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Taking Lantus and Novorapid. Getting problem with blood glucose level. Reason?

Aug 2012
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Practicing since : 1999
Answered : 362 Questions
I have urgent question....
I am 24 years old girl and my Lantus dosage is 8.
Recently I have increased my Novorapid dosage for breakfast, launch and dinner to have blood glucose level in normal range.
More then one month I am having problem with blood glucose level in the evenings and therefore in the morning. Here is the numbers:
In 2 hours after dinner at 20PM the glucose level is in range 5.8 - 6
At 23PM it become 8 without having any meal.
In morning at 8AM it become 9, 10, even 11.
I suppose the Lantus dosage should be increased from 8 to 14 or 16 units
is it possible the Lantus was corrupted?
My weight is 50kg.

Thanks for your answer
Posted Sat, 6 Apr 2013 in Diabetes
Answered by Dr. Madhuri Patil 7 hours later

Thank you for the question here.

If you are taking inj Lantus at around 21 HOURS (9 pm) then the fasting sugars should not be issue. Just go up on the dose to 12 units to start with.
But if you take inj Lantus in the morning hours then it does not cover your night and morning hours properly and hence the sugars are high. In that case you have two options: Take one more prick of Inj Lantus- say about 6 units at bedtime or shift the timings of Inj Lantus to bedtime instead of morning hours.

Let me know the reading of sugars after that. Get back for further queries. Take care.
Above answer was peer-reviewed by
Follow-up: Taking Lantus and Novorapid. Getting problem with blood glucose level. Reason? 2 hours later

Thanks for your answer,
Let me provide additional information.

I am taking Lantus at 8AM in the morning. This is the best time for me.
More then three month up to November 1 my blood glucose level was excellent and in that time I was using 8 units Lantus at 8AM.

Since November 1 I am having blood high glucose level but it was not critical.
Let's say 5.8 at 7AM in the morning and 6.8 at 8AM.
So looks like instead of 24 hours Lantus works 23 hours.

Moved the time from 8AM to 10AM.
The problem was solved partially but I have to have breakfast at 8.30AM
The best time injecting Lantus can be at 11AM in the morning which was not good time for me. So rolled back injection of Lantus to 8AM at that period of time.

Since January 20 I am using another Lantus (buy from Canada without prescription)
Exp Date 2015 May , Serial 2F 399A.
Since February 1 I am having problem with blood glucose level at bedtime and on morning. Buy another Lantus from Armenia. No changes.

Yesterday I take 10 units of Lantus. My glucose level was 7 at bedtime and 9 on the morning.
Today I have injected 12 units at 8AM.

One more question: How the Lantus dosage is depending from the total injected Novorapid units per day. I think this problem happen when I injected for the meal totally more than 12 units per day. If I am using Lantus with 12 units, how much should be my Novorapid units totally per day.

Best Regards,

Answered by Dr. Madhuri Patil 36 minutes later

Lantus works for about 20 to 22 hours. If the Lantus you buy is from company Sanofi Aventis then it does not matter which country you procure it from.
You will always experience this in life that with certain dose your sugars used to be normal for some time period and later you keep needing higher or lower doses for similar control. This has many reasons- weight gain (may not be prominent, but 2 to 3 pounds also increase insulin resistance), age, changes in physical activity, high fat diet etc. So do not compare with what you were taking earlier. But take care of sugar numbers you have to deal with currently.
First let me tell you about Novorapid (the bolus injection) and the Lantus (basal injection). You do not need to run behind the old concept of 50% of basal and 50% of bolus doses. The basal units can range from 25% to 40% depending on the quantity and quality of carbs, frequency of eating and timings of your physical activity (within 2 hours of food consumption vs morning hours).
For you, you need approximately 1 unit of Novorapid for 18 gm carbohydrates and to bring down your pre-meal high sugar by 55 points you need one extra unit of Novorapid. These ratios are approximate and can be little different.
Now about your current problem. The Lantus loses its potency by 6 AM in the morning and the Novorapid does so after 3 to 4.5 hours after taking it. Hence from bedtime onwards your sugars start to shoot high because there is no strong coverage for the glucose coming into blood stream from the liver. This continues till morning with strong anti-insulin hormones playing their role in the absence of insulin.
Hence the solutions are one of the following:
1. Take 8 units of Lantus at 8 AM and another shot of Lantus, say 4 to 6 units at 9 PM
2. Use injection Actrapid or Huminsulin R in place of Inj Novorapid for the dinner, adding 2 units extra. This is because this soluble plain insulin acts longer which you might be aware of.
3. Shift the timing of Lantus prick at 9 PM and make sure to cover your afternoon snack (at about 4 pm) with additional prick of Inj Novorapid. This is because the fading action of Lantus does not cover the carbs in afternoon snack and your pre-dinner sugars would start showing high numbers. To prevent this coverage of snack carbs by some novorapid will give you excellent results.

Let me know if this works for you, else get back to me. Take care. I appreciate your involvement in your diabetes.
Above answer was peer-reviewed by
Follow-up: Taking Lantus and Novorapid. Getting problem with blood glucose level. Reason? 8 days later
Sorry I cannot understand these parts from your answer:
>>>The basal units can range from 25% to 40% depending on the quantity and quality of carbs, frequency of eating and timings of your physical activity (within 2 hours of food >>>consumption vs morning hours).

What do you mean quality of carbs and frequency of eating. She may eat carbs every three hours with Novorapid.
Next if the range of basal units is let's say 40% for example (in case of 14 units Lantus) , the total Novorapid should be 60% (21 units ?). Please clarify

Currently she is using 14 units Lantus at 8AM on the morning.

A lot thanks, XXXXXXX
Answered by Dr. Madhuri Patil 2 hours later

I said 'quality' of carbohydrates also, not only the 'quantity'. The slow carbs or the ones with very low glycemic index need more (even upto 50%) of basal insulin back up and less of the short acting bolus insulin. When the carbs are with high glycemic index (this happens when people mainly eat white rice for their meals, include milk etc in their meals) then less of Basal insulin, say about 30%, is enough.
People eating frequently take frequent shots of short acting bolus insulin and need really less (sometimes even less than 25%) of basal insulin. But people keeping big gaps in between two meals need higher dose of basal insulin to cover glucose coming from their liver during the two meals. The people who exercise during morning hours, need higher dose of basal insulin and evening exercise fetches less basal insulin need.
Now let us not confuse XXXXXXX over this. If she is taking 14 units of Lantus, let her take 5 units for her breakfast carbs, 5 units for her lunch carbs and 4 units for her dinner carbs. This is to start with. This works very well if Lantus injection is taken in the evening hours.
With this 50- 50 distribution, if you find trouble with pre-dinner sugar readings (they are high) or early morning sugars (they are low) then we shall take following steps:

1. For high pre-dinner readings, you will cover the EVENING SNACK with may be 2 units of inj Novorapid and then you'd need only about 2 to 3 units of Novorapid for the dinner as already the pre-dinner sugars are under control.

2. In case of early morning low sugars, you'd reduce the Lantus to 12 units but keep injection timings between 9 PM to 10 PM only.

3. In case of low sugars in between meals, during day time XXXXXXX should reduce 1 unit each from the Inj Novorapid dose.

Slowly she will realise that the ratio of Lantus to Novorapid goes down with regular medium glycemic index food. Right now she does not need to make her Novorapid dose as 21 units at all!

I hope you got the answer, else please get back for any further clarification.
Take care.
Above answer was peer-reviewed by
Follow-up: Taking Lantus and Novorapid. Getting problem with blood glucose level. Reason? 2 days later

Thanks for your answer.
I have get information about quality of carbs/glucemic index,... where I was not aware before. Slowly-slowly we have increasing our knowledges and becoming Advanced User :)
One more:
Can you please provide information(the best web site or document or ....) after getting married, before pregnancy and during pregnancy.
Is there differences of diabetic type 1 during pregnancy and before getting married.

A lot of thanks, XXXXXXX
Answered by Dr. Madhuri Patil 6 hours later
Hello again.

There isn't any specific website for this matter. But WWW.WWWW.WW is a very good website, authentic one, for many such related issues.

The basic difference between a person with diabetes and without diabetes is sugar levels only. The person with type 1 diabetes does not have any issues about getting married. But pregnancy has to be carefully planned. Patient has to keep blood glucose under stricter control, take pre-pregnancy vitamins and get a thorough work up done (thyroid, hemoglobin, Vit B12 check up) by OB doctor and Nutritionist before getting pregnant. A regular follow up with both Diabetes specialist as well as OB doctor once she is pregnant will suffice. The growth of the baby will be normal once blood sugar levels are normal.
Delivery of the baby will be absolutely like any other pregnant woman if her sugars were all normal during pregnancy and post delivery care will be just like any other lady. Breast feeding of the baby is always encouraged.
So I wish all the best to her. Come back for any related queries. Take care.
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