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Lantus issue ... again? not sure.

Discussion in 'Parents of Children with Type 1' started by VinceysMom, Dec 9, 2011.

  1. VinceysMom

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    Weird stuff.. here are Vince's numbers yesterday and today:

    10:30 pm - 137
    12:40 am - 47 juice box, cookie, mini donut
    1:15 am - can't remember but I think it was over 100
    5:30 am - 86
    10:15 am - 118 (lunch at school)
    3 pm - ?
    6 pm - 168 (dinner - and Lantus time)

    10:45 pm - 107 milk, mini donut;
    12:50 am - 42 -juice box, then two small pieces of italian bread with peanut butter;
    1:20 am - 98;
    5:30 am - 143.
    10:15 am - 83 (lunch at school)
    12:15 pm - 47 - Will recheck shortly.

    Two wee early mornings this week same time, in the 40's. He went to bed one day at 137 so I set my alarm for 2 hours and just as it went off, he was calling for me. Then last night he went to bed at 107, but he had milk and a mini powdered sugar donut and STILL woke up 2 hours later at 47 about the same time as my alarm was going off..again..ugh.

    This happened a few weeks back so we lowered Lantus. We have decreased his lunch insulin from 1:8 to 1:10 to 1:12 and now 1:13... So I'm guessing we need to go 1:15 and see how this works... If this happens again tonight, I should probably decrease Lantus again, correct? He has not had any extra activity, etc., maybe just his body does not need as much basal anymore?

    :eek:
     
  2. Christopher

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    If his last bolus of insulin before the two low midnight numbers was 4 or more hours before the low, then you are right, it sounds like a Lantus issue. Have you considered splitting the Lantus dose? His other numbers seem pretty good so you hate to mess with those by lowering the overall dose to deal with the midnight numbers.
     
  3. Becky Stevens mom

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    Yep, looks like basal issue to me Kath. I remember before you had to keep raising his Lantus dose to get his BGs in range at night. Now that they are in range he is probably very sensitive to insulin and needs less. I would go ahead and cut him back one unit per night until the #s start going up again
     
  4. Heather(CA)

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    Yes that is a Lantus issue, how many units are they on now? Lunch insulin has nothing to do with this...Lower the Lantus now. I'm thinking lower it by two units. You can always put it back up...

    I ALWAYS lower Lantus at the first unexplained low during the night...
     
  5. VinceysMom

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    OMG this is terrible, but I think it's 28U Lantus (or 27) :eek: I cant remember right now! yikes!! Anyhow, his fast acting was out of his system already, i was so surprised by both drops ... we will decrease Lantus tonight and see what happens overnight. Thank goodness for my cell phone alarm and for mom-instinct to set it at those times. He doesnt want to split Lantus, that's another shot....:(

    The first low this week I thought was due to exercise... lots of walking around at a high school basketball game... then after last night's low, I thought, wtheck??
     
  6. Christopher

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    Maybe that first low WAS due to the activity and is not the Lantus. And the other one was just...??? So reducing the Lantus may not be needed. What does the Endo say?

    My point was that since it appeared to be at the same time of day, and the other basal numbers were good, if you lower the dose to deal with those few numbers you may effect all the other ones. I know it is an extra shot, but sometimes splitting the dose makes all the difference. Good luck.
     
  7. Heather(CA)

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    Two night in the 40's means the Lantus does need to be lowered. The low right before lunch just confirms that. Did he start a new sport? Or was it one day of exercise? I think I would do 25 Lantus tonight if your unsure. If he knows it's 28 then I would do 26. 40's are pretty low...
     
  8. emm142

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    I'd be lowering the Lantus by 2 or 3 units at that dose. JMO, of course!
     
  9. Christopher

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    But if there are no other times the child is low, don't you think that lowering the dose will make them be high at those other times? I am not saying ignore the 40's, those are not good. But maybe another solution (like splitting) could address it. No one likes an extra shot, I get that. But no one likes finger sticks or ANY shots, but it is just something you have to do.
     
  10. Heather(CA)

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    He was also low at 12:15pm as I put in bold above...BUT, even if he wasn't...Yes, the Lantus needs to be lowered, no way would I allow 40's to get good daytime numbers. Once the Lantus is lowered, it sometimes happens where the I:C ratios may or may not need to be changed, either way, stable over night numbers are way more important. :cwds:

    Splitting the Lantus will not help if it's too much and I would not do that (Add a shot) unless I had tried EVERYTHING else first. They get enough shots...:cwds:
     
  11. Christopher

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    Well, I hope the OP try's lowering it and I hope it works and doesn't mess up the other numbers. It really is more art than science sometimes, isn't it? Hopefully she comes back and updates us.
     
  12. Heather(CA)

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    Yep, me too. It may mess with the other numbers but then you just give a little more at meals...No biggie :)
     
  13. emm142

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    It's been a while since I did Lantus, but I always adjusted based on overnight numbers and then adjusted I:C ratios to deal with variable basals during the day. It was imperfect, and splitting might have worked better. I totally agree that it's more of an art than a science sometimes..
     
  14. Christopher

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    That just seems counter intuitive to me...but if it works for the OP that is all that matters.
     
  15. emm142

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    Just wondering why it seems counterintuitive? Because I never saw a particular peak from Lantus, I never imagined that splitting would make much of a difference (since it seemed to be flat for 24 hours anyway). I guess the other option would be to adjust basal for daytime numbers, but that seems even more counterintuitive because there are less shots and food overnight anyway, so correcting more overnight would mean more disruption. I'm really just curious as to how you would do it if Lantus seemed to have a flat basal action, but a person's basal needs were lower at night?
     
  16. Christopher

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    I guess it is just a feeling. It just seems like you are "feeding" the lower basal dose with a higher fast acting dose...and if the Lantus in this case was flat, then why would there be what seems to be a peak where the child is going into the 40's? I don't know, I guess I need to really think about it a little deeper
     
  17. emm142

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    I'm imagining that Lantus is flat (as in, it's releasing steadily) but that there is just a lower basal need at that time, so the same level of basal will send him low. It's all hypothetical, and we all know that D doesn't work in hypothetical situations where Lantus is actually flat and basal needs vary at precisely the same time every day.. :rolleyes: But sometimes I like to imagine that it does. :p
     
  18. Christopher

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    oh,I see...got it. That makes sense....
     
  19. Heather(CA)

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    It not flat though...:cwds:

    Lantus is only flat when it's correct (As flat as poss anyway) if it's too much it drops them as in this case...If the dose was correct he would stay withing 40 points of the 3 to 4 hour after dinner number which was 137. So, during the day after lowering the Lantus to the proper amount you would not be feeding a basal that is too low, in fact it's the opposite. You would be changing it to the correct amount without the influence of Lantus "Helping" them come down.

    In other words...When you are giving correct basal after giving too much then the fastacting may need to be raised to bring them back down within three hours. Right now the EXTRA Lantus is helping him come down after meals which is not what it's job is. It's job is to keep them steady. Does that make sense?:cwds:
     
  20. Becky Stevens mom

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    Yeah, I agree with this. Anytime there are severe lows (40s are severe) basal insulin needs to be lowered until those BGs come up. If he starts having some higher #s during the day those can be dealt with with lowering his I:C ratios at those times. We are still not splitting the dose and have found it uneccessary at this time and often when the lantus dose is split it often needs to be reduced
     

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