MDI Lantus - take a night or 2 off?

Liam was diagnosed about 2 months ago and 2 units of Lantus and night and 1 unit per 25 has been working pretty well up to the last week or so. Now it seems like he is going low a lot. Last night we literally had to give him between 4-10 carbs like 6 times last night when he kept dropping below 80. (He got abt 30 carbs over the course of the night- he’s 5– it’s a lot). We’ve been getting up a lot at night and his days have been running low too. I’m wondering if he is making enough insulin right now “honeymoon” that I should ditch the Lantus to see if he levels out overnight. He’s only 2 units. I’m thinking my worst case scenario is that I have to do a nighttime bolus to correct. Am I missing something or is this a reasonable test to do?


I was a ripe old 29 when I was dx’d… but I had a similar pattern for quite a long time and ended up using bolus only for at least a year or two… it’s not all that uncommon, although some medical providers seem to be wary of it. In my experience it is not uncommon. If you’re going low without bolus on a regular basis, the basal is too much… even if it’s only 1u… even after going to zero basal for a long time I’d still drop below the ideal ranges sometimes… it’s a tricky time during the honeymoon… which in some cases can last indefinitely


Thanks! It’s nice to hear from someone who has done it!


Hey no problem. Just so you know (since this is all new to you it sounds) there’s bound to be a lot of these unknowns and mystery patterns that don’t add up how you’re being told they will or should. That I can guarantee you. There’s a lot of real-world experience here and we’re here to, and happy to help


No, not only are you not missing anything, you are suggesting doing what I would do in the situation. Honestly, getting sleep is important and I know the feeling of fear that comes with thinking you are responsible for everything for your son. It is tough. But soon you will get the hang of it, and once we got over the fear of adjusting, we adjust often, like every week. We review the Dexcom from the previous week and usually find something to fine tune. So going to zero basal, seems quite reasonable to me. Trust that it won’t be the last adjustment you make.


Ok follow up question (which is likely a quite dumb question- but parts of the mechanics on this still elude me). We did go off of the Lantus completely (Liam’s Dexcom transmitter broke so I felt like my hand was forced as I would rather risk slight highs than lows if I can’t see his numbers as frequently as he is still completely hypo-unaware).

That being said, if he gets a dinner bolus at 6:30 and isn’t low at 12:30 (even if it has required a snack for him to be not low) if he goes “low” later during the night is it an ok low because his pancreas is not additionally reacting to something he has already been dosed for? Will he not go lower than is ok for his body to go? (We usually correct at 80 and I know someone non-diabetic might normally go much lower than that.)

I don’t feel like Drs explain the mechanics of that side very well. I know he will be low if I give him too much insulin or if other activities/environmental factors change how well his body utilizes the insulin I give him. But, if he’s asleep with no basal insulin (and not sick) can he still go low. My guess is yes he can still go hypo and that the glucagon response in a T1 has issues but I’m curious.

If there is no injected insulin in your son, it is unlikely that he would go low in our experience. But if he did it means his pancreas is still providing some insulin which is very likely. Normally his liver would pick up the slack and deliver some sweet sugar during this event and keep the party going. That most likely would happen, but as you mention T1s have some abnormal changes in their physiology. I personally wouldn’t worry about him going low, also I wouldn’t treat right at 80 unless I know I caused it with insulin and it was still trending downward. Normally we try to “catch” lows and land them at about 100, and then we don’t worry unless we hit 70. In your case I would probably get up in the middle of the night and check to understand what is going on until you get a reciever replacement.