Basal and overseas travel- mdi

Hi guys! Another travel question...sorta :) Heading to chicago very soon now, good times! Leaving here (west australia) at 5am on to sydney then to dallas then miami for a week, then chicago for 3 weeks.
As im still on mdi, my question is related to timing of basal dose. I usually hit the lantus at night only. My D educator said to dose as per normal times, however theres a good chance i may have to take up more, but not to worry about split doses etc. Her explanations werent too clear to me as she started to rattle off 'adjust by 2 units extra only' etc, however what i understand is if i wear a 'perth time watch' and just dose according to my normal times, i will end up dosing in the mornings instead in the States. I guess im looking for confirmation that this is a sensible thing to do? I think the 'perth watch' helps till im in the states and i can just start dosing in the am upon waking (12 hrs behind me here)?

Have a good trip, Timmy. Long way to anywhere from Perth!

Maureen, Swan Valley

If Lantus would act equally over 24 hours this would be easy. You just continue to inject at the same west australia time in the states.

The problem is that the action of most insulins does not unfold equally. In comparison the Lantus activity is more equally distributed but we have seen reports of users claiming that the action was higher in the first 12 hours after the injection. This could lead to lows but this could even be used to fight metabolic reactions like the dawn phenomen. Possibly your daily metabolic cycle and the Lantus reaction curve is in sync. If you stay on your current pattern in the states you would get out of sync so to speak. This could make you more prone to lows at times you do not expect. Or it could cause unexpected highs. Another potential problem is the Lantus gap around the injection time. It is unlikely that Lantus will be as potent around the injection time as it is 6 hours after the injection. It will degrade and this can lead to a gap in coverage after dinner (if you inject before going to sleep). Sometimes odd I:C ratios at dinner will indicate that more bolus insulin is needed. The additional insulin will then be used to cover the Lantus gap/degradation. Obviously this has all sorts of negative implications but this must not apply to you.

Just a thought: potentially the I:C ratios are more synchronized with the basal pattern than we might think. As a result it might be recommendable to stay on the basal pattern of australia AND use the I:C ratios of australian time. It would be interesting to hear the thoughts of others on that.

I always prefer to adjust my pattern to the local time of my destination. One week before my trip I start to gradually shift my injection time - one hour per day. I am using two shots of Levemir (every 12 hours as recommended) and this makes it easier to adjust. Usually I just have to shift +/- 6 hours. In your case it could be +/- 12 hours at max. Another advantage of splitting the dosage in my opinion - in addition to all the other advantages.

To clarify, do you think its possible that even though its a basal, my injecting in the morning i may be prone to more lows during the day? Thus come night time, when i wake up, my bs would be conversly high as a kite. This would be a terrible scenario as i exercise like a fiend during the day, basal lows would be hard to deal with on top.

edit- it wouldnt be possible to keep the bolus the same as aust time, i would be injecting all night US time and not eating anything?

bloody long way! Swan valley eh? wine territory :)

Yes, but it depends on the group you are in. Definitely some TuMember have reported that they tend to go low at night from Lantus. To argue the other way around the Lantus was more present when their needs were the lowest (usually around 3am at night). These users often shifted their schedule to the morning. Obviously the Lantus is not equally distributed for them but with the new schedule they compensate that.

Your current schedule with the injection at night works for you. Thus I would suspect that the shift to the morning might make you more prone to lows in the middle of the day. Derived from logic you would then have a coverage gap/degradation in the morning before the injection amplifying the natural dawn phenomen. Furthermore the transition from night to day is not that easy for you. 1/2 of the usual dosage the night before and then the normal shot in the morning. This will be a bit bumpy because Lantus is still a ~22 hour insulin - even at low dosages. So there will be some sort of overlapping that needs your attention.

About the I:C this was just a theory that it might be recommendable to continue to use the I:C ratios of australian time if you keep the australian basal schedule. Not the same time to eat but the ratio from the time. Let me explain: you eat at normal US times but to determine the I:C needed you take the I:C of the australian time. The reason is that your I:C might be more adjusted to the shape of the basal insulin than the metabolic changes due to daytime. Again, just a theory of mine that is only based on the possibility that basal insulins might not act evenly and people do adjust to that with their I:C. I hope this makes sense.

I usually switch to "destination time" when I leave, like in the airport or even when I eat at home before we leave. The sticking to the schedule idea seems crafty but, since you are staying for a while, maybe see how it goes and just flip back after your circadian cycles get reset? Maybe to switch, you could take have the dose in the US AM and 1/2 in the pm and then next time around hit it all at once? I haven't actually done this as I've only gone a couple of time zones at a time.

Perhaps we can meet up when you're in Chicago? Are you staying downtown?

ill be in portage indiana but will be in chicago a fair bit! hiring a car, should be interesting! but would be good to catch up :)