February 11, 2003
Daily Care, Insulin Analogs
Question from New Orleans, Louisiana, USA:
I am 33 years old, I’ve had type 1 diabetes for 26 years, and I started using Lantus in the morning (38 units) with Humalog before meals (5 units) a little over a year ago. I exercise regularly (usually pre-dinner) and follow a vegetarian diet. Everything I read states that Lantus reduces the incidence of hypoglycemia, but it really has increased the incidence of nocturnal hypoglycemia with me. My blood sugar falls as much as 200 mg/dl [11.1 mmol/L] points while I sleep. Lately, I’ve been skipping my Humalog injection before dinner which leaves my blood sugar elevated (250-300 mg/dl [13.8-16.7 mmol/L]) before bedtime. I have found that this is the only way that I can prevent severe hypoglycemia while I sleep. My blood sugar still drops considerably while I sleep but since it is so high at bedtime it rarely drops low enough to cause a reaction. While this seems to be working, I am still very confused as to why my blood sugar drops like this. As far as I can tell, the Lantus peaks about 19 hours after I take it. Every time I ask my doctor about this, he replies that Lantus does not peak. Does anyone have any answers?
Answer:
Most insulin regimens use 50% long-acting insulin and 50% short-acting insulin. You are overweighted in terms of long-acting insulin. Perhaps you can speak to your physician about decreasing your Lantus (insulin glargine) and later on you may have to increase the Humalog.
JTL
