Going low after changing back to MDI

My 18 year old daughter has decided to take a pump break after 10 years. We started Lantus about 4 nights ago. She takes her dose at 10pm and has been having low’s in the 50’s between 3-5 am. We have been backing off one unit a night to see if this helps. She seems to be higher during the day because of that.
She just had another low of 55. She checked before bed around midnight she was 300. I read lantus can peak around this time, and a lot of people split doses. I called the endo today but didn’t get a call back so we are stuck until Monday. She also wants to switch to Levimir since the Lantus burns quite a bit. Any suggestions? This is driving us crazy… :wink:

That actually seems a bit early to go low with Lantus. Most people would not experience lows until 5-10h after injection. Lantus absolutely needs to injected into your body fat layer (subcutaneously). Is it possible that you misinjecting (or partially misinjecting) and are injecting lantus into muscle? The burning is a signal. There are very few nerves in your subcutaneous fat layer and you should not regularly feel burning. And being high during the day may also be a signal that the Lantus acted like a rapid and wore off quickly and she had no basal during the day. Check your injection technique, pinch up very well and if your daughter is lean help her select sites that have adequate bodyfat. Reserve those sites for basal. You can inject meal bolus and corrections basically anywhere.

Many people take their dose at night to try and fit the peak into overnight, but you may find it better to take your dose in the morning. You certainly can split your dose.

I will certainly go over that with her and make sure she is choosing a good sight for her Lantus.

You said most don’t experience low’s until 5-10 hour range. The time frame of her going low is 5-7 hours so that fits it to what you said. Did I misunderstand?

Lantus burns for many people even when it is injected into subcutaneous fat. And for many people there is a distinct peak of action (exactly when it occurs varies from person to person) and its duration of action falls significantly short of 24 hours. If my daughter ever decides to take a pump break (and I fervently hope she never does) I’d want her to use Levemir twice daily. (Along with the Apidra she is currently using in her pump, of course.)

Many, many people report that Lantus does sting regardless where it is injected. It’s one of the (admittedly minor) reasons why I chose Levemir, which has always worked like a charm for me.

Action profiles of basal insulins vary, just like everything else concerning diabetes. Those published results can only be taken as guidelines because every physiology is individual and behaves . . . however it behaves. The “traditional wisdom” is that Lantus has a flatter response and that Levemir has a slight bump several hours in. But those are averages; your results may very well vary.

For me, Levemir’s action is as flat as can be. And yours is not the first report I have heard of uneven results with Lantus, either. So . . . it does what it does.

There is one other thing to consider. With bolus insulin, the size of the dosage can definitely influence how smooth and even the action is. Smaller doses tend to behave in a more predictable way whereas larger ones often exhibit greater inconsistency. Bernstein refers to those large doses as “industrial doses” and recommends splitting a really large injection into smaller ones (at different sites, of course) for more consistent action. I don’t know for a fact that basal insulin can behave in the same way, but it would not surprise me. NOTHING about diabetes surprises me :wink:.


Me too. :slight_smile: Lantus burns! Fortunately, I’ve not had to deal with that for a few years, because my one year pump “vacation” didn’t work out well enough to continue on MDI…

I’ve been on Lantus and it definitely burned at times. I split my dose and it seemed to help with some of the highs and lows (it seemed to peak for me, and also did not last 24 hours). I think I’d try Levemir if I ever wanted to take a pump vacation.

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I am on a pump but when I used Lantus, it would peak about 5 hours later and cause a drop around 30 points. I would typically offset the peak by taking less insulin for a meal. So that is one idea for your daughter to change the time of day when she takes the Lantus such that the peak occurs during a meal-time. Splitting the dose never worked for me.

i would switch to levemir! i endured lantus-burn for a couple of months and then got levemir and what a difference. i would put off doing that lantus injection until i was getting into bed. it would burn for ages sometimes. i split my levemir dose am and pm and it works great! yay levemir!

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I’ve been on Lantus since going on insulin about 2.5 years ago, and it burns about half the time. The burning or pain doesn’t last long for me, though, and I only need to inject once daily, so I still find it preferable to having to jab myself an extra time with Levemir.

When my endo set my initial dose of Lantus, I discovered that it was too high for me and I had to get up in the night and eat to avoid going low. The dose he suggested would probably have had my bedtime and waking BG be about equal - provided I slept in until about 7 or 8:00. But I have a pretty strong dawn phenomenon, which starts at about 4 AM. What I found out I needed to do was back off a couple of units so my bedtime and 4 AM readings were about equal and I didn’t go low or have to get up and eat. My BG sometimes goes higher than I like on days I sleep a lot later, but at least I don’t go low in the night. Does your daughter have a strong dawn phenomenon that you need to consider in setting her dose?

My best guess from what you’ve said is that splitting the dose might be an answer for her. But I want to ask about one more thing. It isn’t too likely, but it might be something that should be ruled out before assuming that the problem is basal dose related. She hasn’t just recently (about the same time as starting Lantus) started much heavier exercise than previously, has she? A person can have a delayed low from unusually heavy exercise.

I have read that Lantus burns for a lot of people. We just don’t have much experience with it. We only had it on hand for a back up in case something happened to the pump, and maybe only used it 3-4 times in the last 12 years. I requested Levemir from her Doc, but we are still waiting on that. She really wants this to work…

So if she splits her dose, would she start with half at night then the other half 12 hours later?

This all makes sense, that’s why lots of medication is split into multiple doses in the first place…I think we will try it until we get the Levemir.

Your daughter’s lows around that time are similar to what I was experiencing - even timing-wise. I had to split my doses,. but even with that, since Lantus levels off over time, my patterns or lows returned 3-4 days after any changes I made (giving the levels a change to flatten out)… For me, the answer was to switch to a pump (I hadn’t had one before) – but I know in your daughter’s case, the whole point is a pump break…

For me, the split was not exactly even - I spaced them 8 hours apart, with slightly less in the evening than the morning – but only experimentation will determine the best approach (if any) for your daughter.

PERSONALLY, I wouldn’t do two doses of Lantus 12 hours apart. Proceed with caution and if it works out well, so be it!

I have read a lot of people doing that on this board. Why did you say hat you wouldn’t do it?

Thanks for the advice :wink:


I use Levemir, so I have no direct experience with Lantus. When I started using Levemir, I did one injection a day. I quickly found that (for me) that gave too uneven a response through the day. So I split the dose in two (morning and evening), and the action is now flat as . . a pancake, or Kansas, or whatever your favorite “flat” analogy is.

I know other people who have experienced the same thing, with both Lantus and Levemir. I also know people who get superb results with a single daily injection. So the bottom line is what it always is with diabetes: your results may vary. The only way to KNOW how something will work out is to try it and see. Diabetes management is first and foremost a pragmatic art.

Because it is likely that using a product such as lantus which for many, works for about 20-22 hours, is going to have a couple of peaks (think of it as “stacking”) if you take two shots, 12 hours apart–that’s why. KISS. I don’t want any nasty surprises with long-acting insulins and things are dicey enough for me anyway, when I went from a pump to MDI for a while. I’ll never do that again!

If you want to try it, then by all means try it, but I suggest testing frequently and reducing your total daily lantus until you see if you get some nasty peaks from taking 2 shots. Once you inject long acting, there’s no removing it. :slight_smile: That’s why I like pumping so much better.

I vote for a Lantus split. Lantus split was the only way it ever really worked for me - 18u in the AM and 15U in the PM.