Brief background - Switched from NPH and R twice a day to the much more “Modern” regimen of Lantus in the morning and NovoLog on a sliding scale with meals a few months ago. I’ve had a tough time getting things under control. BG has been consistently high in the morning in particular. I bumped my Lantus from 28 units to 30 a couple of days ago…not a significant increase considering my morning BG’s have been consistently in the 200’s. Last night after a typical dinner and typical bolus, I bottomed out at 50. I saw this as a great opportunity to treat myself to some chocolate ice cream! Was at 95 at bedtime, so I figured it would be a good night. I woke up at 2:30 this morning with a BG of 51. Treated with OJ and went back to bed. Woke up at 6am with a BG of 270. I took my 30 of Lantus plus a correction dose and enough NovoLog to cover breakfast as always. 2 hours after breakfast I was down at 47 again and I can’t seem to bring it back into range. Any ideas on why I’d be getting these hypo’s all of a sudden? I doubt an increase of 6% on the Lantus when my am BG’s were so high would be having this much of a dramatic effect? Luckily I have an endo appt. tomorrow to discuss the OmniPod, although this sudden change may make initial setup that much more difficult. Sorry about the long post. I’m just searching for some answers.
-Tony
Talk with your endo about splitting your Lantus dose to half in the morning and half at night. It sounds like your Lantus is running out before your next dose. This might help your morning lows, but keep your other blood sugars more stable.
with out knowing what you ate I would guess that you ate a meal with a lot of fats. Fats will slow digestion and for me anyway it will not peak for abut 3 hours or more. The result is your novolog acted before your carbs peaked. so, when you ate the ice cream (lots of fat) it didn’t start hitting for about 3 hours and resulted in the hight sugar in the morning. In other words, your meal peaked after eating ice cream which peaked in the wee hours of the morning.
Thanks Cara and Danny for responding. Splitting the Lantus is something that I’ve considered and I will take your advice and discuss it w/the Dr. tomorrow.
Thanks for the info on the fats slowing down digestion. That does explain some of what’s going on, although I was not surprised by the 270 this morning. I’m just having a hard time trying to figure out these continued lows today. You would think that after 28 years, I’d have a better clue of how this all worked. It’s frustrating to say the least to feel like I’m starting from scratch after all this time.
hey,
Sounds like I got photocopied and shipped to someplace else. I was a Regular and Lente user for a very very long time. It was pretty successful, especially considering the 20 or so years I managed to avoid going to the Endo. When I did I switched to the more modern Lantus +humalog approche, now I do appreciate the increase in freedom, but it does apparently come with some risks while getting used to it. When I started I was doing the lantus before bed. With that I found myself bumping up against the risk of nocturnal lows, which is a thing I have a pretty healthy fear of. So I switched to morning lantus, and was running into pre lunch lows. After a lot of messing with the doses I got that under control.
In the end I am looking forward to getting on the omnipod as well, because I plain old dont like lantus that much.
Ivan!
Tony-
Hello! I am a former Lantus user, Now using the Omnipod; I love it! back to your post. I was on lantus and I always bottomed out. I would have to eat a snack in between meals so I wouldn’t bottom out. The thing about lantus is you can’t control when it peaks thats why you are having so many lows. IF you have any questions about the omnipod let me know or you can check out my blog.
Cherise
Get on a pump Tony. It will help add stability to your blood sugars. I’m not sure about the omnipod but the Medtronic paradigm has helped me tremendously. I’m sure they are equally beneficial.
Thanks everyone for your replies. It looks like the common thread here is that pumping is the way to go, which I’ve been told for quite some time. Tubing may not seem like big deal to many, but it’s a show stopper for me and the only reason I’ve never considered pumping before. So I’m going to give the Pod a try. If it doesn’t work for me, then I’ll start looking for a plan “B”.
As for the Lantus, my endo insists that it doesn’t “peak”. I call BS. It’s provided me with less consistency than I had before.
Dave - Thanks for the tip on John Walsh’s book. I ordered a copy from Amazon today. I look forward to reading it and having it as a resource.
Tony,
First , I’d just like to say you’d be surprised how much 1 unit of lantus can affect your BG. I think when you make adjustments, it’s supposed to be by 1 unit every other day. From what I understand, lantus is also more effective and stronger in the first 7-8 hours than it is in the last hours…I assume this is why my Dr has me taking it at night because that’s when I need it to be more effective. I’m really surprised your Dr still has you on a sliding scale~ they usually do this at first but try to get you to and insulin/carb ratio
Also, when you took the correction dose was it lantus or the Novolog?
Just sounds to me like you’re over correcting both ways.
Good luck at your endo tomorrow and with your possible OmniPod… Keep us posted!
Hi Kristy - Maybe my terminology is incorrect. I was under the impression that “sliding scale” meant that you adjust the dosages based on carb intake and other factors as opposed to what I would refer to as a “static” dose. So yes I have established an I/C ratio of 1:8 and a correction ratio of 1 unit:30 mg/dL and bolus accordingly. Correction dose was Novolog, but I’m starting to think I may have just made a simple dosing error or possibly double-dosed on Monday evening.
Anyway, I saw the endo this morning and he is 100% on board with the Omnipod. So now the expected battle with United Healthcare can begin. It’s always somethin’ I’ll tell ya’.
Cheers.
I understand you, I’ve got the same bad hypos a few months ago. It was before I joined Tudiabetes. I didn’t count my carb and I made 10 units of Lantus and 4 units of Apidra for breakfast, I ate 5 “biscottes” (maybe French toasts), two hours after and sometimes less i was at 48! So now I count and I know how many units I need for 10g of carbs. Now I live with 9 (8 in summer) units of Lantus per day and I made 3 units of Apidra for 5 biscottes. There’s only one problem : at night if my BG is 1,50 at bedtime I wake up with hypo, 50 or 45 at 4 in the morning. So I eat 12 g of carbs before sleeping. I hope you’re well
Hi Tony,
You are exactly correct with your terminology about sliding scale usage of insulin. I wish you well with the OmniPod. My doctor and I are looking at that for me too. And tubing is definitiely an issue for me as well. Please be sure to come back and tell us how that is going for you with the insurance company and everything. I would really appreciate it. It will be the same battle for me.
Saundra - Thanks for the clarification.
I will definitely post about the insurance experience. I’ll probably start a new topic when the time comes. My experiences with UHC have not been great in the past, so I’m bracing for a fight, but you never know.