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Permalink Reply by Devon on April 9, 2010 at 5:00pm

Gotcha.

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Permalink Reply by TimmyMac on April 9, 2010 at 3:42pm

hmm.. apparently I'm the only person who HAS to eat 45+ carbs at night. If I don't I WILL be 50- in the morning. And if I lower my lantus, my humalog needs will skyrocket.

but I will agree with everyone else on one thing, 85 isn't low and it shouldn't be corrected unless you know its dropping

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Permalink Reply by TimmyMac on April 9, 2010 at 4:10pm

I should start looking at what section these posts are in before commenting... its probably slightly different with me being T1

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Permalink Reply by Gerri on April 9, 2010 at 4:12pm

Timmy,

Your Lantus & Humalog doses must be way off for this to be happening. Lantus shouldn't be effecting post meal numbers. Basal's just background to help level BG between meals & overnight. A functioning pancreas sends out small amounts of insulin to do this & then large bursts for food. So not exact, of course, but it's what we attempt to imitate with basal/bolus injections.

You must be taking huge amounts of Lantus for it to be effecting you this way. What's wrong with taking more Humalog to cover your meals? You need what you need. This is more exact, more predictable & easier to control than Lantus.

You could discuss your doses with your doctor & also talk to him/her about taking split doses to prevent overnight lows. They all say that Lantus lasts 20-24 hours, but it doesn't. Many have greater success by taking two separate doses. The trials done on Lantus used humungous doses, so the trials showed it lasted 20-24 hours, but this wasn't the dose range most people us.

I had a horrible time with Lantus causing lows. The dose didn't seem to make much difference. I had terrible lows every afternoon. I switched to Levemir (at the same dose) & things leveled out. Lantus had obvious peaks & valleys despite claims that it shouldn't. Many discussions here from others who've experienced the same. I also like Levemir because it doesn't sting.

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Permalink Reply by TimmyMac on April 9, 2010 at 4:48pm

It definitely lasts a full 24 hours (and maybe then some), but for me, it has a spike. and 27 units isn't exactly a "huge" amount either. and this is working, why should I start taking 15+ units of humalog at a time? I would rather not start using 1:5 I:C again like when I was going through growth spurts. Wouldn't smaller doses of humalog be more like a normal pancreas? Its definitely easier to manage..

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Permalink Reply by Gerri on April 9, 2010 at 7:23pm

27 units of Lantus isn't that much, but it's too much if you have 45 carbs at bedtime to prevent going to 50 overnight. I'd question how well it's working keeping your postprandial numbers within a good range with an A1c of 6.8.

The idea is dosing insulin to food, not food to insulin, not eating to match insulin.

Since Lantus works slowly, how do you calculate Humalog dose for meals? How are your numbers after meals?

Your I:C ratio may be different now then when you had growth spurts. My feeling is that however much we insulin we need to keep BG as close to normal is the goal. A lot or little, it doesn't matter. Good numbers matter.

Nope, smaller doses of Humalog aren't more like a normal pancreas. Larger amounts are produced for meals depending on how much is needed. Small doses of "basal" are secreted throughout the day & as needed.

If your target is less insulin, the way to do this is with less carbs & more exercise, not taking more Lantus than you really need.

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Permalink Reply by TimmyMac on April 10, 2010 at 11:33am

I would rather not experiment while school is still on, I've missed enough time at school as it is. Maybe I'll try something drastic during the summer when my GPA isn't at risk. but as of right now, this is working, so why change anything? My 2 hours are generally good, depending on how close I can count my carbs. 1:12 is much easier than 1:5. being 1 unit off is much better than being 3

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Permalink Reply by Gerri on April 10, 2010 at 12:53pm

Yea, not a time to risk it. I try to do my experiments on weekends. Going high or low at work isn't cool, esp low. When I change doses, I only do it in 1-1.5 unit increments & keep it at that for three days to get a sense of what's happening.

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Permalink Reply by crazyhorses on April 9, 2010 at 6:41pm

Hi! I have been back on Lantus since October 2009. I have thought that I was at the right dose several times. When I sat down with my BS readings, I realized that the dose was too high. I like to keep my BS lower than most are comfortable with. The last month the readings have been getting lower and lower. I have some hypo unawareness and do not have any low symptoms until I am below 40. I have just lowered my dose by 10 units in hopes that I can keep my FBS under 85 and pre-meal about the same. I have found out that if I keep my BS at 100 at bedtime then I usually sleep the whole night through. I am another one that once I wake up in the middle of the night, I have a terrible time falling back asleep. If you can keep your BS at 100 or higher at bedtime, you probably won't go low during the night, if you are still going low, you may need to decrease your daily dose of Lantus.

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Permalink Reply by S Woodward on April 9, 2010 at 7:07pm

Paul, You make some great points and many who have commented should read the book,TLAP, to better understand how managing T1D with insulin works.

The reality is, if your are raising your bg to overcome potential hypos at night or during the day, or before bed, or before taking an injection, there is an issue with how you are managing T1D with insulin.

For those that are, it may be time to get some help or learn more about managing your diabete.

The blanket advice given by the MD at Joslin is WRONG and may mask other insulin/T1D issues that, until resolved, may cause a T1D to never be able to effectively manage their T1D successfully to achieve normal BGs.

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Permalink Reply by Jeff on April 10, 2010 at 4:14pm

Hey Ali,
this may sound crazy but when i started on Lantus, i think more than 5 years ago, i was having the same issue. I was using about 19 units at bed (10 or 11pm) lot's of lows... I was at Joslin at the time and the endo there reccomended I kick my BG level up to 200 before bed, (have a snack that would get me there) then take the Lantus. (now i'm not reccomendign this to you but it's an option to take to your DR.) this worked for me for years, until my newer Endo suggested I stop this and simply split my Lantus shot... duh! >>slaps head 8) so now i take most of it at bed and anothe bit in the morning... this is working pretty well for me, at least until I try to start Pumping next week..
Good luck, hope you find a good balance soon!!!

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