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Lantus in CGM

Discussion in 'Parents of Children with Type 1' started by monkeyschool, May 6, 2011.

  1. monkeyschool

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    Here are 5-days of Lantus for G:
     
    Last edited: May 9, 2011
  2. hawkeyegirl

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    I'm assuming you didn't catch the low and treat it? Because if you didn't, that's a really weird graph. I get the drops (could be either reduced basal need at that time and/or a Lantus peak), but it's the rapid climbs afterward that puzzle me. The lows aren't low enough, nor the highs high enough for rebounds.

    What they look like is what we see when he lays on the sensor wrong, and you see a sharp drop, followed by a quick rise when he rolls off of it. But it's too coincidental to have that at nearly the same time every night.

    Weird.

    ETA: Are you sold on CGM now? ;)
     
  3. monkeyschool

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    I didn't treat any of them. The go down and up on their own. I have no clue what brings them back up that way. I catch them at a down every once in a while and when I recheck 15 or so later they are back up to what they were before the dip...very weird but the ones when the numbers start off lower are quick dips, the ones where the numbers are higher (like a pasta dinner tends to keep us high for a while) dip and stay down a little longer, then climb back up. I am a little freaked out by the dips, because one was under 70 and I did not catch it.

    ETA....I catch the down every once in a while without CGM I mean...then 15 min later the number is back up.
     
  4. hawkeyegirl

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    It will be interesting to see your graphs when you move to the pump. (I think I read in another of your posts that you're heading that way? Disregard if I've confused you with someone else.) It's hard to tell on Lantus what is the effect of the Lantus not being a truly "flat" insulin and what is the effect of your child's varying basal needs. I think you've got a weird combination of Lantus peak and a drop, then increase in basal need going on at this particular time, and it's hard to sort out what is what. It would be really interesting to move your Lantus to the morning and then look at a few nights on CGM to see what that did to this time period.
     
  5. monkeyschool

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    You are right on the pumpt, but it is probably still a couple of months away. You make a good point if there is some increased need at that time in the morning. I have no idea. We have varied Lantus from 8-11PM and I've caught some of the dips varying in time with the changes. Lately it's been between 9:15 and 9:45PM depending on activity (and that peak is pretty steady in time from injection time). I hope to get on CGM before they even allow us on the pump. That will give me some time to play with Lantus before switching :)
     
  6. frizzyrazzy

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    to me it very much looks like the situation that Karla talked about - laying on the sensor.

    it certainly does not look like a lantus peak though.
     
  7. monkeyschool

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    It does look that way, but she actually sleeps facing the other way (she faces to the outside of her bed instead of the wall when she sleeps so the sensor was always on top (she purposely selected that side). It is rare for me to go test her and find her facing the wall. I have also caught those valleys on occasion when doing night checks (in which case I retested after 15 min before giving a snack and the number went higher). The other thing too is that the nights we had pasta the valley is a longer dip rather than a quick one (nights one and five). My gut feeling is that it is how Lantus kicks in for her. After that ~3am valley there is a rise, and then the number steadily drops through the night until morning.

    The only time we did not find this to be the case is when we were at 8 units of Lantus a couple of weeks ago and the number increased through the night rather than decreased (so I thought we may have dropped it too much at that point and went to 8.5 which held us very steady thought the night...and now the lows started to hit again).

    Oh I forgot to add that we also did not see any other valleys like that at any other point in the night...the 3am ones are the only ones.
     
    Last edited: May 6, 2011
  8. frizzyrazzy

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    Lantus would have no ability to act that way though. It's just not what it does.
     
  9. emm142

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    It's weird, but I don't think it's lantus.. They look to me exactly how the false lows given by the MM look. Unless you checked at those times to verify, in which case that's really weird.
     
  10. hawkeyegirl

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    Yeah, the more I look at those graphs, the less I think this is caused by Lantus. I'm not saying you don't have a Lantus peak somewhere, but I don't think it would look like this.

    I've never seen a Lantus peak on CGM (we didn't CGM until after we started pumping), but I've seen about a billion Novalog peaks, and even though Novalog is a much, much, much faster acting insulin than Lantus, even Novalog peaks are not that fast. A couple of those lines are almost straight down.

    That coupled with the fact that they then go almost straight back up to where they were - we've seen that many times on our CGM, and 100% of the time he was laying on the sensor.
     
  11. monkeyschool

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    I have no idea what it is, lol. I know she wasn't on the sensor at the same exact time every night, and only once at night....we have one day where the sensor did not pick up, but it is a blank in the graph in that one. I've caught the down up before in testing without CGM, and also the townward trend afterwards, but I have no idea what causes it aside from Lantus as an option. I'll update with the doc's feedback next week too.
     
  12. emm142

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    It does seem bizarre that it would happen at exactly the same time every night.

    I basically tell the difference between false drops and real lows by the speed of drop and whether or not it comes back up to the same place as before the drop.

    So on the 23rd on this graph at 2PM, that's a clear false drop. Similarly at 1AM on the 24th. 8PM on the 25th is about the fastest real drop that I will see on the CGM, and it tends to happen after a spike rather than after a period of flat.

    [​IMG]
     
  13. monkeyschool

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    Very neat, thank you. I can see that from your description ( I have a graph like that in my report, but couldn't isolate things in it, very small on paper).

    Is it possible our sensor had lsome sort of reset type of thing happening at the same time each day? Do they actually reset?

    How do I post a pic to a message without having to link it to another site? Very cool that u can post it right up :)

    Thank you again,
    D.
     
    Last edited: May 6, 2011
  14. emm142

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    First I use print screen and ctrl+Z to get the graph into MS paint. Then I upload the picture file from paint onto photobucket, and photobucket provides an [​IMG]
     
  15. monkeyschool

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  16. monkeyschool

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    [​IMG]

    [​IMG]


    Is there anything that jumps out that I can correct?
     
  17. wilf

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    These drops and rises are about what I'd expect in the period just after diagnosis. The body still has an ability to respond to lows by reducing its own insulin production and also kicking out a bit of glucose at that point. Over time, that ability becomes degraded and the lows are harder and the rebound response becomes much sharper.
     
  18. emm142

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    BGs look fine on the whole. Are the spikes from meals? Probably with more pre-bolusing you could reduce them a bit, but only if that's something that would be feasible for you.. If more pre-bolusing would be really tough, the spikes aren't really that high, and they come down beautifully quickly. She's honeymooning, right?
     
  19. monkeyschool

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    The spikes are all with meals. I tried pre-bolusing a couple of times (by 10-15 min) but she went low within the hour. I am not sure how to do it correctly :( I also tried waiting and splitting for pastas and other similar foods, but didn't get it right, lol

    I think she is honeymooning somewhat, but I am not sure. Her insulin needs have been higher than the honeymoon calculation, but her nurse does think her body is helping out a bit.
     
  20. emm142

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    Yeah, I never honeymooned properly (I always had highs and lows and my insulin was above the 0.5U/kg but my BGs looked a bit more like yours when I was in my first year than they do now.

    Prebolusing can be really tough, and it really depends on the food eaten and how soon after eating those spikes are. For example, I can't prebolus for pasta because I will go low really fast before the pasta kicks in. It's really trial and error, but I've ended up prebolusing for certain things (white bread, potatoes, white rice, fruit) but not for other things (wholegrain foods, pasta, pizza, anything else with cheese) because I will crash before the bolus kicks in. I think the fat in meat also slows digestion (I've never had D and eaten meat simultaneously so I can't be sure :p) so I'd be wary about prebolusing for that as well.

    But like I said before, those spikes aren't particularly extreme; they barely go over 200 and they come right back down again. The only reason really why I might try to get them lower or slower would be if I felt them (which I probably would, and I don't like the feeling of my BG rising rapidly).
     

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