Help! I need Somebody! Anyone?

First topic here is a semi-nonD subject to get you in the mood for what you about to read. It involves a baby and stuffed toys (they weren’t hurt seriously) – aka Iron Baby and with PWD blogger Kerri Morrone Sparling having popped a bun out of an oven recently, I just couldn’t resist maybe suggesting her daughter call up Patrick Boivin (from Montreal) to ask him to put her in his next “flick”. Even better, is the video he made of the future of air travel – wait – where’s my pump supplies???

Okay, on to my quest of the week as I figure out how to fix out my basal rate with my Lantus. I do love a challenge, oh yes I do!!! I’ve been trying all this week to get help from my endo (endocrinologist); last attempt today was sending a fax, trying to call a few times. I’m getting his assistant saying a voice message, and no, they don’t take messages, just call back later I’ve tried this a few times, not succeeding. I'm giving up, as I know they close up shop shortly, and on Fridays's they don't take calls. Sigh.

During the night, as I did a basal test, pigging out abit on sweet things as I coped with BG’s in the 2-3 mmol/l (36-54 mg/dl) range. My brain was just ticking away with how to figure out what to tweak with my Lantus shots I’m doing twice a day. Many suggestions from people who presently are successful on MDI (multiple dosage injections), but alas, they use Levemir as they say Lantus gave them lows like I am experiencing. Go back to my blog of last week at and you’ll know why I’m back on Lantus again. It seemed to be serving me well before, but now I’m facing these fun brain challenging lows. Sometimes I think being high – 8-10 mmol/l (144-180 mg/dl) - range isn’t maybe so bad.

Today, I decided that there must be an overlap in when the Lantus meets up with the previous shot. I’m not exactly doing 12 hour segments – it’s more like – 23h00 and 09h00. As I type this up, my basal is not working; I’m in the 13 mmol/l (234 mg/dl) range. I could handle 8 mmol/l (144 mg/dl) but 13 is a bit high for me, and it’s way past when I ate and gave my shot of NovoRapid.

So, today, I’m going to post this blog in all the D forums I belong to and see if I can get any help/comments from experienced MDI folks. I know you are out there and very successful with your control! Any suggestion is helpful, as I try to figure out what’s up with these morning lows (and yes, I have a snack before hitting the hay – endo had told me to do this with Lantus – never did this when on the pump). I swear I’m going to gain weight after going MDI – but it’s all for the cause man – all for the cause – as I figure out a way to make this MDI experiment of mine work. I have to admit, I really don’t miss being attached to a machine 24/7 – just wish I could have as good control as I did with the pump!

Help! I need somebody! Anyone?

Ok, not only is your Lantus stacking, your fasting acting meal time insulin can keep working 5 or even 6 hours in your system and contribute to the problem. That may be something you haven’t factored in yet. Makes for some real fun at 3:00am doesn’t it?!

Another factor is insulin resistance. Where are you injecting? Do you rotate sites? How long have you been injecting in that area? Switching to an entirely new area may help, because insulin resistance can cause things to slow down, and may end up with more stacking.

I was on Lantus for a year or two and did very well, until I started having lows at night too. My morning reading was slowly creeping up, yet I’d get these awful lows that woke me up or I’d be unable to sleep at all.

I dealt with mine by increasing my morning dose and decreasing my evening dose, SLOWLY. That seemed to help balance things out better.

Things got worse again, so I tried increasing my bedtime snack from 15 carbs to 20. It helped, but I still had some lows and I was concerned about other factors so I switched to Levemir (less risk of lows, less weight gain, less peak, less risk of cancer).

If your injection site is warm or hot, you probably have a mild infection. Make sure you wipe down with alcohol first and let it dry completely before you inject. Its the rapid drying of the alcohol that kills germs, not the alcohol itself.

These warm or hot injections may be doing no good at all (the insulin won’t work) and they will even raise your blood sugar, because that’s what infection does, as I’m sure you know.

I have never had Levemir cause heat or swelling, even though I’m one of those people with dozens and dozens of allergies, and I get a lot of problems with swelling and hives. If you got swelling and heat, I really think its a mild infection your body is fighting at the injection site, rather than an allergy.

If it was an allergy, this would happen every time and get worse every time. Using a fresh needle tip every time also helps prevent infections. I know its more expensive, but I have had a couple of really nasty infections, and its just not worth the risk, because no matter how careful you are, you are putting yourself at risk. Now I use alcohol every single time, and advocate using only fresh needles.

I hope you find a solution,
good luck!

it’s so hard to say, since we’re all so different. when i cut back on carbs, i cut my basal from 14 units at bedtime to 6 (I actually did it by mistake. i meant to switch to a split morning/evening schedule, but after taking 7 at night, forgot to take it the next morning and realized I was staying almost flat the next day). I haven’t gone low overnight since then, and I can go w/o food for hours during the day and stay completely flat. I do not have a pre-bedtime snack anymore either. When I was on a higher dose, I had to snack throughout the day to maintain level sugar.

It may be a challenge, but you’re right to put in the time to figure out your basals. It’s made a big difference for me.

Not sure this helps as it’s very specific to me, but maybe it gives you some ideas.

I am on MDI and have been for for over a year. My ENDO has me on one shot before bed currently I am at 40 units Lantus. My fast acting is Novolog and usually shot less than 10 units total for the day. I sometimes experience lows between 2:30am and 5am but have not been able to figure it out. I do Low carb no carb so my swings are not big. My last A1C was 5.5. Currently I am fighting a prednisone shot yesterday in my knee and it has me all over the place. My number should go back to normal Saturday.

I had the same issues when I was on Lantus, what I did was work to eliminate the middle of the nite lows that are a result of too much lantus, If I was going to have a low, I wanted it to be at a semi-predictable time, the trade-off however is that I had to correct high sugars more often. It might be possible to get rid of all the lows, I never really tried that tho

The lows from lantus are very insidious, they come on very slowly and if you are the slightest bit hypo-unaware they are very easy to miss

Good Luck!

Since you dropped really low during the night with your basal test, that means you were taking too much Lantus before bed. John Walsh says the overnight basal is the most important & you should work on that first (you know, he has a Using Insulin besides the Pumping Insulin). You don’t want to make big adjustments & it is better to adjust about 10% then wait 48 hours before adjusting more. I do know some people that manage on Lantus & don’t take it at an even 12 hours.

I could never get Lantus figured out but I was also only taking it once a day. I always dropped low at night and if I cut back, I was too high during the day.

On MDI & used to take Lantus. When on Lantus (same now with Levemir), I took 2 doses–one immediately before bed & the other upon waking. So, my schedule is like yours. I didn’t experience stacking perhaps because of my dawn phenomenon. If I sleep more than 8 hours, or don’t take basal first thing in the morning, my fasting is really high. My endo said I overslept my insulin; it was gone. I take slightly more basal at night than I do with the morning dose.

Using Lantus & Levemir, it took months to get my overnight basal close to correct, well as close as we can hope for:) I only raised/lowered by 1-1.5 units at a time (I use syringes with half unit markings) & kept a new dose the same for 3-4 days before making another change. Slow, incremental adjustments give a better picture. My problem with Lantus was afternoon lows.

My endo actually called me up in the evening from home. I’ve never had that before (actually - never had to go to endo for help before - this is a first). His first comment was, and he was chuckling “You are a diabetic mentor - you are coming to me for advise?”. I told him, I am not an RN or CDE, I’m just a gal living with diabetes and I need your help. He then told me what I was thinking, that stacking of insulin is maybe occurring. Today, I’m sticking to same regime of yesterday, splitting Lantus shots over 12 hours (23h00 and 11h00). Reduced p.m. Lantus by 2 units, now at 6 units, but woke up to 2.9 / 52. What’s got me abit scared is usually I know when I’m low, and for some reason, with these lows for past week, I don’t wake up. Luckily, I’m still coherent (I just tested / ate 1/2 an hour ago so going up as I type this out) - but still - as most of you know - hypos are DrAiNiNg on the body, just like hyper (high BG’s) are.
Anyway, will see how it goes today. Trying to get the basal rate of Lantus (basal) to work more efficiently during the daytime. Again, as some people have told me … “Go back to the pump, you had no problems”. I will, eventually I think (I forked out enough for that sucker). It’s just I want to be able to do MDI as well as many of you other diabetics do. If you can do it, I know I can :slight_smile: It’s just taking abit of tweaking / patience (something I don’t have). Usually for myself, diabetes works in the background, and I don’t really even think of it (again, the pump does make it easy BUT am sure MDI folks would say the same thing - and I want to prove them right). Right now, all I think/breath is diabetes, it’s almost like I’m a newly diagnosed diabetic despite being one for 43 years ! I now know what it’s like to be newly diagnosed, it’s not fun, not knowing what is happening, trying to get help (took 4 days to get a response from endo - who now wants me to report back to him weekly until I see him face-to-face in mid-July).
Still wish I could use Levemir tho’ - he didn’t say much when he read my blog about that (he said he had read it). He said he’s not heard of many diabetics having the reaction that I did to Levemir.

BTW, the lip picture in my blog I reference to for my allergic reaction to Levemir - is not due to the insulin - just some freak of nature of me wanting to be a L’OREAL lip model - it only last for about 12 hours - then prick - deflated lips - back to normal pucker again.

Hey Anna,

Hoping the 12 hour split works. You know how it takes more than one day to really tell what’s happening. Am sorry about your reaction to Levemir. Sarah has mentioned not being about to take Levemir either. Lantus was a royal pain for me. I could fell myself bottoming out at the most inconvenient times. Yea, well like it’s ever a convenient time:)

You can definitely do it! Never had a pump, but it seems complicated from reading about all those settings.

Here’s my input for what’s it’s worth. I am still pretty new at Club 1, dx’ed aug./08 at age 52. I am on MDI and they tell me I have good control as my last a1c was 5.8. Here is what works for me. Lantus, yes 30 units in the morning for me, never tried to split. To figure out my basal I did a few 12 hr. fasts, now my bs doesn’t go up or down more than 20 mg/dl in 12 hrs, actually got it about + or - 10 mg/dl. The rapid (Novolog) took a little more. I stuck to a basic food to find my insulin to carb. ratio. I ate sandwiches, grains seem to hit me, that’s why I bread was my choice. I started at 1 unit for 15 grams carbs, when i figured out my ratio it was 1 to 7.5. The last thing I try to do is inject about an 1/2 hour to an 45 mins before eating and this keeps my post meal bs below 180 mg/dl, most times it’s about 140 mg/dl at 2 hours. Hope this was some help!