Lantus Not Working? (And an apology...)

Treatment Insulin
1

Hi, y’all. I meant to post this as a discussion item but I sent everyone an e-mail instead. Typical newbie mistake – how embarrassing. ;0) Anyway, here is my item for discussion:

I am struggling to understand what’s going on with my Lantus injections. I’m a type II with insulin resistance. I inject 35 IU of Lantus every night after dinner. I forgot to inject two nights ago, so yesterday I checked my fasting BG the next morning and was surprised to find that it was 225 md/dl, right about where it was the previous five days when I did inject the Lantus the nights before.

I thought it would be much higher without the Lantus. Perplexed, I did a little experiement: I injected the Lantus that morning and then tested at one hour, two hours and three hours without eating (postponing breakfast until after my test.) My readings were 239 at one hour (it went up?), 220 at two hours and 208 at three hours…???

My doctor told me that the Lantus injections should “peak” at two hours. I saw almost no effect at all.

Is the Lantus doing anything? Am I essentially injecting water? Is my insulin resistance or something else interfering with the Lantus?

My numbers are still way too high, despite the fact that I’m following the Dr. Bernstein diet faithfully now and I haven’t had more than 30 to 40 grams CHO TOTAL for any day for the past two weeks. I inject Novolog to cover every meal. If I have three meals per day and each meal is 10 to 15 grams of CHO max and I’m injecting Novolog for each meal, then shouldn’t the Lantus be doing SOMETHING to bring me down closer to a normal baseline?!?

I had hoped to be getting down into the low 100’s when fasting and below 140 post-prandial on dear Dr. Bernstein’s “carb starvation” diet, but if the Lantus is acting like water in my system, how will I get down into the complication-sparing range?

I’m so frustrated and disappointed that my body is treating the Lantus like I didn’t even inject anything at all. Any ideas, suggestions, links etc. would be very much appreciated. My current doctor is worse than no help – she seems to know less about diabetes than I do.

Thanks for reading this far! ;0)

2

Jean- My understanding of Lantus ( I have been using it for 5 years) is that is a “peakless insulin”. It doesn’t peak at all. Maybe your doc meant that it doesn’t start working for 2-4 hours, which is my understanding of how it works. When you tested at 1,2 and 3 hrs, the lantus only effected the 3 hr. test which did come down. Lantus basically keeps your BS even between meals. The Novolog covers your meals. You didn’t say how long you have been using Lantus, if it is a recent addition to your meds, it will take a little while for your body to adjust to it.
I am a T-1 and the Lantus covers me all day with Humalog covering my meals.

3

Hi there, catlover. Yes, that’s what I was lead to believe by my previous doctors, but when I had a night-time hypo and woke up sweating, cramping, shaking, dizzy and measured at 51 mg/dl after I treated myself and could stand up and go test myself, my doctor suggested doing my Lantus shot earlier in the evening so if I did go hypo it would be while I was awake. In that context she said that “Lantus peaks at two hours” meaning that the effects of the Lantus shouldn’t take me any lower than I already was after two hours (does that make sense?) Maybe a better way of putting it would be “it plateaus at two (or whatever) hours”?

I’ve been using Lantus off and on for five years (I had a brief, shining moment when I starved and exercised myself down to where I didn’t need it, but I’ve moved back up the scale and have been injecting Lantus again for over a year. It seems that a lot of the literature and comments I’m reading about Lantus have changed since five years ago. For example, I was told five years ago that I didn’t need to worry about going hypo from Lantus once it was titrated to the right dose – that it was vanishingly rare – but I’ve had two dangerous hypos in the last six months (one time I had to be rescued by the EMS as I was at 36 mg/dl and couldn’t stand or move my arms or legs) and after that my doctor said, “Oh, yes, you can have hypos with Lantus or any insulin.”

I’m having a hard time winnowing through what my doctor says now, what I remember from before, what I remember reading on the Lantus website back then and now. Sheesh. I just wish I could find a doctor that could help me make sense of all the conflicting information and my body’s confusing responses.

Welcome to diabetes, eh? Keeps us guessing. Anyway, thanks again for your reply.

4

My 5 year old is a T1 diabetic and she has been on Humalog and Lantus for 3 years now. The situation is a bit different but I can tell you what I know about Lantus.

Lantus is supposed to be a peakless insulin, but for some people it peaks anyway. From what I’ve heard it can peak at different times for different people. The peaks won’t be dramatic like when you take Humalog, they will be very subtle. After a while you will probably be able to tell when/if it’s peaking. In the meantime keep checking your blood sugar often and don’t worry about it.

They call Lantus a 24 hour insulin, but that’s only when it’s at its most effective. It accumulates in your body over time so if you miss a dose there should be a difference but it won’t be a big difference right away. Make sure you don’t double up on the doses. If you took it in the morning you can’t immediately start taking it in the evening again. My daughter’s endo says if I need to move the time I give her Lantus I should only do it in 2 hour increments (per day)

If you BG is high all the time call your doctor. He may be starting you at a smaller dose of Lantus and planning to give you more slowly until you’re where you should be. BG that is too high is always better than too low.

5

Thanks, Monica! I didn’t know that Lantus could accumulate beyond the 24 hours. Very interesting.

I appreciate your ideas and suggestions. Very kind.

6

Jean, I am also T2 for 20 years. I have injected insulin the whole time. I tried the pump for 3 years, but developed a reaction to the infusion sets (teflon and adhesive). I now take Humalog and Lantus. Been on that for a few months. I carb count and take Humalog for food and BS levels (learned that on the pump). I take Lantus twice a day (one shot did not seem to last). I take 25u in am (about 7:30a) and 30u at dinnertime (about 5:30p) with my meal Humalog. One thing I’ve found out over the years with this frustrating disease is that everyone seems to be a little different. You have to experiment a little until you get it close (I never seem to get it exactly right). I go a while and think I have it figured out and then, I get a surprise and have to change something. Monica and Catlover seem to understand how Lantus works and I agree. Good luck and keep trying. Hank

7

Thanks for your reply, Hank. You’re right about the experimenting, of course. Not only are our bodies all different, they also change as we age, get sick, experience stress or insomnia, get slack in our self care, etc. Plus there’s new research all the time. Being a diabetic requires two things I find difficult: keeping a regular schedule and not sweating the small stuff. Take care and never give up, eh? Jean

8

Lantus is a funny drug. Some people it works for 24 hours, some (like me) 19-20 hours. Click on this link and it’s a nice graph comparing the short acting analogs (novolog/humalog) and long acting basal (Lantus) The important thing is its very slow but consistent activity.

In regards to the post-meal BG. Lantus should not be bringing your blood sugar down after a meal, that is the role of the short acting insulin. If you are not coming down to about 20 points above pre-meal levels at 2 hours you need to adjust your novolog. However, if you are below the pre-meal levels then it can either be the lantus or the novolog. Since it seems that all of your BG are too high, you may need more Lantus. I have to take 2 injections of lantus each day (15 units morning and night) and that has really stabilized my insulin levels. Also it takes about 3 days for lantus levels to completely even out in your body, so be very patient when adjusting lantus because if you do it too quick it can come back to bite hard. I know that for a fact lol.

Good Luck!

SuFu

9

Hi SuFu – I’m really perplexed by Lantus still. I had a super-scary hypo last June when Lantus was my only medication (hadn’t started the Novolog yet.)

I woke up, tested my glucose which was high but not awful at 149 mg/dl. I injected my morning Lantus (at that time I was doing 40 at night and 40 in the morning) and within 20 minutes I was at 36 mg/dl and fighting to stay conscious.

I dialed 911 because I was wholly unprepared for a hypo (at that time) and by the time the EMS arrived I was unable to stand or move my arms or legs. I was a dishrag and probably seconds from going unconscious when the EMS started putting gel in my mouth. I was sweating profusely, shaking, seeing bright yellow streaks of light, confused.

Everyone says that Lantus has this slow, steady effect, but I can’t figure out how I could go from 149 to 36 in twenty minutes when all I was doing before and after injecting the Lantus that morning was sitting quietly at my computer, checking my e-mail.

I also can’t figure out how when I forgot to inject the exact same medication on another day this past weekend its absence had no effect (apparently) – it had been 35 or 36 hours since I had injected it and my fasting glucose was approximately the same as it had been every other day that week, 12 hours after my normal Lantus dose.

I feel like I’m not explaining this very well. It’s like something random is messing with the way Lantus works in my body – it just doesn’t seem to work the way people say it should.

10

While I can’t explain the extreme lantus low, it could easily have just been a fluke moment. My g-ma-in-law is a type 2 and she had a very similar circumstance, with a rapid drop after taking her lantus. It was a one time occurrence in the 25+ years she’s had type 2.

Remember Lantus was designed for type 1 diabetics w/o any b-cell function. As a type 2, your body still produces the correct amount on insulin, but there is a change in the sensitivity of the insulin receptor or a change in the receptor itself. So if you forget to take your lantus, your body may be able to to compensate for a short duration by pumping out extra insulin. I have forgotten to take my lantus and it only jumped my daily BG average by like 30-45 pts. So, while they say the life of lantus is 24 hours, I’m certain that it is actually around for alteast twice that once you have a stable serum level.

The type 2 thing could also account for how you think things are random. If you are starting an exercise program, that can def do it because exercise makes your body more sensitive to insulin. That’s why, over in my group on here, we have a large discussion going on about how to handle the post-exercise latent onset-hypoglcaemia.

11

Yes, you are no doubt correct – when I had my scary hypo I had recently started a diet and exercise program.

It probably was some kind of weird latent reaction though, because it happened at least 10-12 hours after my working out at the gym the night before, and then :20 after injecting my Lantus that morning…boom!

Perhaps just having exercised a lot the night before made me that much more insulin sensitive the next day?

I’m very interested in your discussion about hypos. Ironically, I had another one last night after I posted to you – 52 mg/dl for no reason I can figure out – shaky, disoriented, sweating, panicky feeling, the whole nine yards.

(Big sigh…) I’m fine now, but more interested than ever in learning more about hypos and this disease.

12

My endo started me on lantus in april of this year. i started at 10u daily. he told me every day i was above 110 in the morning to up my dose 1u and to stop at 20u. i went all the way to 20u and still couldn’t get below 110. i split the dose 10u morning and night and followed the same routine of bumping up 1u morning and night until i finally settled at 17u mornings at 6am and 17u at 9pm every day. everything settled down after that. i know this is an older thread but am curious to know how you are doing after this time has passed.