"Lantus Low"

[aharris2]

Fellow lantus users, has anyone else experienced a sudden severe blood sugar crash after taking your usual dose of Lantus? A couple of nights ago, my brother's blood sugar dropped from 191 down to 45 in one hour - this is much faster than even the fastest acting insulins we have used.

This happened one other time a couple of years ago. I was sure that I had given my brother Lantus, but just came to accept that I must have somehow screwed up and overdosed him with a fast acting insulin. Life went on. Now, it has happened again and there is no doubt that Lantus was administered.This is supposed to be a slow acting 24 hour insulin and we have had great success with it. But a precipitous drop like that - we were quite lucky to have noticed it (the crashing blood sugar woke him up) and to have gotten sufficient sugar into him fast enough to keep him from losing consciousness.

As a safety precaution, there will be no more bedtime Lantus injections - we will always make sure that we have a couple of hours just to watch and see.

[greg10]

Hi aharris2,
  Don't blame yourself as this happens occasionally when you have to do a lot of injections.  In all likelihood, you hit a vein when you injected the lantus.  Try to inject into a roll of skin or adipose tissue.  Also try to put lantus apart from novolog, say on different shelves in the fridge or color code them, just in case.

Also see this: http://www.diabetesforums.com/forum/diabetes/38672-lantus-hitting-vein-during.html

http://www.bd.com/us/diabetes/page.aspx?cat=7001&id=7264

[Marina]

Fellow lantus users, has anyone else experienced a sudden severe blood sugar crash after taking your usual dose of Lantus? A couple of nights ago, my brother's blood sugar dropped from 191 down to 45 in one hour - this is much faster than even the fastest acting insulins we have used.

This happened one other time a couple of years ago. I was sure that I had given my brother Lantus, but just came to accept that I must have somehow screwed up and overdosed him with a fast acting insulin. Life went on. Now, it has happened again and there is no doubt that Lantus was administered.This is supposed to be a slow acting 24 hour insulin and we have had great success with it. But a precipitous drop like that - we were quite lucky to have noticed it (the crashing blood sugar woke him up) and to have gotten sufficient sugar into him fast enough to keep him from losing consciousness.

As a safety precaution, there will be no more bedtime Lantus injections - we will always make sure that we have a couple of hours just to watch and see.

Hi  aharris2,

I’m  so familiar  with that.  I’m  extra  sensitive  to  both  lantus  and  humolog.          If  I  take  humolog  it  acts  in  15-20minutes.   Lantus  ALWAYS  peeks  in  an  hour  or  less,  so I  don’t  eat  something   I  drop.
My  Dr  tells me  I’m  one  of  her  very  difficult  patients ………not  the  way  you’re  thinking…but  because  I’m  so  sensitive  to  insulin.
So,  yeah it  does  happen  with  lantus.
If  it  happens  again,  talk  to  your  brother’s  endocronologist  so they  can  adjust  the  lantus.
I  used  to  take  my insulin  1x/day  but  my sugars  were  out of  control.    So  we  decided  to  try  spliting  the  dose to  8units 2x/day,  I  was  doing  better,  but then I  started  dropping.              My  Dr  changed  my  dose  to  4units  every  8hrs.  It’ s tougher to  do  this  8hr  RX  and sometimes  I have  to  go  9hrs  due to  my  work  schedule.
Ask  your  brother’s  Dr  about  the  Omnipod   (insulin pump)  my  friend  Tim  just  started  using  it  and his  A1c  is  down  to  5.6   it  might  be  worth  trying.                              http://www.myomnipod.com/

Take  care!
Marina

[Sluff]

I have had that happen to me once also. Werird feeling but all was ok. I got to eat candy.

[Pam]

sLantus gave me nothing but problems. We tried everything nite dose, morning dose, split dose. It just did not work. I was finally switched to Levimer and everything is much better. I take it in the AM. It takes about 5 hrs to fully kick in, so
I make sure and eat lunch at that time. For a fast acting insulin I use Apidra on a sliding scale. It kicks in within 10 min and stays in the system for about 2 hrs.
Pam

[SassyArizona]

My last two hospital visits (just home today again, and prior was last week) were for this very thing and my lantus the second time was reduced from 15 units at bedtime to 5 units in the morning, now I am down to no lantus.  Both resulted in severe hypoglycemia, ambulance visits, and a flight for life flight to Tucson with blood sugar of 16 and 10 respectively, seizures and coma.  I will  be seeing a new endocronologist this week and understand you need all kinds of tweaking and adjusting to insulin doses when on diayalsis, which I have recently begin.  Typically with diayalsis much less insulin is required and on non-D days more is required.  Scary stuff, I'm researching additional information now, please post updates if you find out more.

[Pam]

Dialysis has not had much affect on my BS. As soon as I feel lite headed I make them take a blood test and so far it has been low BP and nor BS. The only way I can keep in control and it's still hard is to check my levels 5 times a day. My Ins will  only pay for 3 times a day so we have to buy  an extra bottle of sticks every month and the darn things are not cheap.
Pam

[aharris2]

I have had that happen to me once also. Werird feeling but all was ok. I got to eat candy.

What kind of insulin do you use, Sluff?

[aharris2]

In all likelihood, you hit a vein when you injected the lantus. Also see this: http://www.diabetesforums.com/forum/diabetes/38672-lantus-hitting-vein-during.html

Thank you greg10. Your link got me moving in the right direction regarding Lantus. This is what i have discovered:

Lantus prior to injection is slightly acidic which maintains a solution. Upon injection, the body neutralizes the acidity and the Lantus crystalizes under the skin. These crystals are SLOWLY but steadily absorbed into the bloodstream over the course of 24 hours. That's how it is supposed to work.

Accidental injection into a vein, as you suggest, is uncommon but does appear to happen. When it does, the Lantus does not crystallize. Instead it is immediately available to the body and acts as a regular insulin. That is, the dose that was intended for 24 hours of action becomes available immediately resulting in the observed precipitous and severe crash.

In our case, we use 8 to 12 units of rapid acting insulin with meals and 25 units of Lantus at bedtime. Theorizing that we hit a vein, that means that double to triple our usual mealtime dose was immediately available, at bedtime (i.e. - not associated with food intake.) Sounds like the perfect storm. What disturbs me is that we have never been warned of the possibility of this adverse event associated with Lantus.

[aharris2]

Injection technique:

My sister is an RN. She tells me that the abdomen is a blood vessel rich area of the body. The back of the upper arm is less so. Pinching up the skin gets you away from those deeper blood vessels (pictured in greg10's post.) Depending upon one's weight and fluid retention status, it can be very difficult to pinch up the skin on the abdomen. This is rarely the case for the upper arm.

My conclusion is that the upper arm would be a preferred injection site for Lantus.

Short needles or long needles? Good question. I further conclude that short needles would be preferable or at least a shallow injection (a 45 degree angle) if one is using a long needle, especially if one has opted for an abdomenal injection.

More perfect storm - we always use the abdomen and always use long needles. That will change! Again I ask where was the warning from the medical professionals???

Fellow Lantus users, where do you inject and with what length needle?

[Mimi]

One night last week I had had a bumpy day.  Woke up with a low and tore to the kitchen for some orange juice.  It was a bad low and I eventually went back to bed.  Later in the day I had something to eat and drink.  That night I knew I should eat but I felt nauseated and I put a sandwich  by the computer thinking I would eat it later.  I continued to feel bad and finally went back to bed again.  When I woke up I was laying sideways across my bed and looking into the face of a strange man.  I said 'Who ARE U? So he proceeded to tell me he was an EMT while my family started telling me what had happened to me.  My daughter had come back to my room looking for our little French Poodle, Jacie.  And there I lay on the floor between the bed and the dresser.  They called 911 and my 2 grandsons got me up and sideways on the bed.  They said I must have been 30 to 40 minutes.  They  gave me a shot
of glucagon and I was awake within 5 minutes.  This is the end result of me trying to stay on
Lantus for the last 5 years.  I knew after 6 months that the medicine was not working for me.
I was already having mild lows and my bs was all over the place.  3 Drs refused to take me off
and also refused to prescribe any quick insulin for meals.  I belive they let the diabetes finish my kidnneys off.  I should have a long, long time ago gone to an endoctrinologis.(?)  Anyway till I can get some things rearrangedd I was thinking of getting a glucagon Kit.  Has anyone had
to go this route and if so is it good or not worth it?  I feel like I am caught in a web. 

[Mimi]

I forgot to tell you they had gotten my dosage up to 90 units of Lantus a day.  It's a wonder they didn't freaking kill me.
 

[Epofriend]

No rapid acting insulin with meals? And 90 units of Lantus???!!!

I use 25 units of Lantus and 10 units more or less with meals. What is your doctor thinking?

Mimi, what happened to you is scary. I'm glad your family got you help in time. A crash associated with 90 units of Lantus is hard to manage. I think getting a glucagen it is a good idea. Looking back over your bad day/bad night, would you have used it yourself and when or do you want to have it on hand for your family to use for you?

After my Lantus crash, I asked for a glucagen kit. It took a bit of asking but I did ultimately get a scrip for it.

[Mimi]

Hi Epo thank you for answering my post, I was hoping you or Alene would.  There doesn't seem to be a lot of people who are familiar with Lantus.  I have been upset since this happened last week.  I am now nervous about using Lantus at all. I have cut the dosage down some and am checking my sugar regularly.  My Drs office called the first of last week and asked me to please come in as soon  as possible.  We think the EMT told her about it, because when they were here they said they know her very well.  I would be able to give it my self if I wasn't unconsicius  Mainly it would be if something like this last event were to happen again my daughter or one of my grandsons could insert it.  I am going to insist on some fast acting insulin for meals.  I don't know what I am going to do about Anita, my Dr., for she is my personal friend, too.  But I will have to do something I am too shook up to leave things as they are.
Thanks so much for listening to this jibber jab. 

[paris]

Mimi, This sounds absolutely frightening!   I am glad Epofriend could help you.  I do hope your doctor listens to you.  This situation doesn't sound good.   Keeping you in my prayers        

[Mimi]

Hi my 2 friends, Epo and Paris, I went to the Dr yesterday.   She was upset by all of this, too.  She changed me to Levemir and is going to request Medicare to support me on getting Byetta.  It is very expensive
and they won't pay for it unless the Dr. special requests it.  She will give me quick insulin and a script for glucagon, but she wants me to think about both of them because of the side effects.  The quick insulin is fattening ( and I am already fat enough, I don't   need anymore) and the
glucagon if there is some one to give it to me.  I go back in 2 weeks so I'll decide by then.  I didn't tell her about seeing a specialist, I didn't have the heart, she is my friend.   But I am still looking into it.Thanks for your support.
Love, MImi

[paris]

I am glad there are a couple of choices.  We want you to feel good --- try not to worry about the side effects.  Pick which one will work the best for you. 

We had some news this week regarding diabetes.  Our neice's 5 year old daughter has been diagnosed with type 1. She is in the hospital now to get adjusted to the insulin and for her parents to be trained.  Everyone is very worried for Madalyn.  Of course, since I have read so many stories here of people with diabetes since childhood, I worry about complications as she grows older.  Little ones should never have to bear illnesses.  Just give it to me, instead.   

Take care of yourself, Mimi.  You know we worry.   

[Epofriend]

The quick insulin is fattening ( and I am already fat enough, I don't need anymore) and the
glucagon if there is some one to give it to me.

Hi Mimi, It's good to see that the doc is taking you seriously.

Insulin is not really fattening. Rather, it is diabetes that prevents you from properly using your food - instead of the body's natural insulin moving the sugars into the cells for use and for storage, it remains in the bloodstream until it leaves the body in the urine (if one pees). The body is forced to burn fat as fuel. Sounds good, but the sugar in the blood is very damaging.

When you have good blood sugar control, the body is efficiently using and storing sugar, similar to nondiabetics. It is the food the person eats that makes the person fat, not the insulin. Poorly controlled diabetes saves the person from the full impact of the fattening food but at a high price.

In my opinion, it is best to use whatever insulin will give you good control of your blood sugar and adjust your diet and exercise to keep from gaining weight.

Regarding Glucagen, get the doc to write a scrip for you so that you have the Glucagen on hand. Worst case scenario is that you are crashing and no one is available to give it to you. Best case is that you are crashing and there are people there to give it to you. Totally unnecessary scenario is that you are crashing and there are people there but the doc decided not to write you the scrip. What is the doc thinking?

Paris, I am sorry to hear about your niece's daughter. Diabetes is a devastating disorder, especially type 1 developed at an early age. The worst of it will be when she hits those rebellious teenage years wanting to be just like her peers. Tight control is important.