Increased Lantus but BGs now higher

Need some help please. I take a split dose of Lantus, 10 units before bed and 10 units first thing in the morning. My BG in the mornings have been usually 8 with the occasional 9, so just above target. To try and get these readings down I increased my bedtime lantus from 10 units to 12 about a fortnight ago, but then found my morning BGs had jumped to 14, 15 and 17s. My mum suggested I could be having hypos during my sleep. So a week later I reduced my lantus dose from 12 down to 11 and have now found my morning BGs to be around 10, 11 but most often 12s. I'm completely baffled by this, does anyone have any thoughts/suggestions? Any response greatly appreciated.

Cheers
David

Hi David,
I would do a 3am test (I know this may be unsuitable but maybe at the weekend?) as that will show what your liver and body is doing as there will be no QA insulin in your system at that point and will give you an indication on whether the amount of Lantus your taking before bed is correct.
I tend to agree with your mum and the increases in morning BGs suggest that you may have been having hypos through the night.
Hope this helps
Good luck!
Cheers,
Anele.

i would also suggest a 3 am test, as you say you had ben gven the hypo scenario by your mother, so you should have set out to confirm whether this was the case........

Thanks for the advice guys. Done quite a few 3am readings and my BGs are sometimes 6 but usually 7 at this time, but then I'm waking up with BGs of 10, 11 and 12. Any suggestions?

Cheers

Hi,

Controlling morning BG is probably one of the most common things people have problems with both before and after DAFNE and is really due to a combination of inadequacies of injected BI along with Dawn Phenomenon, where your body naturally releases hormones which raise your BG as you wake up.

Most people who sleep through a hypo will find their morning BG is actually still low (<5.5mmol/l), unless their evening BI is fizzling out, which tends to be more common with isophane insulins (Humulin I or Insulatard) but can also happen with analogues (Lantus or Levemir).

All insulins tend to have some variability in day-to-day absorption and action which is why you're advised to look for consistent patterns before making adjustments, so if your bed-time BG is in target (6.5 - 8.0mmol/l) and you have no CPs and no QA, you should expect your morning BG to be 5.5 - 7.5mmol/l, although it is normal for it to take a small dip around 3am (but should be above 4.5mmol/l)

Therefore if your 3am tests are running around the 7mmol/l level but morning BG are raised, you do have leeway to increase evening BI, remembering that you can adjust by 1u when you get to 'fine-tuning' it.

If you find that your bed-time BG is fine but even a 1u increase in evening BI results in a night-time hypo (<3.5mmol/l), you may just have to accept the Dawn Phenomenon and need to correct with QA each morning.

There may be some mileage in considering a change to Levemir from Lantus as this may provide a little more predictability and less variability.

Good luck

Carolin