View Full Version : Simple Lantus Question
All About Aliya
01-02-2008, 10:52 AM
I am sure this question has been covered many times, sorry....
My dd is currently on NPH/Humalog.....I know a lot of people do not like NPH, but it has worked for us and her A1C's have been right on since diagnosis a little over a year ago.
I am curious about Lantus though because of some unexpected lows lately in the middle of the night which I know is typical of NPH.
Here's the question: Do you have to give Humalog to cover every snack when on Lantus? (My daughter is a big time grazer)...Also, you definately have to give a shot for lunch correct?
We are currently only on 2 shots a day, so wondering how many this might increase to if I were to switch.
Thanks in advance!! :)
momtojess
01-02-2008, 10:55 AM
When we were on Lantus, Jess would get 6+ shots a day because she was a grazer. Anytime she ate over 5 carbs we had to cover it with Humalog.
I know some people can get away with not covering up to 15 grams, so some snacks were probably not covered. I think it all depends on the child.
staciebco
01-02-2008, 11:15 AM
When we were on shots, we did an NPH/Humalog/Lantus combo. The NPH was given in the morning to allow for snacking and no lunchtime shot. Also, no NPH at night, so there was not the variability of that for the potential of nighttime lows. We had great results and I would still be using that method if we weren't pumping.
twodoor2
01-02-2008, 11:26 AM
When we were on shots, we did an NPH/Humalog/Lantus combo. The NPH was given in the morning to allow for snacking and no lunchtime shot. Also, no NPH at night, so there was not the variability of that for the potential of nighttime lows. We had great results and I would still be using that method if we weren't pumping.
If you're on NPH, and it's working great for you, I wouldn't bother to switch, but I see you're already pumping, so that's a mute point. It doesn't work for a lot of people/children due to unforseen lows, and because you're asking a child/person to eat a specific amount at specific times.
With Lantus, you usually do have to take a shot with every meal/snack. There are exceptions, but in our case, if I give my daughter more than 5 grams of anything uncovered, she rebounds later with a high. I have to give her shots with almost morsel of food she puts in her mouth. Unfortunately, we started with NPH, and it was a nightmare for us. I'm much happier with the Lantus, although she gets about 6 to 8 shots a day. Not fun, but more freedom when it comes to food, and more control over blood sugar.
When we were on shots, we did an NPH/Humalog/Lantus combo. The NPH was given in the morning to allow for snacking and no lunchtime shot. Also, no NPH at night, so there was not the variability of that for the potential of nighttime lows. We had great results and I would still be using that method if we weren't pumping.
Ditto...same for us.
staciebco
01-02-2008, 11:35 AM
It doesn't work for a lot of people/children due to unforseen lows, and because you're asking a child/person to eat a specific amount at specific times.
That's not how it worked for us. We knew approximately how many carbs Caleb would eat during the time the NPH would be active and based the NPH on that amount. We have a fairly routine schedule and eat most of our meals and snacks at the same time everyday, but we didn't really carb-count or monitor snacks really. Caleb's a big grazer and did that most of the day. It's different now because he's in school, but that for us, was the beauty of NPH he could graze and still have coverage with no extra shot.
Shenandoah
01-02-2008, 11:58 AM
Gavin has to take novolog to cover his 3 meals a day, he gets 2 free snacks under 15 carbs before dinner and bedtime.
All About Aliya
01-02-2008, 11:59 AM
That's not how it worked for us. We knew approximately how many carbs Caleb would eat during the time the NPH would be active and based the NPH on that amount. We have a fairly routine schedule and eat most of our meals and snacks at the same time everyday, but we didn't really carb-count or monitor snacks really. Caleb's a big grazer and did that most of the day. It's different now because he's in school, but that for us, was the beauty of NPH he could graze and still have coverage with no extra shot.
BEAUTIFUL! Thank you so much Stacie. That is my exact situation with my daughter. I am going to ask about the NPH/Lantus/Humalog regime next visit with the endo. Did you give the Lantus at night in lieu of the NPH? Did this eliminate the need for the nighttime (before bed) snack? That is the one snack I have a problem with sometimes because we do insulin at 6pm...I wait until 8pm to test and snack and sometimes she is just too tired.
staciebco
01-02-2008, 12:27 PM
Did you give the Lantus at night in lieu of the NPH? Did this eliminate the need for the nighttime (before bed) snack? That is the one snack I have a problem with sometimes because we do insulin at 6pm...I wait until 8pm to test and snack and sometimes she is just too tired.
We did give the Lantus at night (eventually we switched the Lantus to the morning with the same result) and still gave a small snack, not really because he needed it, but more because he wanted it. We "padded" the dinner Humalog to account for the snack 1-2 hours later. The only problem was he had to eat the snack, not really an issue because he's never not wanted a snack. ;) This might not work for you and certainly check with your endo before trying it, but it worked great for us.
My dd is currently on NPH/Humalog.....
I am curious about Lantus though because of some unexpected lows lately in the middle of the night which I know is typical of NPH.:)
Are you sure the night time lows are from the EVENING NPH? I ask because they MAY be from the morning NPH dose.
http://www.diabetesnet.com/diabetes_treatments/insulin_action_times.php
NPH can last up to 20 or more hours (may not be real strong, but it's still there). If your NPH dose is incorrect, you may find lows between 4 and 16 hours.........:eek:YES, HOURS!!!!!!!! Crazy! That's just too big a window for TWO doses of NPH per day, IMO!!!!!
When Nick is low (from too much insulin) it is really tough to pinpoint WHICH insulin dose is REALLY the one to change (they ALL overlap)!
That's (partly) why we are switching to Lantus/Humalog. More shots, but NO rollercoaster peaks and dips and extended "chances" for lows mainly from overlapping wavy insulin (I pray;)).
But if you like NPH, adding Lantus at night might be just right for you.:) We were doing just two shots for quite a while with good results and it was nice! Then he needed more.........
All About Aliya
01-02-2008, 02:08 PM
Are you sure the night time lows are from the EVENING NPH? I ask because they MAY be from the morning NPH dose.
http://www.diabetesnet.com/diabetes_treatments/insulin_action_times.php
NPH can last up to 20 or more hours (may not be real strong, but it's still there). If your NPH dose is incorrect, you may find lows between 4 and 16 hours.........:eek:YES, HOURS!!!!!!!! Crazy! That's just too big a window for TWO doses of NPH per day, IMO!!!!!
When Nick is low (from too much insulin) it is really tough to pinpoint WHICH insulin dose is REALLY the one to change (they ALL overlap)!
GREAT info Marci, thanks! Now I am definately going to need to discuss that with my endo. He taught me that my pre-dinner BS number was the indicator of whether I needed to increase the morning dose of NPH....and she has been running higher at dinner....so I figured I needed to INCREASE her morning dose of NPH....It definately is crazy. Her evening dose is pretty small 1 1/2 units. Last night before bed she was high....260....so we kept the nightime snack light. I think that was my mistake. When the evening dose peaked......well, you know. The 4-16 hour thing is definately crazy. Thanks for the input & the GREAT info link! Argh, this crazy disease...
I saw the term NPH and at the risk of sounding silly, what is it? We presently give my dd Novalog and Lantus. She is a big time grazer. Maybe we need something more??? We are having some big time high numbers lately.
Also, I have read about a rebound. She had some alot of lows previous to this incredibly high she is experiencing now. This has been going on for 4 days. My thinking is....from the grazing and lows...could all these highs be from the lows.
Maybe I should get the book "Think Like a Pancreas." Which I will...but I do not completely understand the rebound.
twodoor2
01-02-2008, 03:05 PM
I saw the term NPH and at the risk of sounding silly, what is it? We presently give my dd Novalog and Lantus. She is a big time grazer. Maybe we need something more??? We are having some big time high numbers lately.
Also, I have read about a rebound. She had some alot of lows previous to this incredibly high she is experiencing now. This has been going on for 4 days. My thinking is....from the grazing and lows...could all these highs be from the lows.
Maybe I should get the book "Think Like a Pancreas." Which I will...but I do not completely understand the rebound.
NPH stands for Neutral Protamine Hagedorn
It's one of the older background insulins - developed in the 1950's and it has been routinely used by Type 1 diabetics until recently, when Lantus, and some of the newer background insulins were developed in the early 2000's.
It is a cloudy mixture, and needs to be gently rotated in the palms about 20 times to mix. The newer insulins don't need to be mixed.
hawkeyegirl
01-02-2008, 04:03 PM
We are on Lantus/Humalog, and my son gets 4 shots a day - Humalog with each meal, and Lantus at bed. Right now, he can eat up to a 20 carb snack and not need any extra Humalog, but I suspect that may change as he comes out of the honeymoon.
He taught me that my pre-dinner BS number was the indicator of whether I needed to increase the morning dose of NPH....
Don't be surprised then if your endo does NOT think it is the morning NPH that "could" be causing your night time lows! I was taught the same thing. The nurses at the endos here do NOT think NPH really lasts that long or peaks that late! But it does! Nick's morning NPH (15 units) covers MORE than his lunch and afternoon snack. It peaks about 4pm (8hrs) and it also covers most of dinner (he gets 1H for 45gr carb) and at least part of bedtime snack (no H for 45 gr carb). Not to mention as a "basal."
I was also taught that if he is low at night that it is ONLY the night NPH to blame (in terms of "insulin" reactions past the duration of last Humalog injection....which Nick's is at 5:30pm). Not so! He gets 1NPH at night and STILL goes low (.75 is not enough and 1 is too much.....frustrating)!!!!
I tried to lower his morning NPH (to soften the PEAK and strength of duration....) and increase the Humalog at meals (even adding H at lunch....he needed WAY more than the usual 1H at breakfast AND dinner...so I KNOW the morning NPH is still working strong then). I added more NPH overnight to balance things out better (because he was HIGH from less morning NPH), but it just got CRAZY trying to figure WHICH one was really needing to be changed AND how much.......it's all a chain reaction. I went back to the 15 units and am now SWITCHING to Lantus!!!!:o A variable lifestyle and NPH can be a recipe for disaster.
My hope is that JUST dealing with ONE dose of Lantus (no peak......maybe) and Humalog at meals, it will be much easier to figure out WHERE we need to adjust, since adjustments are inevitable!
NPH is good for snackers, which Nick is, that's why it has taken me longer to switch. Yet, it is frustrating not knowing WHERE you are on the curve at any given moment (it varries from day to day and site to site....rate of absorption)!!!!! With two doses of NPH going, there are TWO curves with variable peaks that you are dealing with and an overlap between them (AND Humalog)!!! Makes me wonder WHY I am STILL dealing with this, lol! It CAN be done (many others do it well), but I'm a bit burned out trying! I think a CGM would help ALOT, but he is phobic of "wearing" a device right now. :o
Wilf gave me the link to that site and it has been GREAT to search there! I finally realized (from info there) that Nick's insulin sensitivity AND his hypo unawareness are likely BECAUSE he is having more than one low within 2-3 days. The lows temporarily interfere with his awareness AND sensitivity....then ANOTHER low because he didn't feel it coming AND is more sensitive to the insulin!!! More chain reaction from those crazy wavy patterns of NPH......
Sorry so long! Best wishes for figuring this out!!!!!:)
All About Aliya
01-02-2008, 07:10 PM
My hope is that JUST dealing with ONE dose of Lantus (no peak......maybe) and Humalog at meals, it will be much easier to figure out WHERE we need to adjust, since adjustments are inevitable! Sorry so long! Best wishes for figuring this out!!!!!:)
Thanks again for all your input, Marci. Our situations sound similar. I will be interested to hear how you like Lantus & how it works out for you.
Keep me posted if you will :D
Thanks again for all your input, Marci. Our situations sound similar. I will be interested to hear how you like Lantus & how it works out for you.
Keep me posted if you will :D
Sure! The CDE is going to call me for my "advanced carb counting class" tomorrow :D. Not sure when the REAL transition will be. She is calling so I don't have to drive 2hrs out there for a 2-3 hr class with my four children (I home school). How nice of her;). Of course the info she will share will probably make me see where I am going wrong with the NPH:o. A little too late. But I think Lantus is the better way for us to go now anyway. I'll keep ya posted.