# rate that lantus works at night



## emma1972 (Dec 14, 2008)

Hi

am on a mixture of lantus at night and novorapid during the day. I am newly diagnosed in the last couple of weeks and am still in the process of adjusting my lantus. I am currently on 16 units a night. I take the dose at 9pm, if my sugar is between 4-7 mmol before i go to bed, will the lantus drop this enough to give me a hypo. I am worried that a normal count before bed will mean I dont wake up at all! as a result I have been topping up my carbs so that I am at around 11 before I go to bed which I know is wrong.

Help?


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## annemarie08 (Dec 14, 2008)

ive been diagnosed type1 since feb this year and was on novorapid and lantus, im now on humalog and levemir. one of my major fears was having hypos especially during the night. i did have a few but woke up, usually 3am i always keep lucozade and glusose tabs next to the bed, just in case. i always make sure i have supper before bed, usually a slice of toast,just to make sure i dont get too low in the night.i think its pretty much trial and error really,


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## Emmal31 (Dec 15, 2008)

Hi Emma,

I've been diagnosed since jan this year and am also on lantus and novorapid. I wrote a post on here a week ago or so about what your body does at night which might be of some help : ''your Liver has a store of glucose which it releases overnight to give you some energy when you are asleep.  If the background insulin (Lantus) level is not right you will often see a higher level in the morning than at bedtime.  The level you go the bed on should be similar to when you wake up'' I was going to sleep on a blood sugar level of around 5-8 and I'd wake up with a blood sugar of 13 or so and thought hang on I haven't eaten anything in hours. So I asked my diabetes care team and they told me why this was happening. 

So now I pretty much get it right I give myself 30 units of lantus so your 16 units isn't that much in comparison. The main thing is that are you waking up between 4-9? If yes then your doing the right thing but if not then you still need to find out what the right level is and the hospital should help you with this. Although they prob would tell you off for eating before bed and raising your blood sugar's above 9. 

I've had loads of night time hypo's and yes they are very scary because you wake up completely confused and dripping with sweat but they always wake me up and once i've dealt with the hypo i feel fine again so i wouldn't worry about thinking your not going to ever wake up. I know how you feel though i was exactly like u at the start was scared senseless of having a hypo during the day let alone at night but I've got used to them now. 

All I can say is it takes a while to get the level's right but you will eventually and also your not alone so always ask if your unsure because we've prob all been through it one way or another. And this site is really helpfull and comforting so don't ever feel silly asking a question on here. 

Gook luck and message me if you need to. 
Emma. L


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## Debbiemk (Dec 15, 2008)

HI Emma1972
My son was on Lantus and Novorapid and we had similar problems.  We found that if he went to bed with a bm of below 10 he would go low in the night and then be sky high in the morning.  He always used to dip at about 3am, having taken his lantus at about 9pm.
Some medical documents state that the lantus hits a peak after about 6 hours so that would tie in with his dips.  So some people prefer to have their lantus in the morning or afternoon so as they are awake and feel the hypo coming on and deal with it better.
Also I don't know how old you are we had to deal with the "dawn rising" which is were the body releases a load of hormones which send the bm up, usually at about 4am.  This is only a problem during pubity so if you are lucky enough to be past that then that wont be an issue!
Sometimes as previous people have said it is just trial and error, but don't worry too much about not waking up, your body continues to produce sugar and will raise your bms sufficiently to wake you, albeit with you feeling very s****y.
My son is now on a pump and he love is!!!!!


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## annemarie08 (Dec 15, 2008)

*hi emma*




Emmal31 said:


> Hi Emma,
> 
> I've been diagnosed since jan this year and am also on lantus and novorapid. I wrote a post on here a week ago or so about what your body does at night which might be of some help : ''your Liver has a store of glucose which it releases overnight to give you some energy when you are asleep.  If the background insulin (Lantus) level is not right you will often see a higher level in the morning than at bedtime.  The level you go the bed on should be similar to when you wake up'' I was going to sleep on a blood sugar level of around 5-8 and I'd wake up with a blood sugar of 13 or so and thought hang on I haven't eaten anything in hours. So I asked my diabetes care team and they told me why this was happening.
> 
> ...



hi emma just been reading your earlier thread, i was told by the diabetic nurse to always eat supper to make sure i didnt go low in the night!! there is so much conflicting advice out there. i think you should just play it by ear and see what works for you.i would probably wake up in the night starving if i didnt have my toast at 10pm!!


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## Northerner (Dec 15, 2008)

Hi,

I'm on lantus 20 units which I normally take at around 10:30 pm. My 'bedtime' BG is nearly always above 7, averaging 8 - sometimes as high as 14, but my waking BG is always between 4-6 (occasionally down to 3, but generally around 4.5). I've been aware that I have nighttime hypos, mainly through feeling dreadful the following day. My nurse suggested that I reduce the lantus to 18, but this resulted in my daytime readings going higher so I changed back to 20. Sometimes my bedtime is 6 or below, in which case I have either a weetabix and milk or a slice of bread and peanut butter. 

I think that my bedtime readings might be generally higher because the lantus is 'running out' before the 24 hours is up. I think it acts quicker in me leading to the occasional hypos at night if I went to bed a bit low, but then has 'run out' towards the following evening, so am wondering whether it's worth splitting to two injections.

Everyone is different, which is what makes it so difficult to get the balance right, but once you understand what is working for you I think it will get easier. Good luck!


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## sofaraway (Dec 15, 2008)

If my blood sugar at bed is 4-7 then I will wake up 4-7. my lantus is pretty well set.

the thing you can do is to test at 2-3am to check you are not going low.

there are different schools of though on needing a bedtime snack. Most up to date stuff says you shouldn't need to (e.g. John Walsh), but DSN's and others will say you MUST snack before bed without any real reason why. If your basal is well set you shouldn't need to snack, unless you want to or have a documented drop that can't be resolved by lowering the dose/changing times etc.


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## tracey w (Dec 15, 2008)

I take mixed insulin, twice a day, so different, (although think will be going on 4 times a day pretty soon)

everyone is different and will find whats right for them, with me I never go to bed below 10 as will have a good chance of a night hypo! Even if im 9.9 will eat supper and usually wake up around 4-5, sometimes below 4. I think the main thing is to take advice from here, your team and see whats right for you. we are all different.


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## litto-miss-loz (Dec 15, 2008)

hey all,

i used to be on mixtard 30 and i remember having my first hypo during the nite and after that i was soo soo scared so i used to go to sleep wif my sugars over 20, which was not good at all!

now im on 4 times a day injections and i take my lantus in the morning as i know if i took it at nite that i would be scared of goin hypo so i would probs eat lots of food to make my levels go over 20.

i take 17 units of lantus and it works great  

sometimes i do wake up 11-13 but hey its a work n progress

good luk, it will all fit into place eventually xx


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## Steve (Dec 17, 2008)

Hi Emma i am on novorapid and lanctus like yourself and take my night injection at 10.30 if my blood sugar is above 10 then all i have before going to bed is a cup of semi skimmed milk but if it is below 10 then i also have a couple of digestives as well and normally find my blood sugar in the morning is about 7.5


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## kincaidston (Dec 17, 2008)

i take my lantus at 7pm to avoid the initial blip that occurs with it effecting my sleep, generally find that my sugars stay pretty stable through the night but it took me a wee while to get my dosage right, it started as being too low then i put it up too high and eventually i settled on 28 units

might be an idea to try taking the lantus earlier than you are at the moment


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## Northerner (Dec 17, 2008)

Out of interest I decided not to have my usual snack before bed when my BG was below 7. Night before last it was 5.4 before bed, and I woke up with a FBG of 3.1. Last night it was 5.4 again, and I woke up with a FBG of 2.7! 

I don't feel like I do during a daytime hypo with those levels, although didn't feel 'quite right'. Either the lantus is working too quickly overnight, or I need to reduce my dose, or go back to snacking!


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## Hapychoralsinger (Dec 17, 2008)

Hi Debbie mk,
I still experience the "dawn effect" and I'm nearly 39!!


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## sofaraway (Dec 17, 2008)

Northerner said:


> Out of interest I decided not to have my usual snack before bed when my BG was below 7. Night before last it was 5.4 before bed, and I woke up with a FBG of 3.1. Last night it was 5.4 again, and I woke up with a FBG of 2.7!
> 
> I don't feel like I do during a daytime hypo with those levels, although didn't feel 'quite right'. Either the lantus is working too quickly overnight, or I need to reduce my dose, or go back to snacking!



it may be that your lantus is set too high you are dropping more than you should overnight. have you tried any sort of basal testing throughout the day? If it works well during the day then the best thing would probably be to have a snack.


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## emma1972 (Dec 17, 2008)

sofaraway said:


> it may be that your lantus is set too high you are dropping more than you should overnight. have you tried any sort of basal testing throughout the day? If it works well during the day then the best thing would probably be to have a snack.




Hi all, thanks very much for your advice. Last night I decided to bite the bullet, Lantus at 9pm, at 1130pm I was at 7 mmol and decided not to have any supper and to go to bed and see what happens. Slept like a baby and woke up at 8am with a level of 8.4. I think as long as I wait for the 2 hour blip I will be ok. Might try 6 mmol tonight.

Thinking of taking my lantus earlier maybe 8pm, how does that work when I take Novorapid with tea at 6pm????


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## sofaraway (Dec 17, 2008)

not bad at all, only a small rise. 

should work fine. you can take lantus and novorapid at the same time If you want (use a different site though).


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## emma1972 (Dec 17, 2008)

*questions questions*



sofaraway said:


> not bad at all, only a small rise.
> 
> should work fine. you can take lantus and novorapid at the same time If you want (use a different site though).



Cool didn't realise I could do that. 8pm would be better for me to inject the lantus especially when I am working early shifts and have to go to bed early. I normally inject my breakfast and lunch novorapid in my stomach (different sites) and then my evening one in my right thigh. The lantus I usually inject in my left thigh. I take it that this is ok???
So I can inject novorapid at 6pm in my right thigh and lantus in the left leg at 8pm? yes?

This blip people refer to is this as it plateaus at the 2 hour point? If so I can manage that. My diabetic nurse tells me I need to learn to walk before I can run but I can't wait that long. I have so many questions that she doesn't w,ant to answer just yet like?

What is the highest you should be running at so that you do not risk your kidneys failing? Do you need high blood pressure for this to happen?

Due to the nature of my work (I am an emergency services worker) my diabetic nurse says to run a bit high at work. What is a safe high level. My works occupational health dept says that running high means I will have complications later in life....even talked about having feet amputated.

I am 36years, 5ft 7 and 9stone 10, low blood pressure, normal cholesterol and triglycerides. Also is there any benefit to taking aspirin each day for circulation purposes, is so how much do you take...

Sorry to be a pest and ask all these questions but my heads bursting with them.


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## aymes (Dec 17, 2008)

in theory your basal dose should keep your levels steady regardless of what you eat ( those carbs taken care of by your bolus insulin). The basal dose should be taking care of the basal rate of glucose your liver continually gives out. It is all trial and error but I've always found it's best to get the basal rate sorted first, then work on your QA ratios. A good way to check if the basal is right is to not eat carbs during the day and no unusual exercise, if your levels stay relatively steady ( +/- 1.5 or so) it should be ok. Some people find that lantus, for example, doesn't last as long as it should or has more of a 'peak' than expected, then it's worth talking to your dsn about splitting your dose.


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## Northerner (Dec 18, 2008)

sofaraway said:


> it may be that your lantus is set too high you are dropping more than you should overnight. have you tried any sort of basal testing throughout the day? If it works well during the day then the best thing would probably be to have a snack.



Thanks. I did try reducing the lantus from 20 to 18, but this did make my daytime readings higher (was getting 6-8s as opposed to 4-6s). I think I'll probably snack, although I don't always feel like eating just before bed.


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## kincaidston (Dec 18, 2008)

did you try taking it a couple of hours earlier, will take a few days of that to see what effect it will have as there will be a very small overlap between today's dose and yesterdays though the effect of lantus usually starts to tail off at the end of the 24 hours

that way you can monitor your bloods say two hours after you've taken it and then compare that with the results in the morning... would also give you some flexibility on when you go to bed


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## sofaraway (Dec 19, 2008)

emma1972 said:


> So I can inject novorapid at 6pm in my right thigh and lantus in the left leg at 8pm? yes?
> 
> What is the highest you should be running at so that you do not risk your kidneys failing? Do you need high blood pressure for this to happen?
> 
> ...



I think it's fine to ask questions, theres alot of people who don't. but this is your condition and you are at least 51% of your healthcare team so you need to ask questions.

yep it's fine to take n'rapid at 6pm and lantus at 8pm 

how high is too high is an area for much debate. Some say damage happens above 7.8 mmo/l. the general guidence is to aim for 4-7 before meals and no higher than 10 2 hours after meals. Really it's as low as you can do safely avoiding too many hypos. Keeping your A1c below 6.5%. 

High blood pressure is an added risk factor for kidney disease so keeping blood pressure and blood sugar under control are helpful. 

I don't take aspirin and probably wouldn't unless significantly indicated. the research that came out recently said that it isn't effective in people who haven't already had a heart attack. 

when you say emergency services do you mean you drive? at work I aim to run slightly high 6-8, i try not to be below 5. I don't think you need to run excessively high.


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## emma1972 (Dec 19, 2008)

Thanks for that think I will take my lantus at 8pm may be easier for me to manage. I think I may have almost cracked this dose, I now have fastings of 6.5 on thurs and 7.3 today. Need to tweak it by another 1 or 2 units perhaps. Not really getting the hang of the Novarapid yet though, it is difficult to estimate how much insulin I need. Some days 1unit to 10g seems to work perfect and others its more like 1 unit to 8g but maybe I still have some residual insulin left which is interfering.

It is not as bad as expected but it does get me down a bit that this is me now forever. All I ever wanted to do was to be a pursuit driver with the Police and now they have taken away those specialisms so that I am really restricted. The Force doctor says Ill never get them back regardless of how well I manage my diabetes. I think this is unfair as these rules only apply to Scotland and the adrenalin rush puts your glucose levels up not down. He does appear to be more than happy to allow type 1 diabetics to be firearms officers????? go figure that???


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## Kiddymonster (Dec 24, 2008)

Like you I take Novorapid and Lantus.  I usually take my Lantus about 10 pm. I check my level first and I usually eat something about an hour or so before I go to bed unless my level is high. I take 24 Lantus.  Your Diabetes specialist nurse should be able to give you advice if you are worried.  If you are really worried check your level if you wake up in the night.


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