Hi Everyone,
I haven’t really posted since the first few months after diagnosis back in January 2023. But I am reaching a milestone this week and thought I’d check in. I am going in to the diabetic nurse educator to learn how to use a long acting insulin called Lantus. Other than my time in the hospital at diagnosis, I have never used exogenous insulin so there will be a big learning curve. Honestly, I wish I could just take the week off to have some ‘thinking space’ while I start up but that isn’t possible. Any words of wisdom/funny memes/cautionary tales from FUDiabetes folks out there? I’m walking the line between “this is serious” and “don’t take yourself so seriously” hehe.
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Lantus is a pretty good basal.
They sell it as a 24 hour insulin, but that isn’t exactly right. The duration depends, but it’s generally more along the lines of 18-20 hours.
You can split it into 2 doses. That might help keep it going for the whole day for you.
If you split it, you will have some overlap, depending on how long it lasts and when you take the doses. But the overlap can coincide with times you need more basal, or when you are eating, so you can make that work out for you.
You can also split your doses into different amounts, depending on if you need more during the day or night.
Just as an example, your numbers will be different, but suppose you take 15 units per day, and you have 18 hours of duration.
If you take 9 units at 10pm at night and 6 units at 8am in the morning, your basal rate would look kind of like this:
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Oh this is very helpful! Thank you! I have been thinking about how this 1x/day injection would work and your answer makes sense. The number on my Dexcom is so variable depending on the time of day. I read your post about glucagon - love the sailor on leave analogy. But I still have so much to learn. I imagine insulin therapy will help me understand my body better too.
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@jpf,
Feel free to ask questions. There is a lot of info available here!
I actually do have a question- does the injection site matter?
I read that insulin is absorbed faster when injected in the stomach. But maybe that’s not really important with the long acting type.
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That’s right. With basal injections, it does not matter too much.
Activity can make a little difference, and injection site can make a little difference. But overall, not a big difference.
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Thank you. I really appreciate your replies. I’m sure I’ll have more questions. At this point I don’t know what I don’t know - if that makes sense.
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@jpf I also endorse @Eric’s comments on splitting the dose and the location not mattering. I was on Lantus prior to moving to a pump. I found Lantus wore off at about the 22 hour mark. Using info from various sites/people (including here on FUD), I decided to try splitting my dose evenly morning on getting up and evening going to bed. I found I needed to increase the dose slightly (one unit each injection) and I needed to make the morning dose a bit stronger than the evening dose (reduced one unit in the evening and added one to the morning dose. I rationalized it as the day long dose is for a longer period of time than my sleeping period, I don’t know that’s right, but it worked well. I used my thigh and stomach for injections with no noticeable differences. YDMV (your diabetes may vary): Your sleep/wake cycle may be different than mine, some areas may be better than others for injections. BTW, I discussed my split dose with my Endo, though after the fact, her comment was if it worked to continue. You should discuss with your Doc/NP/CDCES, he/she may/may not be aware of/support the concept. As always: do your own research and be your own advocate! This isn’t to disparage health care staff; they see you perhaps 3-4x per year for 15-20 mins, they may not be as up-to-date T1/2 treatment as they see many patients for many reasons and may rely on years old training (I recommend discussing this with them, i.e. how many of patients are T1/2, how do they stay current on T1/2). You, on the other hand, live with T1/2 24/7/365 and bet your future life on how you treat it.
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Thank you @TomH. This is great info. My appt is tomorrow and I anticipate the amount of information I’ll be getting will be like the ole “drinking from a fire hose” analogy. But I have been reading a lot and asking for advice from trusted sources like FUDiabetes members. I am much farther along in my diabetes education than I was in January 2023, that’s for sure! Plus I’ve asked my husband to come along with me to the appt so between the 2 of us, I think we’ll definitely come away with the basics.
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Can you remind us of where you are on your diabetes journey? Are you T1 or T2 - how long diagnosed etc. Like @TomH I was on Lantus for a while and then moved to a pump (I became a new T1 diabetic when I was 50 which was now 15 years ago).
Lantus is good - and depending on your diabetes journey, that might be it for you. Or it may be a waystation on to some different combination of pharmaceuticals.
Good luck. Hope it goes well.
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Hi @bostrav59 - I was diagnosed with T1 about a year and half ago. I’m in my mid 50s. Other than the hospital stay at the time of diagnosis, I have not been taking insulin. But since my last appt in August, where things were still looking ok (A1C 6.0, c-peptide 1.3), my fasting glucose is now up around 170-190 and the recommendation is to begin taking a long acting insulin. Today I have an appt to learn all about that!
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With adult autoimmune type 1 diabetes mellitus the lose of Beta cells tends to be quite slow but steady. This is in a way similar to T2DM. Us T2DMs can lose Beta cell function for a different reason, not autoimmune but just wear and tear on the cells from compensating with insulin resistance.
So in a way our experiences are similar. Lantus was my first insulin. Besides not lasting 24 hours as touted, it also has a slight rise about 6 ours after injection.
I was taking my dose at bedtime as prescribed. Six hours later I would wake with hypoglycemia symptoms. At this time I began splitting the dose. What worked for me is 2/3rds at bedtime and the other 1/3rd in the morning. If I was going to do a morning bike ride I would delay the 2nd dose until after the ride.
Use your meter or CGM to help you figure out what works for you. There is not definite answer that works for everyone. We are all unique. What we have are guidelines. Those who do well and live well with diabetes tend to be those who take an active role in their therapy, management.
When I was diagnosed 34 years ago I received several sessions of diabetes education and a book which I still have. Part of the education was to think of diabetes, regardless of type as a team sport. The players on your team are Physicians, Certified diabetes eduacator, Dietitian, Ophthalmologist, Pharmacist, Physical therapist and podiatrist. Back and support players are Family Members and support group ( FU is a great one). In bold letters, “You are the CAPTAIN of the team
We were encouraged to learn every thing about our opponent - diabetes.
There is more, too much to add and some of it is not relevant with more modern understanding of the diseases we call diabetes. Treatments have changed, drugs for T2DM have multiplied and there are vastly improved insulins and ways of injecting/ infusing them, Plus we have better meters and CGMs for measuring BG at home.
Beginning a basal insulin therapy like Lantus I would suggest that you carry with you a roll of glucose tablets to cover any hypos. I stand firm on this because I have no discipline when it comes to other stuff to treat a hypo. I will empty the pantry until I feel better. This results in BG spiking high and starting a roller coaster of Ups and downs.
In my area there seems to be a lack of CDEs who are now called Certified Diabetes Care and Education Specialist (CDCES). So when I lost mine because of insurance changes, well even before, I began self educating with good sites like Joslin and others. The books that have been most helpful have been “Diabetes Solution’ by Richard Bernstein MD (T1DM), “Think Like a Pancreas” by Gary Scheiner and you don’t have to be an athlete, “The Atheletes Guide to Diabetes’ by Sheri Colberg.These 3 books are very good in giving a good and valid understanding of the diseases. I will say that I could not do Dr Berstein’s ultra low carb diet, but overall he is right on target about most.
Take it slow, absorbing and learning how to incorporate what works for you. One caution, take with a grain of salt anything from sites like Facebook, Reddit and the like. There is a lot of misinformation floating out in the interwebs. FU is good.
Good luck and welcome to the club you never wanted to join.
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Starting Lantus can feel like a big adjustment, but it’s great that you’re working with a diabetic nurse educator to guide you through it. Lantus is a long-acting insulin, so finding the right dose might take a bit of trial and error—be patient with yourself, and remember that adjustments are normal.
Taking Lantus at the same time every day can help keep your levels more stable, and many find it best to take in the evening, but your nurse can offer the best advice for your situation. And don’t forget, humor can be a great ally—sometimes it helps to laugh at the little quirks of diabetes management, whether it’s through a good meme or a joke that hits home.
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@jpf I am chiming in here late; you’ve probably already had your appointment, but I was a looong time user of Lantus who recently transitioned to Tresiba. It is a truly 24+ hr lasting insulin and I prefer it so much over Lantus. One injection/day for basal, no peak that I can discern. If you have the option of starting with Tresiba rather than Lantus, I would strongly recommend it.
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Thank you so much for taking the time to share your experience with me. It’s such a relief to have found people who understand and are willing to share their knowledge with others. I really like the way you explained that I am the captain of the team. That’s sometimes hard to do when the members of my team have more expertise! But I agree with you and I will work on it.
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Yes I agree 100% on the humor. I especially appreciate that it cuts right through the ‘poor me’ mentality that I can fall into.
Thanks for the reminder!
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Well it’s true that I already had my appt but I have a follow up in 2 weeks so I can ask about Tresiba then. Thanks for the tip!! I wouldn’t have known about it if you hadn’t mentioned it:)
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here’s my experience. I was diagnised with LADA last year after a bout with Covid. I have always been on Lantus along with Humalog. I inject 18 units a night at bedtime into my upper thigh. That is approx half my daily insulin in total. My Time in Range is 95% and my A1C 6.6. Those of us with LADA have a more complicated time estimating how much fast acting insulin to take for meals due to the fact that we are STILL producing insulin - just not enough. Best of luck to you
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@LADALady Thank you for sharing your experience. I was diagnosed post covid infection as well.
I have been having a lot of site failures with my Omnipods. So I decided to start using some Lantus again to make sure I am always getting some insulin. But I remembered before that I always took it late morning and I was prone to dropping low early in the night and then my BG level would shoot up in the am. I do have a tendency to have DP, but the Lantus was obviously wearing off by the time I woke.
So I decided to split the dose when I started Lantus again. I take 1 unit extra in the am versus the pm dose. This has worked well for me as when the Lantus peaks at night, it’s around my DP rise and helps with that. I still rely on my pods for a minimum dose and adjustments to dosing I need throughout the day.
Keep in mind any dosing that works for you now, might need to be changed as time goes on. Always keep a hypo treatment with you at all times, by the bed is also helpful and easier just in case.
It is easy to try to get Lantus to cover some BG highs from eating. Doctors have a tendency to push that especially for type 2’s, when that is the only insulin source they are getting. But it really should only be for dealing with what your liver is releasing constantly when you are a type 1. It’s just too easy to drop too low in between if your basal rate is too high. And you still won’t be dealing with the highs from eating. If you experience too many highs you need a fast acting insulin too.
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