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When do you give Lantus?

Discussion in 'Parents of Children with Type 1' started by Thornbird, Jun 20, 2013.

  1. Thornbird

    Thornbird Approved members

    Jun 15, 2013
    Since he was diagnosed, we've been giving it to him at dinner with Novolog. If he's going to go low at night, it almost *always* happens around 6 hours afterwards.

    Endo says it doesn't peak at all, ever. It's just weird, though... I almost feel like he has a tendency to go low in the evening anyway, so it's almost like the new Lantus dose kinda pushes him over to a full-on low. I asked if we could try giving it at breakfast, but she doesn't like that it could wear off early morning, and make him go high.

    I've read and heard from other parents here and there that some give in the morning. Just wondering what you other non-pump users do? (Pumps don't use Lantus... right? I am very uneducated about pumps, sorry.)
  2. MomofSweetOne

    MomofSweetOne Approved members

    Aug 28, 2011
    You are correct; pumps don't use Lantus.

    When my daughter was diagnosed, the endo at the hospital wanted her Lantus to be given in the morning rather than in the evening precisely for the reason you're questioning what time. She preferred that any Lantus peak occur during daytime hours.

    We ended up switching my daughter's Lantus to bedtime a few weeks later because it helped her morning numbers better (nighttime growth spurt?), but that was only after watching her be higher in the mornings for a longer periods of time
  3. Sarah Maddie's Mom

    Sarah Maddie's Mom Approved members

    Sep 23, 2007
    Can't help much with the lantus - I'm pretty sure we were using levemir back then, but on the pump part: insulin pumps only use fast acting. Because they deliver tiny amounts around the clock, the basal is provided with fast acting. No long acting needed. :cwds:
  4. Lisa - Aidan's mom

    Lisa - Aidan's mom Approved members

    Dec 3, 2011
    9:00 pm, right before bed. He almost always wakes in a good range; can't remember the last time he woke up with a BG higher than 120. His 'high' time is after lunch; if I tweak his lunchtime I:C ratio every so slightly, he goes low in the afternoon at lunch. Many times I have to correct him at 3:00 pm.

    Some people have luck with splitting the dose.

    Good luck.
  5. Lakeman

    Lakeman Approved members

    Nov 10, 2010
    We split the dose of lantus so that some is given in the morning and some at bedtime. This evens out the peaks which do exist. Also if you forget a dose only some is missing until you discover and correct for it. It does require twice as many pokes.
  6. mamattorney

    mamattorney Approved members

    Apr 9, 2013
    We give it at 9:00pm and haven't had any problems with that time.
  7. hdm42

    hdm42 Approved members

    May 1, 2008
    The party line is that lantus does not have a peak, but we definitely saw one. Our endo agreed that some people get one and others don't. ours hit at the 5-6 hour mark.
    It got worse as he entered puberty. When I refused the endo's suggestion to raise his lantus because of the peak in the wee hours, he had us switch the lantus dose to the morning. This worked much better! The peak would hit late morning / lunch time. Much easier to deal with than overnight.

    Morning dosing worked very well for us, until about a year ago when we started seeing a rise on the CGMS at about 4am. We talked to the endo, and she suggested switching to Levemir and a split dose. She does not like splitting lantus, because of the overlap possibility.

    We split the Levemir about 2/3 in the morning and 1/3 at night. That worked great.

    We recently started him on a pump, so that's a whole new ball game.
  8. shannong

    shannong Approved members

    Sep 15, 2012
    We were on Levemir which is similar to Lantus except that Levemir is supposed to last 18 hours and Lantus up to 24 hours. But if you look at the pharmacological action time on studies, both Lantus and Levemir's action time depend on dose ie. smaller dose last a much shorter time than larger doses.

    We also found a peak in Levemir at around the 6 hour mark. Prior to Levemir, my son was on NPH in the morning. NPH is only supposed to last 12 hours, but my son did not need any NPH initially at bedtime. Because of this, when we switched to using Levemir, we gave it in the morning only because his body clearly needed less insulin at night. However, eventually he started waking up with higher numbers and then we just split the dose of Levemir - most of it in the morning (like 90%) and 10% in the evening.
  9. Turtle1605

    Turtle1605 Approved members

    Jan 6, 2012
    We were not successful with Lantus. It actually only lasted about 22-23 hours for us and it was clearly much stronger in the first 12 hours or so that during the last 10-11 hours. That is one of the reasons we went to the pump as soon as we could.
  10. Shopgirl2091

    Shopgirl2091 Approved members

    Mar 16, 2013
    We have taken our Lantus at 8:00 am from the beginning, I think it fits my son well because even though the Lantus is supposed to last 22-23 hours, I think we have the same pattern the poster before had, that it is stronger the first ten hours. That fits us perfectly though because my son tends to run higher during the day and stay pretty level and constant during the night.

    That's just what we have always done, and it works great for us.
  11. wilf

    wilf Approved members

    Aug 27, 2007
    Your endo doesn't have a clue. Of course there is a peak with Lantus. Not for every child, but with many. I just figured out how to search this site, and have brought back a poll I started a few years back that would be worth a look. You'll see that more than 2/3 of respondents indicated there was a Lantus peak for their child.

    Because of the peak we moved to giving Lantus in the morning. All of a sudden the night-time lows stopped, and we needed less insulin to cover breakfast.. :cwds:
  12. mmgirls

    mmgirls Approved members

    Nov 28, 2008
    RIGHT before bed, but my dd has a spike about an hour after she goes to sleep so the "peak" of Lantus helps. We definately have a peak right at the 4hour mark.

    When on the pump we had basals set twice that of day to cover the normal bedtime rise..
  13. Thornbird

    Thornbird Approved members

    Jun 15, 2013
    Interesting. I guess I need to just *tell* endo that's what we want to try.
  14. justice1315

    justice1315 Approved members

    Jun 11, 2013
    We recently went through the same thing. She has been taking Lantus every night about 9 pm, but has started to have extreme lows between 12:30-2:00 am. Our doctor switched the Lantus to an A.M. shot, and so far (Knock on wood), she has had no night time lows. Although, she has had a few afternoon lows now, but she is awake and can tell me as soon as she feels a little low. So it is working for us now, but as I've learned with her D, NOTHING is ever constant, so we may be changing again next week.
  15. missmakaliasmomma

    missmakaliasmomma Approved members

    May 31, 2013
    Lantus most definitely has a peak. That is why when my daughter was on mdi, we had to let her be 200 at night, because it would peak during the night and bring her sugar back down to normal when she woke up. This is a lot of the reason we switched to a pump, I didn't want to "let" her be high just because.

    We did Lantus at night and tried it in the morning too but it didn't help the peaks. It will still peak, though not as bad as NPH would peak.
  16. Michelle'sMom

    Michelle'sMom Approved members

    Aug 21, 2009
    I hope this works.

    This is from a handout of the slide presentation at a workshop I attended. I tried to find out the source of the data, but haven't found it yet. The workshop was presented by a peds endo, so it may be from a professional journal.

  17. LucyAmber

    LucyAmber Approved members

    Dec 27, 2012
    I give at 9pm, and haven't had a problem with lows.
  18. Heather(CA)

    Heather(CA) Approved members

    Jun 18, 2007
    I have not read the other responses, but I would suspect that's your problem is not when you give the Lantus but where on his body you are giving it. It's needs to go in a fatty area such as his bootie to help keep it stable. Or you may need to lower it a unit. :cwds:

    I actually think that dinner time is the best time for Lantus...

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