I would appreciate any help … I finally thought I had it figured out…my very low carb diet handled my pp numbers - the real culprit became my basal secretions either overnight (creating dawn phenomenon even when bedtime #s were perfect) or raising numbers in the afternoon if I went several hours without eating. So, I started Lantus - 30 U in the evening. Dramatic change on my overall numbers - they were perfect - EXCEPT that after a week or so my morning #s became dangerously hypo.
After some research online, I switched to 15 U am and 10 U pm - this worked very well… for about a month. Now, my numbers have started rising about 3 pm - whether I eat or not - so of course, no matter what I eat, the pp numbers are now unacceptable in the evenings.
What to do? Is it possible the Lantus isn’t even lasting 8 hours? Why else could this be happening? I have been exercising and slowly dropping a few pounds.
Thanks in advance for any assistance.
Should I switch to Levemir since it’s intended for multiple injections per day? Do I add other meds (I now only take the Lantus and Metformin).
Wow always nasty surprises when you are a diabetic.
Your 15 units of Lantus in the morning should last much more than 8 hours. Not sure what to do, can you up the morning shot to 20 or will you go low in the morning.
I am trying levemir for weight loss reasons not for BG control. Cant really say if it gives better control. My understanding is the levemir is a lot more expensive. was given a free sample by the Endo so dont know how much. also cant say if it makes you less hungry because I am taking meridia an weight loss pill. I feel less hungry but dont know if it is the insulin or the pill.
Or go to 3 injections per day ? Try a supplemental 5 to 10 units in the early afternoon.
Could also be you now need a pre-meal fast acting insulin. Usually it is asking a lot to have the slow insulins like lantus and levemir take care of meals. The slow ones usually release over 18 hours at least. So even 30 units divided by 18 hours is 1.6 units per hour not that much for a meal. The meal may need from 3 to 20 units depending how much your own pancreas is still working and how insulin resistant you are and of course how many carbs and other stuff you eat.
Hi Anthony - thanks for the reply. And you’re right about the “nasty surprises” - just when you think you have it figured out.
I did try 20 in the morning (should have mentioned that) - the rising #s in the afternoon still happened. I hadn’t thought about 3 injections - hmmm.
I don’t think this is about meals, however. First, I am consuming only 30 to 40 carbs a day - never more than 15 at any one time. Second, it is happening after 2 to 3 hours with NOTHING in my stomach. For example, today, my bs at 2 hours post-lunch was 129. 3 1/2 hrs later - with no food during this time - it was 173. I was then faced with either no dinner or taking my numbers up even higher.
By the way, how do you like the Levemir compared to Lantus?
The levemir unit per unit seems to be at least as good as the Lantus as far as BG control goes. As far as weight loss goes I have not yet lost a significant amount so I cannot vouch for that although my Endo said chemically the levemir should be better. could be big pharma hype or could be reality we will see.
The thing is that protein and fat also convert to glucose and they might need insulin to cover. Unfortunately we have only the choice of carbs, protein and fat. the less carbs we eat the more of the other 2 we need. The P and F will digest and convert to glucose a lot slower. You wonder if a regular 5 hour insulin would be good for a low carb diet. some people also end up with a slow emptying stomach I think the syndrome is called gastroparesis or something like that.
There is no harm in trying levemir except cost.
I never tried controlling my BG with long insulin only. I have used as much as 50 units of slow with 15 units of fast in the past and done ok control wise but never 65 and 0. I have done ok injecting the fast insulin in small amounts: 2 units ever 2 hours when I ran out of slow. Tedious but it works.
You can up the dosage of slow quite a bit but be careful you may go low at some point in the 24 hour cycle. Keep some sugar pills handy
Thanks for your advice and input. Lots to think about.
Funny thing is, my morning (fasting) BG are fine.
I read about gastroparesis but I understand it’s rare. Is there a test for this?
I need to learn a bit more. Gotta figure this out.
I had better control switching to Levemir. Levemir is less expensive, plus it lasts longer at 5 weeks, compared to Lantus’ 28 days–an added plus!
One thing to check is if your Lantus has expired. I found it markedly losing potency at day 26 & kaput at the 28th day.
While Lantus doesn’t last the promised 24 hours (which you found out), it does last 8 hours. Are you doing a lot of exercise in the afternoon? For some people exercise raises BG & then lowers it hours later. Works this way for Type 1’s, but don’t know the effect on Type 2’s.
What are your post meals numbers?
You may need bolus rapid acting insulin to get those numbers down, if increasing your daytime Lantus or Metformin doesn’t do it. Or Regular insulin, which works not as fast if you have gastroparesis (yes, there are tests for this). A third dose of basal won’t help.
Hi Gerri - OMG - do you mean the entire package expires after 28 days (this was my first batch)?? I thought each individual pen was good for 28 days after being opened. If it is the entire package - the pen I’m using (last one in the box - just took it out of the frig a week or so ago) is almost 40 days old. Yikes!!! If that’s it, I feel like a dope.
Whew!!! That’s a relief. Each pen is lasting about 2 weeks.
I am going to switch to Levemir, though - mostly because it isn’t intended to last 24 hours anyway and evidently some people notice a difference in weight control. So far, I’m holding my own - but with the low carb diet and daily exercise, I should be losing. But, I’ve only been back to training for a couple of weeks - I had a bone spur in my foot that kept me out of action for about 6 weeks.
I understand the spikes after exercise - but that only happened to me while I was taking a Sulfonylurea - hopefully, I won’t have to do that again. Now, when I exercise, I have to watch going too low and always carry a couple sweet tarts with me.
So, this has only been happening for about 5 days, so I will stay on top of it until I figure it out.
I also need to check into testing for gastroparesis. I also have a C-peptide test coming up.
Since it’s only been for five days it could be anything & not necessarily related to Lantus–hormones, stress, lack of sleep, you name it. You could try raising your daytime Lantus slowly by a unit at a time to see if this makes a difference.
As a Type 1, I can eat nothing & see BG rise. In fact, eating nothing when I skip lunch makes it worse.
Seems that from what people here have shared, that Type 2s go down from exercise & many Type 1s go up for a bit & then low.
When I was not on insulin my BG would really spike with less that 1 hour of exercise moderate mountain biking more that and they would start comming down slowly and never hypo. still the same unless I inject a lot of insulin before exercising then I could go hypo.
I can’t do really strenuous exercise without huge spikes, so I just don’t. I hate those highs! Sticking to moderate stuff these days–long walks, some weights & short aerobic.
Gerri -
That’s where I’m at. I walk 1.5 miles a day, I go to the gym everyday doing moderate rate of aerobics on the bike, and then the weight machines (switching upper/lower body every other day), and finally, I try to ride my 10 speed every day. I have found, though, that if I increase intensity slowly, over time, I don’t get the spikes.
