Hey everyone,
I’ve never really noticed until recently, while trying to gain better control, and now using the Dex, I have been having a pretty significant drop 3-4 hours after taking my Lantus in the morning and at night. Its enough that I have to take a unit off my Humalog shot compared to eating around the same time of day without the Lantus.
I typically do eat at the same time as the Lantus, but I’ve had a couple times recently where I haven’t, and its been enough to drop me by a lot. With nothing else weird going on during the day, food, exercise, odd rise or fall, on one occasion, it was enough with only Lantus to drop me from 188 to 41 in about 3 hours.
I have made some Lantus changes lately, but didn’t think they were that drastic. Does this sound like too high a dose of Lantus? I would have more expected lingering or recurring lows throughout the day if it was too high a dose. This seems to be more of a single episode with a quick onset, behaving more like the action of fast acting insulin. I know there is some peak with the Lantus, just don’t ever remember it being this drastic.
Lantus has a variable activity curve even though it’s long-lasting. The worst hypo event I’ve ever experienced I think had at least partly to do with that. I find the flat activity of Levemir better for me for baseline (I bolus w Humalog) and I never really liked that every dozen Lantus injections seemed to feel weird or bad, which I assumed resulted from its in-situ crystallization process.
I’ll keep Levemir in the back of my mind. I just started the Dex in June. I’m considering going back to a pump. I was on a pump about 12 years ago. I know they’ve come a long way since. I used to dread infusion set insertions, and am still a bit hung up on that, as well as some vision issues which make pens potentially a bit easier. Still weighing my options.
the sets they have now are painless, such as the Sure-T. No occulsions (well, maybe I will have one in a year or so), very short needle, very THIN needle. they are so painless sometimes I end up wearing two of them until I see myself naked in a mirror and see that I’ve forgotten to take the previous one off.
Haha…I could see me wearing two sets. I used to use the Minimed (Medtronic) silhouette sets, and they were fairly long for me to manually insert, and I’d sit there for 45 minutes or more just trying to build up the nerve to do the insertion sometimes. I think I’d still prefer the manual insertion. I’m a control freak like that about how fast I inject, but I’ve been kicking around trying out one of the shorter straight in sets. I see at least Animas has a 6mm, which is only as long as the syringes I had been using before the pens. Still trying to convince myself to give it a try again.
I can’t tolerate Silhouttes and don’t know how anyone can. They are creepy-long and painful to insert. My Sure-t’s are the 6mm ones with 32" (a stretch. MM is lying a bit on the length) tubing. I didn’t like the Quicksets either–irritating and they would occlude so often I nearly quit pumping. Same with the old Soft Sets.
I had many near death experiences with so called basal insulin’s. My worsts days where on NPH, Lantus was also a big problem for me at night I would go low 2 or 3 nights every week around 3-4am. My Lantus® dose would vary by 30% and it was imposable for me to achieve reasonable BG targets. I was only in target range about 40% of the time using long acting insulin’s. I can stay in target range 75-90% of the time using a pump and I no longer have low BG events in the middle of the night (only if I make a mistake). My best Results:
I would stay up at night until 11pm to take my night time Lantus so it would peak when my DP was starting and this worked the best but it was still not reliable and I hated not being able to go to sleep before 11pm.
Everyone now has a 6mm set in plastic or steel, I use 6mm QuickSets and a 13mm Silhouette depending on where the insertion site is. I’m allergic to steel sets like the Sure-T or the old bent needle sets and reject them on the first or second day, they instantly become sore and uncomfortable.
Pumping insulin is the “Gold Standard” for intensive insulin therapy…If you want the best there is no other way…
Silhouettes (Comfort Shorts) are the only infusion set that work well for me. I have manually inserted them for ten+ years. I use the shorter length and insert them at a shallow angle. I have very few set failures-maybe one a year. I have tried just about every 90 degree set. I get pain with them and lots of failures. I have tried QuickSets, Mio, Insets, Cleos, and the metal sets. The slight pain of inserting an angled set is worth the three days of reliable insulin flow with no pain.
I appreciate the info on the sets and take some comfort in knowing others have so much trouble with Lantus. I’ve never realized people have such a difficult time with it. As I’ve really tried to tighten things up the last few weeks, its been like there is no rhyme or reason for a lot of readings with the same food, activity, etc from day to day. Starting to make a bit of sense now. I have struggled with doing what I should for control up until the past year, and prior to that, I was on the pump. Before the pump, I was young, and my parents took care of the shots, so I don’t really have much to base how difficult Lantus has been compared to anything else.
I will say, when I was pumping, for 5 or 6 years, I probably only had half a dozen sets actually fail, if that. It was a very rare occurrence for me.
Pumping has many advantages, but the one I will mention now (since you mentioned Lantus issues) is that you can do temporary basals whenever you would like to compensate for activity or for sickness, cortisone shots, etc, etc. I use a temporary rate every day that I do sustained outdoor activities like hiking up mountains. Once you take a Lantus shot, you can’t “back it out” for a few hours. With a pump, you can reduce your basal rate one or two hours prior to anticipated strenuous activity, to keep you level, safe, and sane.
I used temp basals quite a bit when I was on the pump in the past. I was very active in my teen years, working in the yard, wrestling the rototiller around the garden, among other things. I really do miss that kind of added control, as well as multiple basal rates.
