I need your help on this one!

i take extremely good care of myself, especially the past two years. i eat very healthy and run each day. i was using the omni pod for about 4 years…its a really great way to manage carbs and insulin, but i felt like i needed to take a break. i was a few weeks into the bernstein diet, seeing great results! my numbers were almost perfect! but i was having constant omni pod issues - broken pods, detachment while exercising, things like that. since my numbers were good i asked my endo if i could come off of it for at least a month and go back to shots. (lantus and apidra). on the omni pod i had been taking about 24 total units daily and still finding lows, so i was put on 18 units of lantus and an apidra pen. it is my second day and i find myself in the 200s, i HATE that feeling, i feel like i am destroying my next A1C. I see a lot of info on here about splitting a lantus dose in half, does that help the numbers? and i also saw some info about lantus and weight gain, really hope thats not true, but if it is then i would like the details! thanks so much. if anybody has some advice or feedback.

I would wait 3-4 days before making any changes to the Lantus. Unlike with rapid insulin in a pump, the long-acting actually hangs around a bit longer than 24 hours (or however long it seems to work for you)… while the “bulk” of it is done working, some is definitely still active for up to 72 hours, which is why it can take 3 days to see the full effect of any dosage change… or in your case starting back on it. I have documented this time and time again… I need higher doses of Lantus the first two-three days when I return to MDI, then much lower basal rates (as much as 30-40% lower) once I switch back to pumping (24 hours after my last Lantus dose, of course) for a few days.

Just try to treat the highs with rapid as they occur, and things should smooth out a bit in a couple of days… if they don’t, then you could consider upping the lantus, or if you notice a pattern where you have higher #'s at certain times of the day, you could consider splitting the dosage since that could help, but if you pretty much feel like you are just running higher all the time, I’d wait it out and see if all you need is a couple of days for things to settle down first.

I never gained weight on Lantus… even when I’ve taken longer pump breaks, and I do use more (basal) insulin on MDI then when pumping… so I wouldn’t stress out too much over that.

thank you so much for this response. i will wait out the next few days and see how things play out. my daily pump dose was 24 units usually so i figured eventually i may need to bump up the lantus to 24 units. i just hate the feelings i get from running high, emotional more than physical. thanks so much! glad to hear you didnt gain any weight with lantus. i have spent the last year working so hard to lose 20 pounds, i finally did it and i will NOT go back.

I split my lantus 66% in the morning 33% in the evening, I had been taking it at night but having lots of lows. The split seemed to smooth everything out. Were the 24u total for basal or is that including bolusing? I was taking 60 or 70 units of lantus and when I switched to the Pod I dropped my basal totals to 38u. The Pod was much more effective in using insulin. With D it seems to always throw me a curveball when I think I have it figured out. I just keep adjusting and adapting.

thanks for the reply seth! i am thinking of doing the split, i have been taking the full lantus dose at 6 am. sugars are stuck between 180 and 280…yuck. my 24 units on the omni pod were usually all basal. i never found myself needing to bolus much, i eat a very small amount of carbs and i use exercise to cover for that. my numbers are usually A+. part of me thinks i should just go back on the pod entirely, but i would love to know that i have the option to switch between two regimens. sometimes the pump gets so frustrating! but shots seems to be equally as difficult so far. i think i should give it a few days. but i am also thinking of upping the lantus to 24 since thats what my total basal was…i feel that would make most sense. i guess i need to run it by my endo. and the split may make a big difference in sugar levels?

I changed my lantus to a bidaily almost right from the start. I’m doing 16/14 split morning/night and that works well for covering workouts and not having nocturnal hypos.

do you find weight gain with lantus?

I am trying to gain weight, so I'm pry not the best person to ask that. I lost 40 lbs (20% of my bw) before I was dx. I have put about 20 back on and it's a struggle for me to hold that even with my huge diet. I am just now starting to put on a little fat, but still not much. My lantus dosing is tied directly to my bw. For every 2 lbs I add I have to bump my lantus 1-2 units.

Keep in mind what Seth has suggested, the insulin absorption and effectiveness between the pod and lantus can be very different. You may need substantially more than 24 units of lantus for your basal. Walsh in Using Insulin provides some guidance on how to increase your basal. Until you get close, you may be able to increase your dose in steps of up to 20%, but you should check with your doctor. In either case, marked changes in lantus can take several days to equalize, you can’t really change it every day. As Sarah notes, it is best to observe over 3-4 days and see how it plays out. In the meantime, what you should be doing is correcting to target with apidra for every meal (in addition to your meal bolus). Don’t expect the Lantus to just bring your down. The amount of lantus required to bring you down from running high will be markedly more than your basal.

I’m on an extended pump vacation (almost 3 years now) I didn’t get weight gain from lantus. I recently switched to twice a day too because of lows in the early. It smooths things out and gives a little more flexibility. I’ve read elsewhere on this site and experienced it myself but with lower doses of lantus (around 24 or under/day) lantus doesn’t seem to be that smooth over a 24 hour period, but since splitting it’s a smoother absorption.
Also with pens/needle injections, you may not always fully absorb the amount intended (esp. compared to pump). So make sure to leave in after pushing down…though for me even after leaving in etc. there’s also a drop or two that’s coming out from the pen…so for that reason you may end up taking more than on the pump (though the amount actually absorbed may be the same…)

Have you used Lantus before the OmniPod? Was your control good then or was it the reason to switch to the pod? If it was worse then it might be better to choose another basal insulin. Of course you could evenly split the Lantus dosage to cover 24 hours. But to have just one injection per day with Lantus is its main advantage. If splitting is necessary you can better switch to Levemir. It should be applied twice a day (evenly split). With this pattern you will have only small spikes and the reaction curve of both shots will nicely combine to a smooth basal coverage for 24 hours. Please ask your medical team about it. It is very valuable to try different insulins. It just takes a vial and one or two weeks of adjustment. For some people different insulins will not work as expected and this is likely related to genetic and or metabolic differences. But if you find the basal insulin that really works for you this can be life changing. The only thing not to try is one shot of Levemir per day. The reaction curve clearly indicates that one shot is not sufficient. The dotted lines show Levemir the solid line shows NPH (with its nasty peak):

I was on Lantus with no weight gain & also follow Dr. Bernstein. Don’t know if that was a factor because it’s hard to gain weight eating low carb. I took split doses of Lantus (pretty much 50/50) because it didn’t last near 24 hours for me & I had consistent afternoon lows.Lantus has peaks. Because of dawn phenomenon, I took one dose before bed & another in the morning. I argued with my endo (they all seem to love Lantus, must be marketing) to change to Levemir & glad I did. I’m doing far better on Levemir. It’s more level & doesn’t sting.

To echo what Xanthasun suggested, it could be the pen.

thanks! yeah i m going to look into levemir too. bernstein diet is what really keeps my numbers stable. what is your short acting insulin? i use apidra

i have often thought about switching my short acting insulin, i am using apidra now and it i supposed to be faster but sometimes it doesnt seem to fully work, despite all of the changes i make to my doses.

I use Apidra also.