Ineffective BI?

One size fits all?

If your body raises your background glucose level at different times, on different days how do you adjust around this, other than correct after the fact with QA?

One injection of lantus BI is not adaptable enough. I liken it to one outfit for:- work, going to see my mother, digging the garden.

How about two injections of lantus. Split and over lapped to deal with any BG bumps. Hmm - still no better.

What about not eating many carbs for 2 months? 10 - 20 grms per day... This just helped hi-light the issue more.


Q. What ways are there of calculating what your BI needs are when there are no FIXED patterns of background glucose behaviour to help predict? Also why does background BG change?

I am more than likely missing something so any advice or experience would be welcome.

There is no way of testing, or there is, like CGM for example, but unless your on a pump, there is no point, as that is the only way to deliver hourly/half hourly basal rates......

Having two split doses of background is always better than one in my opinion as no one has one single rate of glucose delivery from the liver.....

I think background needs change when your body's needs changes, there are many changes but the most likely one is gaining and losing weight and therefore needing more or less from the liver. Also the increase and decrease of insulin resistance from the working/not working of muscles........

Lantus was initially billed as 'one injection a day', but many of us realized it doesn't fit the bill. I now split my Lantus, one at 0900 and the second at 2100.

However, I only came to this conclusion after testing, many times a day. I was initially on one injection at 2100 daily, but noticed that after lunchtime my results were rising regardless as to actual BG and CP's taken.

You can only come to the conclusion that you need to split you Lantus after being able to point to a rise in BG 18, 19,20 etc hours after taking the one dose of Lantus.

If you are seeing this pattern ie not just on one day, but over a week, then I would consider splitting the Lantus despite the makers claim it will last 24hrs. I split mine equally ie I was taking 24 units once daily but now take 12 units twice daily, but everyone is different and after a week of the new split doses you may need to the readjust your doses.

The BI is there to act like your body does, but in a different way, your body releases a constant supply of QA insulin, although in very very small amounts, which it boosts when you eat, to deal with the intake of carbs. Your body is very adept at doing this.

What we do is only a rough approximation using the limited tools available - those on pumps get closer by ditching the BI and always pumping a very small amount of QA - please anyone feel free to correct me, as I am a non pump user, although I would wish to use one.

The pump users will get very good results - although they have to do lots of testing to get it right, but those of us with out can get very good results, and one way is splitting the BI to twice daily.

You may argue that splitting the BI even more may get closer to what the body is able to do naturally, but I would imagine that the counter argument is that you have to increase the injections and it becomes a burden.

Using the current BI method is a blunter tool than the pump and the natural flow, but it is better than older regimes.

Simon

Simon, presumably your Diabetes team agreed to your splitting your Lantus dose ? I ask because the HCP's I have spoken to insist that Lantus IS a 24hr insulin and that Levemir is better for splitting your dose. That said, in agreement with the original theme of this thread, one size does NOT fit all and Lantus may work better for you. I agree with your description of a normal bodies operation, although hopefully in years to come if we all get CDM's then we might have the feedback mechanism to allow us to control insulin release in our bodies to simulate a 'normal' pancreas.

The normal way of caclulating your BI needs is to not eat, monitor you BG and adjust your BI accordingly. It is supposed to provide your non-eating insulin requirement which largely should be 'relatively' stable, of course I say largely because life just isn't that simple unfortunately. As you have found there are variations and the only way you can tackle these really is QA adjustments. Its not perfect but then any insulin regime is just a rough simulation and thats the best we can do.

Thanks Marke. Lantus lasts a little over 17 hrs from when I inject it. I have been using it for 18 months. I did very strict testing to discover this. I approached my diabetes team but was asked nicely to persevere. My control went out of the window not long after going onto it. I was correcting with QA. I now have two injections of Lantus at different times. The more I have of Lantus the longer it lasts in my system. The two injections are roughly the same but I am still evaluating. I tend to have elevated BG in the morning, most times after I have got up. I am trying to lower this morning peak by injecting the second dose of Lantus before the first has finished thus overlapping creating a shorter Lantus boost. Tiny carbs at the mo whilst eval.. Lantus works really well overnight for me. It's just not doing the doo in the day time. It would be nice for once to have BG results I can be proud of.

So is the overlap giving you reasonable waking levels then?

What problems is your daytime dose of Lantus giving you.....?

One of my reasons for prefering Levemir over Lantus is that you can change your dose if you are going to be doing something that is particularly energy intensive for a long period of time (going on a hike for example) and it has an imediate effect and you can not do this with Lantus as it can take upto 3 days for a change to take effect. As a female at a certain time of the month I can reduce my dose by 20% and it will stop be going low all the time. I also used to wake up low on Lantus because the dose I needed to work in the day sent me low overnight - this has not happened since I have changed to split dose Levemir. I know that what worked for me may not work for someone else, but I think that the dose splitting and ability to alter dose with imediate effect is a great imrovement.

Marke

Manufacturers make many claims - in all walks of life, and most of them fall far short of reality. HCP's may claim that Lantus lasts for 24hrs, but that is based on what the manufacturer tells them - my reality is that it only lasts 18 - 20hrs at best.

I'm afraid I did not discuss it with them, I noticed it wasn't lasting, changed, noted the vast improvement in BG, then presented them with the evidence. In my experience this is always the best way, although I am not advocating this as a method for all, but I get sick of HCP telling me what to do when they have only read a text book. I am the only HCP when it comes to my body, and whilst I will listen to their advice, it does not mean I will follow it. Having totted up my Hbc1A over the past 10 years and averaged them I get a figure of 6.3, and so clearly I am doing something right. I have never been over 6.9, and did get down to 5.9 - once, but have hovered around 6.4 - both pre and post Dafne.

Dafne has helped me enormously, and the general principal is something I can relate to, but it is down to me to put it into practice and fine tune it, based on my experiences and the reality of working shifts, not based on a text book or some manufacturers blurb

In my experience, and clearly that of others, is that Lantus does not last. When I told the team I had made the change the nurse stated she had long suspected that it didn't last in the majority of cases. I suspect that HCP's are legally bound to only state what is on the manufacturer's box, as if they deviated from this, and something went wrong, the manufacturer would point to the fact that the HCP had deviated from their specifications. HCP's have to be very careful about what they say when prescribing these products for fear of being sued.

Sorry if this seems to be a rant - it isn't, its just the way I type.

Thats great sjohno - everyone is different - thats what makes it so complicated! If it works for you then that is brill - 6.2 is a great result!

never been below 7.9%.........