and i would say that if the 13 units seems to be working stick with that and then in a month if you determine that you are getting high throughout the day then go back to 15. good luck!
Posted by smileyR | Jun 25, 2009 at 2:08 pm