On Sun, 15 Feb 2004 08:44:46 -0500, "oldal4865" <[email hidden]>
Quoted message said:
Radioactive Man wrote in message ...
Quoted message said:When I was first diagnosed with type 1 back in the summer, my doctor prescribted one dose of
Lantus in the evening and a pre-meal bolus of novolog. This regimen worked for a while, but over
the last few months, I have discovered the need for a lunchtime dose of some additional basal
insulin (can be L - Lente or UL injected separately for large lunches or mixed with regular for
low-carb lunches), or else I end up with high blood sugars in the late afternoon. I have tried
using only regular insulin at lunchtime and using a couple of extra units to cover the gap, but
that still wears off too soon and causes too much of an early drop in blood sugar.
From what I've read here, this is a common problem with Lantus. Since I'm injecting the Lantus
into slow-absorption areas (thighs/hips) and using as much as can be used (11 units) without
causing nightime or morning hypoglycemia (morning readings are usuallys 70's or 80's), I just
don't see a way to beat this problem. I believe, in my case, the Lantus is lasting about 15 hours,
since I do occasionally get mild lows before lunch, but long after the breakfast bolus of novolog
has worn off.
Anyone here use Lantus and actually get it to last 24 hours? Given the cost of Lantus, I am
seriously considering switching to L and/or UL for basal insulins. I am very familar with the mild
peaking nature of L and actually prefer it for a lunchtime basal injection because it allows me to
eat a small snack several hours later, but I would prefer to avoid using it at bedtime for these
very same reasons. For UL, I will simply have to do some more testing to find out how useful it
could be in the evening.
Folks who are "fast absorbers" as far as Lantus are concerned just can't enjoy that "Only One
Shot Per Day - Hurray - Hurray" advertising. They/You have to take at least two shots of
something or another to keep your background insulin supply above the liver-dump concentration.
(Remember that a T1 uses a basal to keep his background insulin up, not to handle meals. If meals
spike your bG, you handle the spikes with a bolus insulin. Regular insulin is very difficult to use
if you want really low post-meal peaks. You have to inject an hour before eating for the most
reliable results. Otherwise, you end up shooting too much and going low later on)
But for some meals such as a large salad with meat or pizza, I can actually get more stable
postprandial blood sugars with regular than novolog. For either regular or novolog, I always use the
same 15 g per unit rule, but the difference is in the timing. I generally get the best results with
about a 15 minute delay on novolog and 40 minutes on regular. If I wait much longer than that, I
will experience a hypo.
The reason I believe the Lantus is wearing off a bit after luch is that I can successfully apply the
15:1 rule at breakfast (without getting subsequent highs). Same applies if I eat a late supper (say
8:00 pm and inject the Lantus at 9, as I usually do). What I discovered several months ago was
that it did not work at lunch, thus I tried adding the second basal injection and it solved
the problem.
Quoted message said:
Some techniques for dealing with a fast absorbence basal problem:
1. Split your daily Lantus into two shots taken 12 hours apart. Try to shoot at the same times
every day.
The main reason I don't do that now is the fact that Lantus cannot be mixed with anything. I have
had good results from mixing a basal shot of Lente with a lunchtime bolus of regular when eating
meals that are either small or low in carbs. For larger lunches, I normally use novolog (which I
never mix with anything) separately from the Lente. In this case, the mild Lente peak will cover the
gap left by novolog ~3 hours after injecting.
Since I'm currently buying everything out of pocket, I'm very much inclined to switch to twice daily
doses of ultralente for basal coverage, provided I can get good waking numbers without night time
hypoglycemia. Again, the advantage of both L and UL is mixability.
Quoted message said:
2. Add a second shot of NPH, timed at least 4 hours before your experience predicts the Lantus
will "fade"
From what I have read from Bernstein, and posts here about it's unpredictable nature, I believe it
would be in my best interests to avoid using NPH altogether. For those reasons, I've never tried it.
Quoted message said:
(I think the docs use "fade" to mean "wear off/stop absorbing/be used up"😉
3. Use Ultralente. I would stay away from Lente; there's a sense in the diabetic community
that Lilly will give up on it. Novo has already cancelled its version.
I've noticed that as well. My understanding is that Lente is actually a mixture of ultralente and
semilente (never seen this marketed anywhere).
Quoted message said:
You need at least two shots of Ultralente per day. For many people (me included),
Ultralente has a weak peak between 8 and 16 hours with a maximum at about 12 hours. You can
use that weak peak to help with a meal or such if you are dogged enough to figure out
exactly when your fat layer decides to release enough Ultralente to make a peak.
I split my daily Ultralente into three shots. Two shots 14 hours apart for background, a third
shot at 5 pm which throws a mild Ultralente peak right into the middle of my fierce Dawn Effect.
(The 14 hours apart technique is to cater to my CRS problem; 7 am and 9 am every day is convenient
and makes it easier to remember)
Ultralente is difficult to inject. The zinc-insulin crystals in Ultralente are the largest of all
the cloudy insulins and thus tend to settle out really fast. You have to shake the vial (that's
shake, not some wimpy roll) right up until the last second before drawing into the syringe.
The Bernstein book has some nice illustrations on the technique. If you try Ultralente, you might
want to swing by your Public Library and take a look.
I actually bought that book several months ago. I've found some useful info in it, but being a
competitive athlete, I just cannot get by with the 30 g/day carbs he advocates.
Quoted message said:
Finally, Levemir seems to have an absorbence curve about the same as that of Ultralente. However,
Levemir is a 100% liquid insulin with no need for all those shaking the vial tricks. It ought to be
available soon, maybe even this year.
Regards
Old Al
