Senkise Vagyok wrote in message <[email hidden]>...
Quoted message said:Folks,
am using Lantus since mid-May. Slowly I have been forced to increase the dosage: it went from 17
IU/day to 36. Lately I have started measuring BGs at night: I have had several measures in the 260
range and once it even went up to 350! I inject 1 or 1.5 IU of Novorapid and things calm down in
the morning, but next night problem is back.
My diabeto, strongly reticent has finally agreed that I go back to NPH Insulatard.
Any comments? Thank you.
N.B. please respond privately too, I only read the NG once a week.
--
Senkise Vagyok
[email hidden]
Quoted message said:To get to real sender replace nemo with
me
It is not apparent as to which insulin therapy you are following. Therefore, some very
general remarks:
1. Many users remark that a vial of Lantus has a very short "use" life, only about 28 days. It is
stable if sitting, never-used, in the refrigerator but as soon as you draw any Lantus from the
vial, it starts to degrade. Your current vial of Lantus may have degraded.
2. For many users, Lantus has an "activity" period of less than 24 hours. If you only inject once
a day, then you will lose the slow infusion of your Lantus basal insulin into your blood a few
hours before the next injection. If your other insulin, the fast insulin injection, is not
entering your blood at sufficient rates when the Lantus is totally gone, you will experience a
sharp rise in blood sugars.
This effect is caused by the liver releasing glucose into the blood when it senses low
insulin levels.
The liver is responsible for releasing glucose into the blood to prevent us from fainting due to
low blood sugar. However, the liver does not measure blood sugar, it measures blood insulin. When
it senses low blood insulin, it "assumes" that we also have very low blood sugar and thus
releases glucose into the blood. We have had posters report that this release will cause a 300
mg/dL blood sugar.
One overcomes this less-than-24-hour-Lantus-activity-period by either:
a. Splitting your daily Lantus into two injections, spaced 12 hours apart, or.
b. Shooting some NPH insulin three hours before you usually observe this possible release by
the liver, or
c. Shooting some Novorapid insulin one or two hours before you usually observe this
possible release.
We have had several posters report a 19-hour activity period for Lantus. I read one post which
claimed 16 hours.
3. Lantus absorbs very slowly compared to NPH insulin. For many people, it is active for 24 hours
while NPH is only active for about 8 hours.
Thus, if one wishes to obtain the same effect from a Lantus injection as from an NPH injection, one
must shoot more Lantus.
One example is the common practice of injecting NPH at bedtime to control morning blood sugar. The
NPH is strongly active during the night, and wears off at about the time one awakes and injects his
morning insulin. In contrast, the Lantus spreads its activity over most of a 24-hour day and thus
cannot be strongly active during the night unless one injects much more Lantus than NPH at bedtime.
An example:
Suppose one injects 12 units of NPH at bedtime.
The 12 units will mostly be absorbed and active during the night-time hours and will control
blood sugars.
Suppose one attempts to obtain the same effect by shooting 12 units of Lantus.
The 12 units will be absorbed over the entire 24-hour day, and only about 4 units will be
absorbed and active during the night-time hours.
Therfore, for this use, one would need to shoot perhaps three times as much Lantus as NPH. Note,
however, that one determines this ratio by trial and error, first starting with lower ratios.
The trial and error is important. Some report Lantus absorbs over 19 hours, some report Lantus
absorbs over 36 hours. The slower absorber would have to shoot twice as much Lantus as the fast
absorber in this application.
4. Your "diabeto" has recommended trying Lantus because it is much easier to use than NPH. The
proper and most efficient use of NPH calls for at least 4 injections of NPH per day, and
preferably 5 injections. An injection should be taken 3 hours before each meal or snack, and a
final injection taken at bedtime. In contrast, most people duplicate the 4-shots-of-NPH-effect
with a single, larger dose of Lantus ; or the "quick-absorbing" people, 2 injections of Lantus
taken 12 hours apart.
You have been using the powerful insulin NovoRapid in combination with NPH insulin. You have the
ability to produce an HbA1c of less than 6.5, and perhaps less than 6.0 with this regime. . .if you
are willing to inject often enough. If you have not attained an HbA1c below 6.5, perhaps your
"diabeto" hopes that the more powerful insulin combination, NovoRapid + Lantus, will help you
achieve this goal.
Note that many regard Beef Lente as even more useful than Lantus but it is very difficult to obtain.
Regards
Old Al
