Tuesday night, I switched my Lantus over to a once-per-day shot instead of the split doses I'd been using previously. I started with 22 units of Lantus at 8pm. I knew I'd see some highs, but I didn't want to risk an unexpected night low after making the first switch.
And I did see some elevation. I ran mostly in the 180-290 range all through Wednesday, which wasn't as high as I was expecting really. I made sure to consider food in the highs, along with the usual post-breakfast spike. And I was confident that a few more units of Lantus might do the trick (or at least get me closer).
So Wednesday night, I increased the dose to 25 units. I took it at about 10pm instead (not really by choice, just life getting in the way). A 4am check showed me at 173, despite a nagging feeling of being low (think it's the hormones though on that one). By 9am, I was 192. Not the kind of spike I like to see before I've eaten anything for the day.
I'm going to watch it carefully today, making sure to check more often and bolus appropriately. But I can't help feeling that something is amiss.
Maybe the Lantus needs a few days to kick into this new routine...which leaves me hesitant to raise it again tonight. Or maybe the birth control is affecting my sugars by now (you know, the whole "risk of elevated blood glucose" thing). Or maybe it's none of the above and I still haven't hit the right Lantus dose.
The biggest fear is that it won't work. That Lantus can't give me the control I want on a once-per-day schedule. I know it's not an exact 24 hour lifetime, it ranges from 16 to 30 hours depending on the person. And unfortunately, I can't remember my previous days where Lantus wasn't split (to consider what my Lantus lifetime might be).
If it doesn't work, I've inevitably told myself that I have to go back on the pump for the rest of the school year (well, until May 2010). Because I can't keep bouncing around like this. I can't forget my insulin. I can't watch these pattern-less trends and expect an A1c to be within range.
It doesn't even make sense to forget insulin, not focus on patterns, and still even care what my A1c is. What's the point of an endo check up if I'm not doing my part?
So I sincerely hope my body adjusts to this new insulin thing. I think I'll raise it again tonight to 27 units (back at the 8pm time hopefully). Those two extra units might show me a slight drop, keeping me within a 150-170 range. I know my full Lantus dose should be 29 units. And maybe I'm just being stubborn by not trying that right off the bat here. But I've seen how low I can drop after a 15 unit Lantus injection...so why risk it with 29 units?
Stubborn must be my middlename.
It really is surprising to me to read about people who talk about Lantus increments of 1 or 2 units. Also what is this Lantus lifetime or the right dose?
Sorry to be a little blunt, but are we dreaming here? Or am I so different that I am in a unique situation? I don't think so!
I have been a Type 2 diabetic since 1991, almost 20 years. At first I was on a diet and exercise program. Two years later I graduated to Glynase and Metformin and my sugar levels were fair, but soon I started neglecting exercise and diet thinking the meds would take care of the problem. I had a rude awakening when I got a minor stroke that caused a bad case of strabismus (cross-eyedness) which lasted until I went back to a good plan of exercise and good eating.
Since this is a progressive disease, three years ago I was put on Lantus and Humalog. I now inject myself with 10 to 20 units of Humalog before meals, depending on what my BS numbers are and how much I am preparing to eat. Likewise,right before I go to bed I check my sugars and adjust the amount of Lantus to my BS levels. If my BS is around 170 to 180 I give myself a shot of 30 units, if around 150 to 169 then 25 units, if 130 to 149 then 20, if 120 to 129 only 15, if 110 to 119 only 10 units. If my BS is 100 to 109 I inject myself with 5 units of Lantus and if less than 100 then I pass on the Lantus completely. Once in a blue moon when I have eaten too much and no exercise and my sugars go to 200 or more I have done 50 units of Lantus. My readings before meal are usually lower than 150 and around 110 at bedtime. My A1c last month was at 6.3.
My NEW endo told me last month not to be too concerned about occasionally hitting a low (under 70). It will not kill you or cause brain damage (as long as it doesn't happen too often).
The amount of normal insulin that the bodies
of non-diabetics produce is not a set amount at all times. It varies with how much you eat and exercise, etc. So why must we think that we diabetics who shoot ourselves with insulin must have the "lifetime amount"set on stone? No! The amount of Lantus and Humalog must be proportional to how much you eat, how much you exercise, how much stress you are on on a given day, etc.
Moving Lantus on a day by day basis is not an option for me. Although it's exciting to know that it works for you, Lantus does not work that way in my system. The only "moment by moment" insulin in my system is Humalog, which I vary according to activity, blood sugar, and food. Lantus is a steady basal insulin...which is how the body generally works. Although the insulin pump works most closely to the pancreas, there are still two "types" of insulin in the human body which work according to the general body's production of glucose and bolusing activity.
Whether you take Lantus once a day or in multiple split doses, you will still need the same total amount over a period if 24 hour to meet your basal needs.
The only reason to change your daily basal dose is if you are going through a significant lifestyle change, such as a change in stress, weight, or activity - or the dose wasn't correct to start. In any other case, a change in basal dose without corresponding changes in your boluses will cause your weight to change in the same direction, and your BG to change in the other direction.
Compensation for short term BG fluctuations should be done with bolus adjustments, not basal adjustments.
If you've been splitting your Lantus dose 5/50 AM/PM and suddenly take the same total daily dose, the predicted response is a gradual drop in BG from your previous nighttime levels, because 1/4 of your daily total is still in your system from the previous morning. So, if your morning BG level is much higher than expected, you may be experiencing a rebound after nocturnal hypoglycemia.
The smoothest way to make this kind of transition is to reduce your evening bolus doses by 1/4 your total basal dose that first evening, and resume your normal boluses the next morning. You may run a little high that first Am as a result, but that's safer than running low while you re unconscious.
Your goal should always be to avoid hypo episodes as you continue to dampen swings in your BG and bring your average levels toward your long term target, because even one hypoglycemic episode can be fatal if it happens at the wrong time.
If you want to determine if your basal dose is correct, pick a day when you can stay home and relax. Measure your BG, and if it is in the safe range, eat a measured breakfast, bolus for it and don't eat again until your BG drops below your fasting level. Assuming your bolus correction factor is accurate, with a correct basal dose, that should be 8 hours or longer.
It's much easier over time to use sliding scale bolus doses than to guess what you are going to be doing for the next 24 hours. Rather than making seat of the pants decisions about changing your Lantus dose, hold it steady and check to see if your bolus correction factor is right.
PS, if the duration of Lantus in your system is much shorter than 24 hours you'd be better off taking continuing to take a split dose. It would make your boluses easier to calculate.