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Lantus users

Discussion in 'Parents of Children with Type 1' started by mph, Feb 15, 2008.

  1. mph

    mph Approved members

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    How do you "use" your Lantus?
    A: to keep child "level"
    B: to "pull" down a bit and allow "free" snacks and less fast acting insulin
    C: other

    I am stuck btw A and B. I'd like A at night and B during the day. So I guess I'm a C.

    At 7 units of Lantus, Nick can have free 10 gram snacks, less Humalog at meals, and NO Humalog at bedtime even with a 25 gram snack. It REALLY helps with morning spikes and keeps him at the 40-50% basal rate which makes the days run smoother for us.

    It is a bit "NPHish" this way "having" to eat. But more snacks and less injections would make Nick VERY VERY happy! Which makes me happy.

    I went to 6.5 units earlier this week and we were chasing highs day and night. He was going up a good 50-100 btw meals (after 4 hrs post meal) and at bedtime. He stayed higher at night. So no big "drop" at least. I just had to check for ketones..........ugh. I just can not believe a HALF unit can make such a difference.:(

    Nick watched a suspenseful DVD last night which most likely sent him on an adrenaline high. Does that extra glucose "disappear" without extra insulin after the excitement is over (hours later)? Could that account for the larger drop last night from 180 to 72 btw 3am and 9am?

    The "usual" drop has been 30s or 40s per night which is OK because his bedtime bg target is 150. If I decrease Lantus for a lower overnight drop, it just brings on HIGHS galore.

    Thanks for "listening"........any input is always greatly appreciated.
     
  2. cydnimom

    cydnimom Approved members

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    We are kind of between A and B also, but purposely. Ryan hated having to eat snacks at school, he's just not the snacking type. He does eat snacks for activity like before gym everyday and other sports. Sometimes he can get away with eating 10 "free" carbs" at bed time, but it all depends on what his numbers are. If he is 7.5 (135) then he can snack, but anything higher he needs to take a needle. He doesn't really care if he has to take a needle though.

    With respect to the adrenaline high - Ryan gets these too when he plays competitive sports or birthday party kind of things. I don't feed before sports but after and sometimes I will even lower his Lantus before sports by .5. He always drops a couple hours after, plus I have to watch in the middle of the night. This is generally when your liver replenishes the glycogen that it gives out in the adrenaline rush.
     
  3. lulu

    lulu Approved members

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    This may be a silly question, but how do you figure that out? We have never had anything resembling normal to actuall predict what will happen. When I read these posts, some schedules sound so ... predictable :confused: which is good for all of you :)

    But, with that being said...we just cannot seem to get there. I don't know if it is just the age 13 that my dear daughter was diagnosed?

    Or, if I am truly doing something wrong.
    :(
     
  4. czardoust

    czardoust Approved members

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    Since day one of Katerinas dx, she has needed lantus on top of her Novolog for a good BS range. Without it, Novolog would be like giving water. I guess a A&B combo then?
     
  5. czardoust

    czardoust Approved members

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    Since day one of Katerinas dx, she has needed lantus on top of her Novolog for a good BS range. If you are giving Lantus just for allowing extras, then your blessed! We give it because its medically necessary. All the novolog in the world would not keep Kat in a good BS range without her Lantus.
     
  6. twodoor2

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    My opinion is that if the Lantus is the right dose, it should pull down postprandial spikes and keep the person level all night long. That is optimally how it should work, but as we know with Diabetes, this isn't always true. When people are no longer honeymooning, then it's more difficult to keep those spikes down, especially during times of the day where insulin resistance is greater. Therefore, I heavily rely more on making sure the Lantus keeps you level at night, and using the carb ratios and Novolog to help keep the spikes down during the day. Pumps are very helpful in that you can adjust the basal insulin to account for times of day that more insulin is needed. However, you just cannot do that with Lantus, especially since it is a 24 hour insulin, and it's difficult to modify it.

    There are some people on this board that have successfully split Lantus into two dosages, so there may be some variability in the way the day basal acts vs the evening dose. They may want to chime in on this.
     
  7. saxmaniac

    saxmaniac Approved members

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    Actually, both. Aim for A, but I get B.

    When Alex's Lantus is set to be level at night, that Lantus will pull him down during the day a bit. But the B is just a fringe "benefit" that I deal with. I'd prefer it not be there, for predictability.

    If it's set to be level at the day, then he'd go up at night. And we all know how good a day is when they wake up high. Ugh!
     
  8. wilf

    wilf Approved members

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    In the technical sense of the term, basal insulin should just cover the steady release of glucose from the liver which fuels the body's cells - esp. at night.

    That having been said, there can be considerable benefit to using your basal insulin(s) to "pull down" BG levels. We have done this since DD's diagnosis to good effect.

    Here's our rationale:
    - each bolus injection will result in BG being either too high, just right, or too low;
    - for the many times when we've underestimated the carbs and BG ends up being too high, the fact that the too-high BG is being steadily pulled down means that the upward spike will not be as bad and if left long enough will often come back down to target range;
    - for the times when the bolus injection results in BG being just right or too low, the basal pulling down BG opens up lots of room for "free" grazing for DD;
    - since DD can never graze enough, this is not a problem;
    - the "pulling down" effect will also combat spikes in BG right after meals.

    Using the basal to "pull down" BG is hard to do with Lantus, because you are looking at a substantial night-time drop if you want the Lantus to also be "pulling levels down" during the day. Unless of course you're like Marci and plan for it :)

    It's easier with Levemir, because if that is your basal you will likely be giving it 2x per day. This opens the door to a lower night-time dose (keeping BG level through the night) and a higher day-time dose to pull BG down. NPH works better yet for this sort of scenario, because it can be given 3x per day in varying tailor-made amounts.

    It goes without saying that if your basal is set to be pulling down BG levels then you need to be testing BG at least once if not twice between meals.
     
  9. coni

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    We have a slightly larger basal dose to cover snacks. DD's class has a 10:00 am snack, so she eats 15g without a shot. (DD loves being like everyone else at snack time - no shot!) She also eats a 15g afternoon snack.

    We split the Lantus, so we can have a lower basal dose at night, but right now it's split 50/50; consequently, we give a bedtime snack with 15g uncovered by fast acting if BG is lower than 150. It works for us, but I can see moving away from the snacks as she gets older, especially any bedtime snack, and adjusting the Lantus accordingly.
     
  10. mph

    mph Approved members

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    Do you have the book Using Insulin, by John Walsh? If not, you may enjoy it! It is FULL of info about all aspects of D. Including basals, boluses, ratios, and TEENS! I'm not there yet with a D teen, but I read it is a whole different ball game.

    In it he talks about teens generally needing about 60% of their total daily insulin in their basal. YDMV, of course. He also says that teen hormones and growth bring humility to the best clinicians in diabetes. So I wish you well!

    If you have specific questions about teens with D, you can start a thread (where more viewers will see it) and get some great responses. Then be sure to share them with ME when I get to the teen years with Nick, lol:)
     
  11. mph

    mph Approved members

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    Thanks to all who have responded!:)

    It's nice to hear how others deal with D and it's great to have an objective view given! Especially when it opens my eyes to something I have overlooked!;)

    Just wasn't sure if I was crazy wanting Lantus to work more like NPH when the "selling point" of Lantus is its 24 hour "level" action.

    Now that his ratios "seem" set, he is getting a cold............:eek:.

    Never dull with D!!!
     
  12. Heather(CA)

    Heather(CA) Approved members

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    --------------------------------------------------------------------------------

    How do you "use" your Lantus?
    A: to keep child "level"
    B: to "pull" down a bit and allow "free" snacks and less fast acting insulin
    C: other

    We do "A", I make the Lantus keep him stable if he's doing nothing...Seth runs around enough to end up getting lots of free snacks due to exercise. If I know he's going to want a snack, I'm more likely to give him a little extra Apidra so he can have a snack later...This only happens once in a while though, we don't make it a habit:D
     

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