Ok, so I just got into an argument with my mom about this… I just want to make sure I’m not insane here…
Usually, when I go to bed, I’ll eat about 40 carbs, take my Lantus and go to bed. The past 2 nights I stayed up late (yay summer vacation!) but I still took my Lantus and ate around 11:30ish like usual. At 1:30 AM I checked my blood sugar and I was 240 the first night, and 222 tonight. My bloodsugar was decent before I took my shot on both nights (150s) My bloodsugars in the mornings have been normal, so I’ve been thinking that maybe I’m taking too much Lantus if I have to put my BG up to 240 just so it will even out in the morning.
I tell my mom this, and she tells me that I should INCREASE my Lantus! I then told her that I should lower it because I’m obviously having to eat too many carbs before I go to bed. She then tells me that the highs are because of the fast food I ate at supper (5:00PM) and its because I took my Humalog after I ate. She also said my Lantus should cover the amount of carbs that I eat so I should increase it. I tell her that that will make me go low… and the argument continued for a while.
It ended with her yelling at me about not believing what I read online and then storming off into her room and slamming the door.
So is my logic here flawed? If I have to eat 40 carbs just to last the night and spike my BG up 100+ points to avoid going low, wouldn’t it make sense to just lower the amount of insulin by a few units so I wouldn’t have to eat as much and therefore have less of a spike?
You reference a “fast food” supper; are you also doing “fast food” snacks before retiring?
Fat content is problematic for insulin absorption, but the spikes are drawn out farther beyond the two hour testing time frame you’ve used the past two nights. So, I wonder what type of carbs those snacks contain… high sugar content? bread? Do you experience crashes after the highs?
Despite your mom being right about the post fast food spike I wouldn’t mess with the Lantus dosing. I wonder, given your age, what effect changes in hormones has on BGs?
Regardless, I think experimenting with food first might be the way to determine what will take care of the spiking.
I agree with you. Lower the Lantus! There’s no reason to eat 40 carbs before bed.
Even with the high fat from fast food, it would be digested 8.5 hours later & not responsible for the 1:30 AM high.
Is your morning BG under 100?
I think we have the same logic here! What I read that your mom is saying is to take more lantus because of the high’s at night, but then you would just have to eat more or something to stay normal in the morning? That’s too much, haha. Also… your mom suggested that you use long-acting insulin to cover the carbs you eat? I never thought you could even do that. Cos if you were on a pump you couldn’t cover your food with basal…? Idunno. Maybe I’m wrong.
I’ve had to mess with my levemir (used to be on lantus) after emailing my Dr. about it. I would just change the dosage 1 or 2 units up or down, nothing drastic. A couple units really makes a difference in the morning.
If your fighting with your parents about it, just add that question on your list of things to ask the Endo! For me, it seems like that’s the only way to settle disagreements like this–then everyone calms down
Have you asked your Doctor?
Can you call a health care provider? Then, if it’s still a bone of contention with you and your mom, perhaps the health care provider can neutrally explain any changes.
A small snack–under 20 g carb–is often used at bedtime on MDI, but 40 g without rapid-acting insulin to go with it seems quite high.
Best wishes!
The basal insulin is there to cover the basic insulin needed by your body. The liver is constantly releasing small amounts of glucose. These glucose amounts are covered by the basal insulin. So it would be the optimum to have a neutral state that needs no additional carbs. To need 40g of carbs to reach a good number in the morning prooves that your basal is too high. Now you have a huge spike that will decrease slowly over night. This is not good for your A1c for sure. Try other options with your medical team like a two shot regime with Levemir. I always recommend this for someone that needs a huge dosage of Lantus to cover 24 hours and experiences many lows at night.
this morning I woke up at 90
Nope, I had a Wendy’s spicy chicken sandwich at supper, and then at bed I had a granola bar and some chips (23 carbs in the bar, about 15 in the chips) The doctor wants me to have some higher fat foods at night, but I don’t think I need this much of them
I really doubt that if it is hormonal, I would have predictable spikes in blood sugar, I’ve had diabetes long enough to know that eating without fast acting insulin will cause my BG to spike up, and without the insulin in me, I can expect to stay up for longer than 2 hours because it would take longer to bring my sugar down using basal.
Me, too! We’re D twins.
I WOULD ask my doctor… if I actually had one. After one appointment with the local pediatric endocrinologist about 3 years ago, we never went again. She was mean and almost a little arrogant and said that I don’t have anything right. (well duh, indoor track ended and I had the flu, of COURSE my BGs are gonna be off)
I would rather not discuss me not having a doctor, I did that in another forum about a week ago and it turned into a huge debate about parenting, and the topic got locked. It is what it is… so leave it.
We all adjust our doses constantly ourselves. Just do it slowly with small changes & keep that dose the same for 3 days to get a sense if it’s right. Takes experimenting & basal doses are harder to figure out.
Clearly, your Lantus dose is too high. Doesn’t make sense to need 40 carbs, spike & then come down to normal. Lantus isn’t intended to handle fast acting carbs like granola bars & chips. It also takes about 2 hours to begin working & works slowly.
Eat a small amount of protein before bed ( cheese, nuts, etc.) because protein digest slowly, if you’ve got overnight lows.
I have better numbers taking two doses of basal.
These books are great. Maybe your mother would read them also.
Think Like a Pancreas: A Practical Guide to Managing Diabetes with Insulin By Gary Scheiner
Using Insulin, Everything You Need for Success With Insulin By John Walsh
“Clearly, your Lantus dose is too high. Doesn’t make sense to need 40 carbs, spike & then come down to normal. Lantus isn’t intended to handle fast acting carbs like granola bars & chips. It also takes about 2 hours to begin working & works slowly.”
glad I’m not the only one who sees it like this… now if only I could get my mom to think this way.
If I ever could get my hands on those books I would, I’ve been hearing about them a lot. but the “local” library is a good 8 miles away and there is no chance that my mom would ever buy them for me.
Pretty much everyone agrees with you. Would your mom be open to reading this discussion? You could cut/paste it into an email & print it for her.
Doubt the library would even have these books.
Lantus does have a small peak 6-8 hours after you give it. That may be taking care of the high you get midstream. Forty carbs seems like a lot before bed. I don’t know your carb ratio but I wouldn’t do 40 grams of carb without a bolus to cover some of it. If you are trying to avoid the low, less Lantus may be the answer. Reducing your bedtime carbs may help. If you get to a good point before bed, you should be fairly even through the night. When I was on Lantus I would go low between 2 and 3 and not wake up. I’d wake up with a BG over 200. It can be tricky business.
Hello Timmy,
OK well you both have valid points, but for the most part you are right, Ivebeen type 1 since I was 11 , and I would definitely not recommend taking any more units of lantus at bedtime, what I would recommend is maybe taking your lantus shot a little earlier, and with the shot take maybe a peanut butter sanwich with some good bread , stone grain wheat works great , and a small glass of milk , the logic behind this is that it will sustain you through the night, so you are not chasing the sugar down, it should be a rather even thing, lantus is a very good insulin, so that is one suggestion, a s far as the fast food, well I dont have to tell you, that the fatty food, just stinks for us diabetics, so the healthier you eat the better you are, any questions feel free to ask , after 25 years of battling this disease, i have been where you are, so be patient , remain cool, be nice to mom, and work through it together ,…
Magic
A peanut butter sandwich & glass of milk would be more than the 40 carbs he’s eating now that causes over 200 BG in the middle of the night. Eating to feed insulin isn’t a formula for success.
I suggest you take your lantus earlier in the evening. Test to find out when your normal body cycle presents a lowered BG. For most of us, that happens between 3 and 6 pm. Remember your lantus has a cross over period when the new dose is climbing in your system and the old dose is dropping. I think dosing late in the evening is what’s causing your BG pattern.
Check out the spreadsheet in the TAG group if you really want to pin down your insulin, diet, and BG cycles so you can figure out when to make changes. I’m on a pump and my insulin is fast acting but I was on lantus prior to the pump. Check to see how much of your daily total insulin dose should come from the lantus (basal). Then do the same kind of testing those of us on pumps do…fast for the same 5 hour period and test and record the results each hour. Do this for three days in a row. This will suggest basal (lantus) changes for that 5 hour period. You will have to compare the lantus dosage 24 hour path with the BG time period you tested. You may find that once you have compaired the lantus pattern with your BG testing that moving the injection time will take care of the problem. Keep testing though cause D will constantly change for you.
I think if your Mom sees a hard copy of your testing against something objective - like the TAG spreadsheet - she will be more open to your reasoning. Remember, she’s probably more scared about this disease than you are. You have to learn to control your own disease and it’s difficult while others believe they know better than you because you are still a kid. I think lantus has a web site, which may or may not be helpful. I’m sorry you have to deal with this problem along with the regular stuff everyone else is dealing with and that it’s great you are trying to make sense of this disease instead of always having other people give you instruction.
A couple people mentioned splitting your Lantus dose. That would definitely be worth a try. When David started Levimir (similar to Lantus) with MDI we had to choose to do the Levimir dose in the a.m. or the p.m. We chose the a.m. as the insulin needs to be given at the same time, each day, so we figured the a.m. would be easier to plan and I didn’t mind getting up weekends if David slept in to give him his Levemir. It turned out though that the Levemir always cut out around midnight. Never lasted 24 hours, so we had no choice but to go to a split dose. If you typically stay up past 11, try 11 a.m. and 11 p.m., which will allow you to sleep in if you get the opportunity, then you should be able to cut the night time carbs down, to a glass of milk.
Does your school have a library? If it does and the books that you are interested in are not part of the regular inventory, speak to the librarian and see if she can get her hands on the books that you are looking for.
I came across an interesting website owned by someone by the name of Dan Evans in the UK. He attached a spreadsheet to his webpage that you can download and gave some info on how the spreadsheet works.
http://www.danevans.co.uk/insulin/
If you have easy access to a computer, time spent graphing your current insulin doses, BG’s, activities and carbs might help you visually to see how your insulin doses work and how it relates to what you eat. Take a moment to read through Dan’s info page when you download the spreadsheet. Some numbers have been entered into the log sheet for the purpose of demonstration only. You would delete those details when entering your own log info and would stick to the log sheet tab only as other tabs are for the background information. I am going to give it a try myself with David’s info for a few days just for the fun of it.
Cheryl
Levemir is not similar to Lantus. It is not a 24 hour insulin. At a Diabetes fair in Germany I asked several Diabetes educators if they would recommend one shot of Levemir. Most thought I am asking a silly question and all of them said two shots is the correct approach to have 24 hour basal coverage. The one shot regime is only promoted to compete with Lantus because products in USA are easier sold via the argument of easyness not via reliability or quality - at least this is my interpretation.