Hello, I've been following the forum for a while, but don't post because I haven't felt I could contribute much. I'm not sure that's changed, but my treatment plan has been modified recently and I have some questions I'm hoping you all might have insight on.
Quick background: I was dx'd LADA several years ago, I believe in it's very early stages, and recently began Lantus in the evenings. It's still early but so far a low dose (7u) is bringing my fasting number to my target (100). My problem/concern is that now I am going low every day between breakfast and lunch. My 2 hour post breakfast numbers are around 80, and by 2.5 hours I've dropped 20 - 30 more points. I don't see anything like that after lunch or dinner. Those 3 hour post meal numbers are still above 150 and even 4 hours with no snacks is achievable.
My main question is, is this typical/expected? I do realize everyone is different and YDMV, I'm just curious if anyone else has seen this type of pattern and what the explanation might be. I don't want to bore with details, but I'm trying various breakfasts ranging from around 30 - 60 grams of carbs in the form of skim milk, fruit and whole grains and roughly half that many grams of protein via milk and eggs or peanut butter - so far the results have been similar. Should I be happy with the results and just plan for a mid-morning snack or is this something to investigate further. Given the nature of how Lantus works, especially with this low of a dose, I was expecting a smoother pattern throughout the day...
Welcome to the forum, Dazed! A couple thoughts.I'm assuming you're only taking Lantus so far? Since you are going low in the morning you might try splitting your Lantus dose, half in the morning and half in the evening. Lantus is supposed to last 24 hours but for many people it just does not. Hence you are getting too much effect in the morning and too little as it wears off.
Another thing to consider is that if you are above 150 three hours after lunch and dinner that is too high. Technically you should check your post prandials at 2 hours, so you may be higher than that. It might be time to consider a small bolus dose (fast acting insulin) before those meals. Have you read Using Insulin by John Walsh. It's a bible to many of us.
Thanks so much for the reply Zoe. You're correct, I am only taking Lantus so far. I think my endo is introducing insulin slowly so bolusing may be in my not too distant future. I didn't want to bog my post down but I have been running detailed tests this week, testing 1, 2, 3 and even 4 hour post prandials. Maybe a little overboard but I'm trying to get a handle on what's really going on.
You're correct, my 1 and 2 hour post prandials are typically much higher than the 3 hour mark. I just thought it odd that my 2 hour post breakfast number was so markedly lower than my 3 hour post lunch and dinner numbers. I was assuming the Lantus was working as advertised and didn't realize it affects people differently so thanks! I've been trying to make my way through Think Like A Pancreas (so much to absorb), but I think I will order Using Insulin now - disappointed to learn it's not available in an ebook so I will have to wait. Patience is NOT a strong suit :-). Thanks for your help.
I was on Lantus 8 years ago and had big time lows until I found out about splitting my dose. I did half in the a.m. and then half 12 hours later with a few tweaks.
I had a very similar issue on as low as 6 units of Lantus. My lows were coming during the night, though. Going down to 4 units kept my numbers stable, but I couldn't keep my post meal numbers as low as I wanted them without eating only 10-15 carbs per meal. The bolus solved the problem.
Until you go on a bolus, the split dose is definitely worth a shot. Definitely eat the mid-morning snack until you get things evened out.
