Posted by on Monday 19 July 2010

Lantus problems and going round in circles

And on and on and on...

When we began writing about our experiences of living with Diabetes it was, at least in part, in response to a nasty overnight hypo brought on (I suspect) by the action of Lantus glargine. From some reading I have done since it appears I am not alone in this. That there are other people with diabetes using Lantus and injecting their dose at night time (recommended by the manufacturer and for most people the best option) who find they sometimes go low overnight, or wake up low in the morning.

One of the difficulties in managing diabetes with MDI (multiple daily injection) basal-bolus is that if you don't get your basal (background) dose correct then everything else becomes incredibly difficult to manage. You have no firm footing on which to start your day.

I think the late-at-night injection timing is suggested because it puts Lantus's onset period (perhaps an hour two until full strength) at a time when you have finished eating for the day and are usually if not actually asleep, then pretty much at rest. When I moved my injection to the morning, though my overnight levels were suddenly very steady and reliable, I had problems with high blood glucose spikes after breakfast. In response I began to split the dose, morning and evening, having a little just before bed, and the rest at breakfast. My hope was that this would spread the activity more evenly over the day. Sadly though, after a few months I can see that this has caused more problems, and not really solved anything. I found I was waking up low again, or waking slightly clammy having gone hypo overnight. On several occasions my liver then took matters into its own hands and began dumping glucagon into my bloodstream as it's own emergency measure. I would wake high, inject rapid-acting insulin and wait until my levels dropped before eating breakfast. After 2 hours or so I would give in, my levels still stubbornly high, eat a fraction of my usual breakfast and wait to see how things were going at lunch. Not only that but if the smaller Lantus dose didn't send me hypo overnight, then it had run out of steam by breakfast anyway and I was heading for spike central again after breakfast. Smaller doses you see, tend to act over a shorter time. With no Lantus hanging around, and anything from 15-45 minutes for Humalog to get going even a fairly low GI breakfast was going to cause problems. What my neice might describe as an #epicfail.

So I've gone back to Lantus in the morning. Suppertime and pre-breakfast readings are more constant. The post-breakfast problem still exists, of course, but at least I've lost the overnight hypo and liver-dump double whammy. Last time I didn't spend much time experimenting with the timing of my breakfast bolus (rapid-acting) doses. My hope is that with enough time between injecting and eating I might be able to stay out of the teens between breakfast and lunch.



  1. Mike, just caught up with this. I've been going around and around with Lantus as well and have now had months of success with a once a day injection at 1:30pm. I find that the Lantus does not give me full 24-hour coverage and the afternoon shot keeps me in range overnight without going too low, while allowing me to up my breakfast insulin to cover the period when the Lantus is wearing out. It took me a lot of playing around to get to the afternoon, and because it's usually around when I have lunch, I take it in combination with the Novolog lunch-time fast-acting, which makes it easier to remember. Everyone is so different, but I wanted to share something that has improved my control tremendously!

  2. Thanks for your comment.

    Lantus does seem to take a little experimentation to get it to work well. As they say... 'Your Diabetes May Vary' :)

    I've tried to post a more considered reply a few times, but Blogger's comment system seems to be on the fritz today.


  3. Lantus Problems
    I tried taking Lantus but found that it did not seem to work as well as NPH/TOR insulin. I found that blood sugars were higher during the day when taking Lantus before bed time and causing me to take more Humalog at meal times. I was taking 28u NPH/TOR before breakfast, with the Lantus I am having to take 40 to 50u of Lantus/Humalog. For Lantus does not seem to work as well.

  4. Yes it's interesting how different insulins suit different people better isn't it. I know some people via forums for whom Levemir is essentially like injecting water, and yet, on average Levemir twice daily is generally the most effective/best basal insulin on MDI. And for you Lantus is not so great, but NPH (which some people call 'Not Particularly Helpful' because it gives them so muh trouble!) seems to work better.

    Just goes to show how important individualised care is.