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September 19, 2002

Insulin Analogs

Question from Portage, Michigan, USA:

My son, who has type�1 diabetes and who has also been treated with antibiotics for Lyme disease, is on Lantus at night, and, in the morning when he has a bowel movement, his blood sugar will drop dramatically (0-20 mg/dl [0-1.1 mmol/L]). You can tell that he is low, and we have used up to four meters during this situation which all yield very similar readings. I know that he should probably be seizing at those numbers, but he isn't, probably because he is given the supplement glutamine, which allows him to function at low numbers. When he drops like this, he can go from 150 mg/dl [8.3 mmol/L] or higher to 0-5 mg/dl [0-0.3 mmol/L] within a few minutes. We feed him and give him concentrated juice to bring him up, and the amount that he takes in should skyrocket his numbers, but it doesn't. I have bounced the theory around that the Lantus might be pooling, but it is a long-acting insulin, and it shouldn't drop him that fast. My wife thinks it still might have something to do with the Lyme disease he was treated for. Any suggestions would be appreciated.

Answer:

Lyme disease is an odd entity. I have a single patient with Lyme disease managed with an insulin pump for her diabetes prior to Lyme disease diagnosis. Her blood glucose levels were extremely labile when the Lyme disease was acting up. It was never clear to us whether or not it was the medication being used or the disease itself.

If you notice this problem consistently, then I would adjust his insulin doses to try to counteract this effect. On a pump, this is done quite easily with changed basal rate, for instance. On Lantus (insulin glargine), you would have to decrease the bedtime Lantus dose and consider using some Lantus in the morning and some at bedtime so that there was not as much Lantus at any given time. If insulin dose adjustments do not work, then you will have to give him more concentrated glucose (i.e. juice) about 15-30 minutes before these consistent early morning severe drops.

Who knows why some people have seizures and some don’t with such low blood glucose numbers? Remember that they represent blood glucose and not brain glucose values, of course, and there is some time delay between the two always. I’m not sure I believe the glutamate is doing much (sorry).

SB