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the effect of the Lantus peak

Discussion in 'Parents of Children with Type 1' started by wilf, Feb 1, 2014.

  1. wilf

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    DD is a teen, and like many teens she likes to sleep in weekends. This gives us the chance to see the effect of her daily Lantus dose, given in the morning. It may be of interest to those of you with children on MDI.

    Blood sugar at 8 am - 225, gave usual Lantus dose and went right back to sleep.

    blood sugar at 10 am - 142

    blood sugar 11 am - 129

    This is a drop of about 100 points in 3 hours, unaffected by food or boluses (she is still sleeping) :D
     
  2. mmgirls

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    well we use Lantus for 60- 75% of basal right now along with her Animas pump, and I am interested!

    I am surprised that the peak was so fast, within 2 hours you saw most of the drop. For my dd the peak does not start for about 1.5hours and may continue for up to 4hours. We do ours at night because she has a nightly rise and when she was un-tethered we used the Lantus peak to help eliminate her that rise.
     
  3. C6H12O6

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    I do not think that shows that the lantus peaks. Say she was using a pump and the pump was set to run at 1 unit per hour all day, if the same thing happened you would not conclude that the novolog was peaking differentially at different times of the day.

    Sleep wake cycles are very complicated; there is a complex neuroendocrine cascade behind one’s sleep wake cycle.

    Ex. some people have no dawn phenomenon because for their cortisol levels do not peak in the hours leading up to dawn.

    It relates a lot to your circadian rhythm.

    Sleep tends to activate the parasympathetic nervous system, or be associated with its activation. When the parasympathetic nervous system is at work insulin needs will be lower.

    Insulin needs are variable; you cannot rely on a dose of lantus to have the same effect on blood sugar all day everyday and in every context.

    The brain is very metabolically active during REM sleep, so even your dreams and their intensity can affect BG levels.

    I do not think there is high quality evidence to support the assertion that lantus has a peak.

    If there was any sufficient evidence to show that lantus peaks the manufacturer would acknowledge it.

    These are just my thoughts on the matter, I would be curious to hear what other's think :)
     
  4. Joa

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    Hello,
    Is she using Lantus 1 or 2x/24h? How many units?

    The need of insulin differs between lying and upright. Horizontal it is about 30% lower than vertical (sitting, standing).
    That belongs to a hormonal system, stabilizing the circuit, that needs more blood pressure in upright mode.
    The hormone making the need for more insulin is aldosteron a mineral corticoid of the Renin-Angiotensin-Aldosteron-System (RAAS). It interacts with gluco- corticoid receptors too even though less than ie cortisol.

    So if one is sleeping longer, than usual it may be due to that effect if the BG is decreasing more as it would have done if the person gets up at the usual weekly time. See "the get-up phenomenon" in that context.

    Regards
    Joa

    Punctuation marks are saving lives:
    "Come on we eat grandfather"
     
    Last edited: Feb 2, 2014
  5. GChick

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    Due to the time given, I do not believe that to be a "peak", but the "onset" of it instead.

    I noticed while on Lantus that I had to work around both the onset of the Lantus (+/- an hour or more after the shot) as well as the peak (which was for me) about 6-7 hours after the shot. Not as big of a peak as other long-acting insulins that I have used, but still a peak none-the-less

    So, I'd basically have to be 180 or above if I wanted to "sleep in" to up to 3 hours (generally gave shot at about 6:00am) after giving my morning Lantus, and also have to eat lunch by 12:30-1:00pm or risk going low
     
    Last edited: Feb 1, 2014
  6. C6H12O6

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    thanks for explaining this :)

     
  7. wilf

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    You could call it "peak", "onset", or "overlap". Bottom line for us has always been that DD's BG goes down significantly after she gets her daily Lantus shot.

    Regarding daily rhythms, we saw the same thing when DD got her Lantus in the evening. Wanting to avoid overnight lows was the main reason we switched to giving it mornings.

    And for the record, DD gets 1 shot a day - 30 units.
     
  8. Megnyc

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    How would you handle it if her blood sugar was closer to 100 at 8 am? This is really interesting to me because when I tried MDI last month, I would see a steady rise to around 250 (from 100) for about 4 hours after getting lantus (9.5 units in the evening). I have a feeling it wasn't lasting the full 24 hours and I also just need more insulin at night. I ended up adding 2 units of regular in with my dinner injection to cover the rise and it worked really well.
     
  9. wilf

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    I would just hold off on giving the Lantus, and monitor blood sugars. I'd give it once they clearly started rising.

    Good move with the Regular. :)
     

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