Why is Lantus given at night


Leave the archive and display this page in the standard design: Give basal insulin even if blood glucose values ​​are rather low in the evening?




Hello,

the basal insulin only works later and a little later it reaches its maximum effect.
Should the full dose still be given at night when the evening BG values ​​are rather low (old patient clientele)? Probably not omit it completely, but reduce it, right? Or not?

It depends on whether the person has nocturnal hypos and what values ​​they come out of the night with.
Patients can come out of the night with good or rather low values ​​in the evening with high values.
Has to do with the body's own glucose production.

Had already seen that a colleague had not given a patient the one value, I think around 110 (patient over 80 years), and the doctor said that this was wrong because he needed it. I don't know any details. But the patient did not have hypoglycemic values ​​before.

And if he did have hypoglycemic values, should basal insulin be omitted or reduced in dose, possibly recalculated?

And if he did have hypoglycemic values, should basal insulin be omitted entirely or reduced in dose, possibly recalculated?

I think not to give at first

You would then have to see how the values ​​are not only in the evening but also at night. And yes, you would have to adapt. Possibly different times, different types of insulin (because of maximum effectiveness), different dose, or a different dose throughout the day.

Basal insulin given in the evening does not affect the evening values.

Basal insulin given in the evening does not affect the evening values.

would you still give the basal insulin with the above value? it is necessary for the basal level.
And that it is not short-acting, you don't have to worry that the BG of e.g. 100 measured at 10 p.m. will slip into hypoglycemia.
Apart from the daily doses, which you then think about again next. But as I said, do you still give the patient his basal insulin?

Yes, I would still give the basal.
Measure again at night if necessary.

measure definitely.
So I imagine creating an insulin schedule is sometimes really difficult if you haven't had any prior experience in diabetology. Especially when the patient complains about high values ​​and after you have known the patient for just one day, you cannot change the whole scheme right away, if one exists at all.

Many relocations come without any schema.


Why does the German guideline differ from the American guideline when setting the Type 2 DM? Why is the BZ set stricter in Type 2 in this country?
Is it just the propaganda machinery of the pharmaceutical industry behind it?

And that it is not short-acting, you don't have to worry that the BG of e.g. 100 measured at 10 p.m. will slip into hypoglycemia.
^^ Says who? Given the occasion: This morning, 5:45 am: the key word hypoglycemia, 31 years old. BG measured by the woman: 25mg / dl, we measured 18mg / dl. Last night Lantus injected normally, 18IE. NOT measured! Neither before nor after ...: -wall


Yes, I would still give the basal.
Measure again at night if necessary.
But nobody does THAT! When in doubt, nobody measures at night. As a rule, the patients are then found to be deeply comatose by relatives at some point in the night / morning ... if they are lucky!

As I understand it, said patient is currently inpatient.

We actually have many patients who, for example, go into the night at 120 and then have values ​​of 250-300 in the morning. You can't take the basal away from them just because the values ​​are good in the evening.
And yes - if there are problems with the setting, they should actually measure again at night to avoid the hypos.

As I understand it, said patient is currently inpatient.

We actually have many patients who, for example, go into the night at 120 and then have values ​​of 250-300 in the morning. You can't take the basal away from them just because the values ​​are good in the evening.


For some, 120 is a little bit too little for the night. You have to be careful that they don't have too much insulin on board and go into a hypo at night unnoticed and in the morning you only see the counter-regulation ... Or they just have a dawn. Even without a recognizable basal gap, a Gupf attempt may help.
In any case, have it measured at night.
If necessary, instruct them to hire - but not to me ;-)

@ Thread creator:
What is the therapy regime? CT, ICT, BOT? What kind of diabetes?

Yes, that is the other possibility - that it is counter-regulation.
That's why we always tell them that they should measure after / early in the morning.

I'm in a diabetological focus practice. But it's not really my main focus of interest.

Don't worry - none of my "sheep" will come to you - it's too far away.

@ Thread creator:
What is the therapy regime? CT, ICT, BOT? What kind of diabetes?

as I said,

the patient was not on my ward, so no detailed information was available. I only know that she was stationary, had stable values ​​overall, i.e. no hypoglycemic values, and that she had a BG of about 110 at the 10 p.m. measurement that night.

Then there was the question of basal insulin in the full dose ... I think I should give 22-30 units, reduce it or leave it out completely.

My colleague hadn't let it go, the senior doctor said it was wrong because the patient showed marginally high values ​​in the morning. Type 2, I think ICT ... Pat. had received insulin with meals, depending on the value, and solid basal insulin ... but I certainly don't know anymore

Hm. Always difficult from a distance ;-)
From my stomach I would have said on the basis of the information: Before this time sleeping, additional BE, for the next dinner adjust the BE factor a little better into the night. Leave basal insulin like that for now. Before changing it, take nightly measurements and a morning basal rate test ...
Secondary question: Type 2 without any OADs?

Hm. Always difficult from a distance ;-)
From my stomach I would have said on the basis of the information: Before this time sleeping, additional BE, for the next dinner adjust the BE factor a little better into the night. Leave basal insulin like that for now. Before changing it, take nightly measurements and a morning basal rate test ...
Secondary question: Type 2 without any OADs?


Unfortunately I do not know it. But thanks for the numerous answers and tips.

I have learned to adjust the basal insulin to the fasting sugar in the morning. If I'm too deep in the evening, it's usually not the basal insulin to blame. For inpatients in the setting phase, check-ups at 10 p.m. and 2 a.m. Then you can estimate where there was too much / too little insulin !! Do you also have short-acting or mixed insulin on board? Or only long-term (possibly plus OAD)?

short-acting insulin with meals depending on BG (morning, noon and evening), and then basal at night

Then I guess (without knowing the values) that the evening insulin was too high. I would not change the basal insulin with plus / minus normal morning sugars if the early morning values ​​are okay.

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