How can you tell when Lantus runs out before 24hrs?

[mph]

If Lantus does NOT last the full 24 hrs, does the bg "steadily" rise, "quickly" rise, or can it remain "steady" and the child just begins producing ketones?????

He has had small ketones the last two mornings even though his fasting bg readings were 166 yesterday and 203 today (granny's sweet roll...ugh). I tested because he said he didn't feel well yesterday (maybe BECAUSE he was making ketones) and today "just because" and he had trace ketones again!! He cleared the ketones by lunch both days with a little extra Humalog and water.

The CDE thinks his Lantus is running out before 24 hrs and should be switched to dinner time (NOT bedtime) if he has ketones again tomorrow morning. She realizes that he does not need any MORE Lantus, but just that it is not lasting the full 24hrs and if we moved it to supper, we could cover that "fuzzy" time with humalog at lunch. I "see" that logic, but I just don't "see" a clear sign of the Lantus NOT lasting UNLESS ketones WITHOUT bg increase is a sign!?:confused:

Each night's numbers are steady with a bit of a rise, a bit of a dip, and another small rise which brings him back almost exactly to the starting point by breakfast. So it "seems" to be holding and "seems" to be lasting, IMO, but I'm not a doctor;).

I don't "see" any signs of illness now either, but keep in mind this is the "not so smart" child who has been drinking out of the "rinsed out" soap bottle all week:o. He has had stomach cramps (surprise, surprise) a couple times earlier in the week, but nothing consistent or no bowel changes.

Any thoughts??????? I REALLY don't want to change the Lantus from mornings unless I KNOW it is indeed not lasting long enough!!!!!

TIA!!!!!!!!!!!!!!!!!:)

[Christopher]

I think it is pretty hard to "tell" if the Lantus is running out before the 24 hours, there are so many other factors in play. But I can tell you that I give Danielle her Lantus at dinner time every night and so far (Knock On Wood!!) it is working out well. So maybe a switch is in order? :)

[wilf]

Lantus does not last 24 hours in some people, especially those receiving smaller doses. That does not however mean I agree with your CDE..

Ketones are produced when the body burns fat for energy. If they are being produced because the "Lantus is not lasting", then this would be
because there was no insulin left in the bloodstream to transmit glucose to the cells. But to my knowledge, this is always accompanied by BG shooting up because no insulin in the bloodstream signals the liver to release large amounts of glucose.

Try to think of other reasons his body might be burning fat. Has his appetite been off lately (maybe because of the soap bottle..)? If so, it could be he's just not been getting enough carbs to keep his system running. Other issue causing ketones could be heavy sports.

I would not switch the Lantus timing yet, and if I did I would keep an eye out for night-time lows..

[Momof4gr8kids]

What time do you eat dinner? And why are you checking ketones in the am with good numbers?

When my neighbor was doing atkins she checked her ketone levels in the morning. She said that's when she was highest because she hadn't eaten for a while.

All ketone levels mean is you are burning fat for energy. In diabetes with high bg it means that your body is not getting enough insulin to absorb the energy so you are burning fat instead.

Has your child had any bad lows lately, or have you had to use glucagon lately? I could see an 8-10 hour fast causing ketone levels if your child is low on glycogen (sugar stored in the liver).

I have to agree with Wilf though. I really don't think it is the lantus.
I'm going to check Julia in the morning though. We eat between 6 and 7, and eat breakfast around 7 or 8 on the weekend. That's over 12 hours. I'll see if she has ketone levels with a normal bg, and let you know. I have no clue how long of a fast it would take for a person to produce ketone levels. It probably depends on the last meal/s consumed.

[wilf]

The funny thing is ketones are not necessarily bad! If any of us parents tried to shed a few pounds we'd be seeing ketones if we tested for them.. :)

[Momof4gr8kids]

Normally only small amounts of ketones are excreted daily in the urine (3-15mg). Diabetic patients who detect high levels of ketones should seek immediate medical advice. High or increased values may be found in:

Poorly controlled diabetes
Diabetic ketoacidosis
Starvation:
Not eating for prolonged periods (12 to 18 hours)
Anorexia nervosa (http://www.patient.co.uk/showdoc/40000626/)
Bulimia nervosa (http://www.patient.co.uk/showdoc/40024902/)
Alcoholism
Poisoning (for example with isopropanol)
Ether anaesthesia
Alkalosis
Some metabolic disorders (http://www.patient.co.uk/showdoc/40000357/) False positivesThe main purpose of testing is to detect diabetic ketoacidosis. A false positive is regarded as a positive result which is not likely to signal the start of diabetic ketoacidosis or agents which give a positive result in the absence of ketones.Testing may not be helpful and can be misleading if there is a chance of false positives. This may occur in non-diabetic (as well as in diabetic patients):

Positive test result but 'no' ketones:
Some medication:
Levodopa for example sinemet (http://www.patient.co.uk/showdoc/40025033/)
Phenazopyrazine
Valproic acid
Vitamin C
Dehydration
Positive result and ketones present but not relevant to diabetic ketoacidosis:
High fat diets (for example the Atkins diet)
Some metabolic disorders and inborn errors of metabolism (ketones but low or normal blood glucose)7 (http://www.patient.co.uk/showdoc/40001083/#ref7)
Starvation (as above)
Poisoning
Ether anaesthesia
Alkalosis

[LantusFiend]

When I don't have Lantus, my blood sugar rises 20-30 mg/dl per hour. Which is about what you would expect because 1 unit lowers me 35 mg/dl, and I take about 18 units of Lantus per day. I've only had ketones when I've been really sick, so I don't think I'm really ketone prone. I don't think it's the lantus if the blood sugar isn't rising though. I do think you could have a rise of only 100 points or so and have been short on insulin long enough to get ketones.

[mph]

THANKS all of you for your replies!!!!!!!!!!!!!:D
Great info on the WHYS of ketones! I'm convinced also that it is NOT the lantus. Hopefully, it is just a bit of a "bug" he's fighting off.

Jamie, no bad lows and thank GOD...no glucagon ever!!!!

If his liver put out some "sugar" (rebounding), how long does it take to "refill"? Less than 24hrs, or more? Just curious.

I checked for ketones because he said he felt sick, but had no outward signs of illness. I know having ketones can MAKE you feel sick, so I checked and he had some. This morning I checked again just because I had that "mother's intuition" feeling after being surprised by ketones yesterday.....and I was right, unfortunately.

He has had fewer carbs than usual as we are trying to figure out his meal ratios for sure. But I don't think enough to be "starvation" but I have no idea when HIS body consider's itself to be starving enough to produce starvation ketones!!!!!

He had a horrible day of highs and insulin resistance today and I'm not sure WHY!!!!! 501 after breakfast even!!!!:eek: NEVER that high from breakfast!!!! He only had 40 grams of food and 3 units of Humalog (1:20 ratio and 1 for ketones)!!! He still does not "seem" sick.

So, we'll see what happens tonight and tomorrow morning................:o

I just wasn't sure if the CDE had a legitimate reason for thinking the lantus was wearing out before 24hrs which would CAUSE ketones even if his bg was not high.............

THANKS for helping!!!!! :)