Still have Lantus Questions

I'm relatively new to using Lantus, probably only 4 - 6 months. But do't get a lot of information from medical people, and can't afford appts with them anyway as often as questions come up. So I'll ask here. When I was NOT on lantus, I was using humalog before meals when BS was over 150.....not very often, on Janument 500's twice a day otherwise. Okay, so since on Lantus, starting at 14 units, and moving up the scale to 27 now. My number have come down to normal (between 90 and 130 ---- and FBS in the 95 - 115 range.) I've lost 100 lbs in two years, and exercise daily for an hour. So it's funny/strange, but when my numbers went to the normal range, I rather freaked out a little. OK with it now : ).....but when my bedtime number is 97 a couple of days ago, my brain went to 1) if it's that low now, and I take lantus, it will go lower in the night 2) So should I NOT take it and not worry about lows during the night or stay on track? I won't tell you what I did....but would like to know what other Lantus users do...or your ideas on this? Thanks so much!

If I was concerned that my Lantus dose would make me low overnight, I would either:
a. Take a reduced dose, or
b. Take the reglar dose but set an alarm to check my blood sugar in the night.
Much more likely a.

I would never ever skip it.

I'm a type 1 diabetic who took Lantus for 7 years, and for 5 of those years I took it at bedtime. I missed three doses in those years.

Your numbers sound like a big improvement!

When I was on Lantus before going on a pump recently, as a Type 1 diabetic who still makes a little insulin, I adjusted my Lantus so I'd wake up as close to 100 mg/dL as possible. I used to split my Lantus doses morning and evening, but found that I actually got more even coverage by just doing it at night.

Lantus trickles into the bloodstream very slowly, so your evening injection won't necessarily push you low. For many of us, an optimal Lantus dose slowly reduces our blood sugar in the early nighttime hours and then slowly lets it rise a little before waking due to the dawn phenomenon. With a pump, you could actually make BGs stay level, but with Lantus you have to build in a little room for movement up and down.

That also means you probably need a little buffer at bedtime. I tried to be at 110-120 at bedroom, and if I lower than that, I'd sometimes eat a little something to raise my BGs a bit. I kept my Lantus doses very consistent, unless I had major exercise planned for the next day (e.g. a hiking trip). The problem with adjusting your Lantus for the nighttime is that you're also affecting your Lantus for the whole following day.

Well, I did the wrong thing...or the non-healthiest choice....I skipped it! Took my nighttime Janumet, so I was covered a little. So now after doing some more research and chatting with a diabetic doc/actually a diabetic, she asked about my humalog doses, and suggested that I might want to supplement with 2 u of humalog in the middle of the day before's not long lasting of course like the Lantus, but it might give me that edge for my higher evening numbers, We did talk about splitting the dose up, but I'm not ready for that big change yet, I don't think I've reached the max on my Lantus yet...might still have room for going up to nearer 30 u..,,,,but that's a wait and see.

Eh, live and learn, this is a marathon, not a sprint.

Humalog doses should really be calibrated to what you're eating. I know some people aren't keen to carb count, but it's not that big a deal and can give you dramatically better control.

If you're getting higher evening numbers, that's likely the Lantus tapering off short of 24 hours, which is very common. That's why people split their doses, morning and evening. Whether you increase your Lantus or not, if you're typically higher in the evenings, I'd split.

Basal insulin like lantus (unlike bolus) is really quite forgiving. It shouldn’t drive your bg down, but keep it steady if dosed properly… Any lower than optimal number caused by appropriate basal doses would just gradually drift a tad low then gradually drift back up like the ebb and flow of a tide, not like the tidal wave of bolus.

If you’ve determined an appropriate basal dose, take it every day. If you see a pattern you don’t like, adjust your dose accordingly. If you see a single low number (which 97 is not) then eat an appropriate # of Gluccose tablets, hard candy, etc to bring it to where it belongs without overdoing it…

I only make changes to my basal when there are long-term changes I observe. Usually a pattern seen over several days or in a week of readings. My two biggest readings I use to determine whether my basal is correct is my morning reading and my reading before dinner. I may make one-time adjustments to my basal temporarily if I have had a day of extraordinary exercise or am sick, but I don't adjust based on a single reading.

ps. If you skip a dose of Lantus, it may actually take you a couple of days to get back to normal as the effect is actually somewhat cumulative over days.