The Mysteries of Lantus and Insulin Resistance Continue

I have a new doctor and a new insulin protocol.

He wants me to inject Lantus at roughly the same time each day (between 6 a.m. and 7 a.m.) to avoid the mid-night hypos I’ve been getting. He asked me to hold off on my Lantus injection the night before last and just set an alarm to inject Lantus this morning instead.

Being the good girl that I am (heh) I woke up this morning at 6:00, tested my BG and injected my insulin. I had another medical appointment and some lab work to do, and so I didn’t eat breakfast.

Check this out:

Rising BG at 6:11 a.m. (fasting): 291 mg/dl

Injected Lantus (40 IU) at 6:15 a.m.

Tested my BG at 9:45 a.m. (still fasting): 319 mg/dl <— It went UP

So once again, injecting Lantus did nothing, despite all the pretty brochures and websites that say that it takes effect (reaches its peak and levels off) at two hours. After 3-1/2 hours my BG was higher than if I’d injected saline. WTW?

Did I mention that this is frustrating? All these research projects and articles and books I read seem to be designed for people for whom Lantus just…works. For me? Sometimes it does NOTHING and three other times I’ve injected it and dropped a hundred points in less than an hour, going into a dangerous hypo.

I wish there was some way to predict this, but it seems to be totally random. Which is very frustrating.

Living with insulin resistance feels like living with an erratic, grotesque giant who will be sleeping one minute and the next minute will be smacking me down hard with his claw-hand for no reason.

I’m praying every day for the scientist who figures this crap out.

Crap it is…I get info on latus in the mail, on my email, in magazines, and I read the other side of it too. I don’t want it. I take Novolin N, and it has been pretty darn good to me. Some people say I am at risk being on it, there was a list of wrongs for it. I was confused…

I think your Dr needs to pull another magic trick out of his sack, this one didn’t work.

Sure hope you both get this figured out for your sake:)

Have one word for you–Levemir. You can search Lantus here to see how many people it didn’t work well for. I don’t understand why he didn’t suggest split doses, unless he’s going on the myth that Lantus lasts 24 hours. Clearly it doesn’t for you with your high fasting numbers.

Insulin resistance is hair pulling. Sorry for the aggravation when you’re trying so hard.

With dawn phenomenon, numbers can continue to rise without food. In fact, not eating often causes a spike as the liver dumps more glucagon in the absence of food.

Hey, thanks, y’all. He said he’s switching me to a.m. shots because of my night-time hypos (the last two were between 12 and 1:30 a.m.) Once he sees how I react to the Lantus in the morning, he’s probably going to raise my dose (if I understood him correctly). I guess we may go to multiple Lantus shots eventually. I don’t really understand everything we’re doing yet. I guess we’re walking a tight-rope between my dawn phenom and night-time hypos.

I keep wondering if the time I should be injecting the Lantus is 2:30 a.m. or 3:00 a.m. so the Lantus can crash into my dawn phenom?

He also raised my insulin:carb ratio from 1:15 to 1:5 and my correction factor from 1:30 to 1:15. He probably didn’t want to throw too much at my body at once. I’ll be e-mailing him my numbers and he’ll adjust them.

I already found out that my HMO doesn’t cover Levemir – which I think is just sick of them. Truly sick.

However, my main concern right this minute is the variability of my insulin resistance.

I don’t see how I’ll ever get regulated if I can inject a large (VERY large by Dr. Bernstein standards) dose and get zero, zilch, nada one time and a HUGE drop another time – for no known reason other than, “Eh, you’re injecting a hormone subcutaneously. It’s fraught with imprecision.”

It makes me feel scared…and hopeless.

But what can I do but soldier on?

Hi Jean,

I was diagnosed about 2 months ago with type 1 and have also been struggling with my Lantus. I don’t feel that it is consistently helping me in monitoring my BS levels, and I have switched my dose as much as 12 units in a given week, just to try and find the balance-less hypos and BS stability throughout the day. I would love to consider switching to levimer, in general I hear more positive chatter about it. I don’t even have insurance int he first place, so getting insulin in general is a struggle.

Anyway, I hope over time you are able to find a balance. How to soldier on? I have been asking myself that a lot lately. There is a lot that seems outside our realm of control as diabetics, but one thing that I remind myself of is to be patient and kind to myself, and to take it as it comes, one step at a time. To be in the present moment, whether it is 391 or 48. Good luck!


What’s your BG before bed? How low were your two overnight hypos?

Evil of your HMO to not cover Levemir.

Have you tried dividing the Lantus shots across two or maybe three injections at different sites at the same time? I have heard that there is a diminishing rate of return for absorption of insulin. I have also found that splitting my doses seems to make the insulin work more effectively - I do this for my rapid-acting insulin.

I too have read about the small dose issue in Bernstein and that’s fine if like him you are insulin sensitive but not very helpful for those of us cursed with insulin resistance.

Another thought is that with a morning FBG of almost 400, I’d be looking at injecting some rapid-acting and then testing and testing and testing and testing to see what happens.

No mystery at all:

  1. you did hold off basal insulin. So the first day will be a mess. The injection at 6am takes some time to be active. In general basal insulin can not lower an already high blood glucose. You will need a correction or you need physical activity to compensate.

  2. likely Lantus will not cover 24 hours. This is true for many people. To get 24 hours covered the dosage is often very high. Thus the risk of lows at peak time is very high. With a lower dosage the low would be gone but 24 hours are not covered (dilemma). You wrote that Levemir is no an option. So I think it is best to split the Lantus dosage in two injections every 12 hours. After this transition is might be necessary to increase the night dosage to compensate for the dawn effect. But one step after the other.

Thanks for your replies.

My BG’s this morning were essentially the same as the day I skipped forward 7 hours on the Lantus???!?

Yesterday (no Lantus in p.m. because I was shifting forward):

Rising BG at 6:11 a.m. (fasting): 291 mg/dl

Injected Lantus (40 IU) at 6:15 a.m.

Tested my BG at 9:45 a.m. (still fasting): 319 mg/dl

Today (24 hours after switching Lantus to a.m.):

Rising BG at 6:32 a.m. (fasting): 289 mg/dl

Injected Lantus (40 IU) at 6:35 a.m.

Tested my BG at 9:24 a.m. (still fasting): 317 mg/dl

See what I mean? It’s like the Lantus has no effect whatsoever. From the looks of these numbers, I’m thinking several things:

  1. The Lantus is wearing off loooong before 24 hours (hence no difference in my fasting numbers);

  2. The Lantus is taking a MUCH longer time than advertised to take effect or my liver is really pumping out the glucose (hence no drop after 3-4 hours despite no food intake); and

  3. I’m probably going to be forced to get up earlier, inject the Lantus earlier and eat + inject Novolog at the crack of doom whether I’m hungry or not just to switch off the freakish and hideous Dawn Phenom. I wake up mildly nauseated most mornings so this will…not…be fun. Just to add to the joy of all of this, I have to take my synthoid in the morning and wait one hour to eat, so I’ll spend my entire most-favorite sleep time watching a clock and taking various medications and injections. Crap.

My BG the night before:
Before dinner @ 9:15: 235 mg/dl
Injected 12 IU Novolog (20 gm of low-glycemic carbs w/ dinner)
One hour after dinner: 215 mg/dl
Two hours after dinner: 215 mg/dl

Yeah, dinner was late (I took a big nap in the afternoon) but I’m injecting a lot more Novolog in this new protocol and … not much is happening.

I’m about convinced that insulin is a myth for type 2’s like me. I need to starve myself and walk three hours a day and just t

Ooops, I went too long:

I said that I think I need to stop depending on insulin to actually do anything, start a starvation diet and walking three hours per day because my insulin resistance is like mixing the insulin with water at random times. The same does that does nothing one day will send me hypo the next for no reason.

Also, to those who recommended a split dose: I did that for months and the only thing I got out of it was a hypo of 34 one morning about an hour after I injected half of what I’m injecting in one dose now.

It. Makes. No. Sense.

Gerri, my overnight hypos were in the 51-52 range; my early morning one was 36. Each time I was a wreck: drenched with sweat like I’d taken a shower in my clothes, shaking, heart pounding like I just finished being chased by a bear, seeing lights. It took me several doses of 15-gm carb gels to climb up to 65-70 and then I topped off with too much food in a panic. The time I hit 36 I dialed 911 and then by the time the EMS got to me I couldn’t move my arms or my legs so I may have dropped lower.

I guess I was in no danger of dying but it wasn’t much fun, either, especially as one hit the night before a job interview. Gah.

What are your readings before bed? You need more Novolog since your pp readings aren’t going down & staying essentially the same before & after eating. If you didn’t include a correction dose in the 12 units, then your ratio is accurate since the goal is to have pre & post meal numbers the same, assuming premeal BG is at target.

Walking is wonderful exercise. Using weights to increase muscle mass helps greatly with insulin sensitivity.

Hi Gerri, my “before bed” reading is essentially the same as my 2-hour pp reading because I eat dinner too late.

I’m trying to correct this long-standing behavior so I’ll have some readings later when I’m not eating at 9:00 and going to bed at 11:30 or 12. Realistically, having any readings after dinner is a big behavioral improvement for me. I hate to stop watching a movie and test or test before I get into bed. Don’t know why. I guess I’ve been testing all day and I’m sick of it. Gah.

We just increased my Novolog bolus from 1:15 to 1:5. I’m looking at my numbers and wondering if it shouldn’t be 1:1 ??? LOL

For example, last night:

Pre-Prandial was 235 so I injected 8 IU to lower my baseline and 4 IU to cover my meal of 20 gm carbs.

If the goal is to get me to 100 then we failed miserably. Again. I only went down to 215 at 1 hr and 215 at 2 hours.

I haven’t been walking the last few days so I’ll keep with these new dosages for a week and walk :30+ every day and send him my numbers after a week.

I’ll be interested to see what he suggests.

Thanks again!

Your dawn phenomenon isn’t drastic because morning fasting isn’t that much higher than your bedtime BG. Your current Lantus dose might be accurate because you could be going higher from dinner while asleep & not know it since you’re in bed 2-3 hours after eating.

Guess I’ve gotten used to testing so it’s become automatic.

Hard to change habits, I know. Eating a couple of hours before bed isn’t helping, sorry.

I’m sorry, Gerri. I don’t understand your post.

What does eating supper late have to do with my blood glucose 10 to 12 hours later?

Is there some kind of rule I don’t know about regarding when I should be eating dinner if I’m diabetic? Is that a thing?

If I have 20 grams of carbs at 9:30 p.m. at 235 mg/dl and my two-hour post-prandial at 11:30 p.m. is 215, why would the clock-time of my dinner cause my fasting to be 317 twelve hours after eating, at 9:30 a.m., a one hundred point rise since my 2 hour post-prandial?

I’m not trying to be thick-headed, I just don’t understand how a 100 point rise in my blood glucose from 2 hours post-prandial to ten hours later (twelve hours after eating) is not a sign of severe dawn phenom…???

Sorry. Didn’t mean to confuse you. Meals with heavier protein & fat take more than 2-3 hours to digest. Protein takes a while. You mentioned when you wrote me that your dinner, like most people’s has a lot of protein. Carbs hit right away as digestion starts as soon as food hits saliva. Evening is when digestion tends to be slowest as we’re winding down & not as active. Going to bed several hours after eating doesn’t allow you to know about & correct the rest of your meal, if this is needed. It’s possible that your BG is climbing when asleep from dinner. Lantus won’t lower these highs or the 215 at bedtime. It may be dawn phenomenon or morning highs could be the result of your dinner meal because there’s not suficient insulin to lower it. Yep, it’s best to try to go to sleep on an empty stomach.

OK, I see what you mean. Thanks!

I did just take my blood glucose at 2:00 a.m. (can’t sleep) and it was higher than expected (328…eeek) partly because all of my doses are still too low, partly because I had dessert (sugar-free pudding) after dinner but forgot to add it in to my dinner-time Novolog, partly because the Lantus from 6:00 a.m. is starting to wind down, and partly because my dinner is no-doubt still digesting.

So I just injected 8 units of Novolog.

I see what you mean. If I were eating earlier (say at 6:30 instead of 9:30-10:00) then I could check to see if I’m still going up from the protein/fat in dinner four + hours later and correct for it, right?

Regardless, I think I need to try counting one-third to one-half my protein and covering that with Novolog, too.

Maybe I’ll start doing that with breakfast and lunch first, so I’ll be awake to track the results.

I need to get a battery for my food scale to make the protein-to-carb conversion calculations more accurate.

I also think I may be getting pyloric valve spasms as my food doesn’t seem to be “going down” into my body as well as it used to – I feel bloated two or three hours after dinner. (Oh, joy.)

Going to bed now with my still-gurgling stomach. (Sorry if that was T.M.I.) ;0)

Yep, that’s what I meant & you’ve now seen this for yourself. Dawn phenomenon can happen to anyone, but it’s more common in T1s. You may want to split your Novolog. Take some before dinner to cover the carbs & more later to head off the protein. You don’t want to go low before the carbs hit & then have Novolog gone when protein is digested. Fun, huh? It’s not merely doses, it’s timing also. Do you experience the same thing with breakfast & lunch?

Not TMI:)