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Re: [IP] Morning Lows!

Hi Dustin,

I'm in almost exactly the same place you are - thinking about a pump,
approved by insurance, *and* wrestling a little with overnight lows from

> I take Lantus in the morning.  I didn't know you could take it twice a
> day.  I thought it was spread out over a 24 hour period.

Lantus can apparently have some person-to-person variation in how it's
absorbed. There are some reports of people for whom there's somewhat of
a peak around 6 hours after injecting, so on the advice of my endo I've
recently switched mine from one 10 PM shot to a split dose, 7 AM and 7
PM.  But a peak at 6 hours wouldn't explain your overnight lows if
you're taking it in the morning.

Other possibilities, as others have suggested, are that your night-time
basal needs are lower than your daytime needs, or that you have your
overall Lantus dose set a bit too high.  I think it's harder to tell
during the day if your basal is just a little too high - since you're
probably testing and adjusting your mealtime insulin several times
during the day, there aren't very long periods when you're *only* on
basal, so it's hard to tell the tail of a too-high basal from a small
miscalculation at a meal; the only way to know for sure is some longer
fasting tests during the day to see whether you drop or not when you go
for hours with no food or insulin, *and* the last meal's food and
insulin is out of your system.  (Hard to work into a busy day, I know -
I haven't managed this myself very well; just too much going on.)

My new endo has been dialing down my Lantus dose to try to eliminate the
night-time lows, and I first thought it would play havoc with my
control, but it hasn't, so indeed apparently the dose *was* too high
overall.  I've gone from 11 units per day down to 8 units per day - not
a big change in number of units, but a large percentage change!  I think
I'm getting closer to the right number now, but have also just started
exercising more, which complicates things, too.  Too many changes!  But
I'll sort it all out eventually.

So, talk to your doctor, maybe do some day-time fasting tests, and let
us know how you make out!  Most importantly, hang in there - you *can*
figure it out.


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