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RE: [IPk] Lantus ( working out how much you need)

Helen wrote:

> Jackie
> I, and I think others from what I have heard on here and from the DSN, find
 > that Lantus seems to cause early morning drops (3 to 6 am), even if the BG
> OK on going to bed. (Although I was told the Lantus has a level background
>  right through). A snack before bed, without any humalog tends to help this.
> I've

 That is one of the reasons why Sasha has her Lantus in the Morning rather than
the evening.

> also found that I've needed to reduce the amount of Humalog I take for meals,
> etc. Don't know if this is anything to do with the Lantus providing a more
> efficient background level.

 I have found this too. Although I am not sure that isn't because the Lantus is
too much at the moment.
 It seemed OK for the first day or so but I am not sure if that was because it
hasn't had time to kick in
 fully or because Sasha has been extra active. I guess its a matter of testing
on "normal" days to make a
clearer judgement.

> Do you normally give extra short acting for correcting levels under 13? Just
 > that I was always told to only do this if it was over 13. My BG would drop
> dramatically if I gave anything for a BG under this. I would say next time
 > leave the BG if it is 12 or so. The Lantus should kick in and take care of

 The other regimen that Sasha used we found that if we didn't correct a high
over about 10 mmols then her
 BG would carry on rising. Of course if it was near to a meal time we would
wait. But of course we would
 take into account any extra exercise she might be about to do etc. Previously
if Sasha was above 10
 mmols after 2.30 am we might correct using half a unit otherwise we would start
the day high and mess up
 the whole day. It wouldn't drop her very much. Because Sasha had experienced
nightime hypo without waking
 since she was diagnosed we have always given the minimum long acting overnight.
She has no dawn rise.
 This means that sometimes we have to add a little NR in the night. If we do we
always check 2 hours

 I am finding with Lantus that Sasha needs less NR to correct a high than before
on NR and Insulatard. So
 we are not correcting much at the moment until we get more experience of using
it. I would have thought
 though that if a high of over 12 comes down by itself that would mean that the
Lantus dose is too high?
What do you think?

> It took a few weeks for my BG's to 'level (as level as they get anyway)! I
 > did need to experiment with the dosage a fair bit and eventually come down to
> 10
> units whereas with the Humlin I was taking 12. I had tried 8 but that led to
> too many highs.

 Sasha is taking 14 units on Lantus and about 10 of short acting. Before she was
taking 17 unit of
 Insultard and 11 units on NR. It seems a bit top heavy with Insulatard (taken
in a split dose) but if
 she had less that 12 units of Insulatard in the morning she would be too high
at lunchtime.

I suppose it just a matter of taking BG levels more often and making notes.


> I do still get lows early am, though. My 'peak' tends to be 9am to 11am. Glad
> the gym went better this week for you. What you said about the exercise
 > affecting things later on could be true. I know after a busy day, my BG's
> drop
> long after the event.
> Hope this helps
> Helen
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