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[IPk] Lantus advice needed

Hi All

 Sasha is a small nine years old and weighs about 62 lbs. We just started on
Lantus about two weeks ago.
 We are currently injecting 11 units of Lantus in the morning (we started with
the morning as we have
 often had problems with night time lows with NPH. The daytime numbers haven't
been too bad in the last
 week or so but I am finding that when I give her enough Novolog to cover the
evening meal she seems to go
 low between 1 and a half to 2 hours later. Then even though I don't think I am
over correcting she seems
 to go higher later. Even when her blood glucose levels seem ok after a meal,
she always seems to be just
 above 190 (10.5 mmol) at about 11.00pm when we test before we go to bed. If I
give anymore Novolog
 with the meals and bedtime snack she goes too low. We are having to correct at
11pm and sometimes later
as well or her levels don't seem to drop.

 Today I was trying to see if the Lantus dose was correct for the daytime when
she misses a morning
 snack. She had been having a small 5 or 6 carb snack at school. Today after
giving 4 units of Novolog
 for breakfast (Sasha was 122 (6.8 mmols on waking) and she was 120 (6.6 mmols)
a couple of hours
 after breakfast. I did not give her a morning snack and although she wasn't
particularly active by 12.20
 lunchtime she had gone right down to 65 (3.6). So it seems like 11 units of
Lantus is too much. If I
 drop the dose of Lantus I am concerned that it wont be enough to cover the
evenings. I cant think that
 it is running out and the action finishing that early! As it would mean it was
only lasting 15 hours.

 Has anybody switched from Morning Lantus back to evening Lantus for this
reason. I just wondered if it
 was peaking slightly in the morning, when it seems a peak in the evening, four
hours or so after the
 evening meal might work. We would give the Lantus at the same time as dinner.
Its not much use asking
 our D nurse as they have only just started using this insulin with children in
the UK

Any thought on this welcome

Jackie Jacombs
email @ redacted
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