Beware of Sanofi’s Lantus

I’ve been using Lantus ever since my diagnosis with T1D in February 2002. In the beginning, I used a vial along with disposable needles and later transitioned to the more convenient Solostar pen. Every once in a great while, I would experience a severe hypoglycemic event, but I was never able to find the cause. However, after accumulating four or five of these horrific events in the past four years, I noticed they all occurred within 45 – 60 minutes of a Lantus Solostar injection. These events occur despite being VERY careful to inject into sub-cutaneous fat and not accidentally into a muscle or vein.

Just this morning, I woke up with a BG of 84 mg/dL. I took my usual dose of Lantus at 5:15 am and started cooking breakfast. At 6:15 am, I was feeling light headed and my vision was starting to tunnel. I checked my BG again. This time – 24 mg/dL. I chugged some orange juice and ate breakfast and things returned to quasi-normal. However, now I don’t know how much long acting basal insulin I have in my body right now versus how much of that original dose acted as fast acting regular insulin.

Because of these deadly hypoglycemic events caused by Lantus, I’m switching to another brand of long acting insulin. In the meantime, I would like to share this message with anyone else using Lantus just to provide a heads up. I think Lantus is a good product so long as it behaves as it’s supposed to. The problem is trying to predict when it’s going to mis-behave.

If you’ve experienced one of these events due to Lantus, I’d love to hear about it and what you’ve done to prevent them from happening again.

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Paradigm shift

Over the last ten years, there have been some astounding advances in the management of diabetes. We have more powerful medications, better insulins, easier ways to monitor blood glucose, and we might even see the first closed loop system (insulin pump/CGM) as early as this summer. Despite these innovations, markers of diabetes control over the last ten years have actually gotten worse according to a study released by the American Diabetes Association.
I believe people with diabetes will continue to have declining outcomes over time unless we attack the management of diabetes with a multi-pronged strategy on five different fronts:
Stress mitigation
Improving duration and quality of sleep
Diet
Exercise
Medication

In my 15 years with type 1 diabetes, I’ve never had a doctor ask me what I eat, what I do for exercise, how I’m mitigating stress, or how I’m sleeping. Doctors are not schooled in the other four prongs of diabetes management nor do they have the incentives to improve the quality of life for people with diabetes. So here is where the paradigm shift comes in. Either patients need to educate themselves on these other four prongs or we need doctors to help us pull together teams of experts trained to help patients with all five prongs of diabetes management. Whether patients take on the responsibilities themselves or rely on a team of experts is immaterial. Somehow the other four prongs need to be addressed in order to improve diabetes outcomes.
I want to share my strategy for managing diabetes. It has taken 15 years to evolve and I really wish I had some more help. The first thing I addressed after diagnosis with type 1 diabetes was diet. I slowly removed wheat and grains from my diet because it was clear I could not control these foods. I experienced way too many highs and lows after eating rice, pasta, breads, cereals, and oatmeal. These foods might not be especially bad for a young healthy person with a functioning pancreas and good insulin sensitivity, but they were a disaster for me. The removal of grains was pivotal because I learned how powerful food choices can be. I then turned to things like protein, coffee, alcohol, and fruit. Protein is great, but too much at a single meal left me chasing highs two to three hours later. Certain fruits like pineapple, strawberries, figs, and some tropical fruits would spike my sugar pretty wildly so these foods had to be minimized or eaten with a more balanced plate of food that included fats and proteins. I learned that I could eats loads of fresh vegetables, healthy fats, appropriately timed carbohydrates in the form of tubers, plantains, and fruit, and quality sources of animal products and achieve an A1C of 5.1 without lows. But I also had to learn how to adopt a healthy sleep routine and learn how to exercise smartly. I also learned that short periods of meditation and long walks helped me mitigate stress.
I share my strategy because there was no one in my life who could help me with the other four prongs. By finally addressing these other aspects of diabetes managementI able to truly take control of this disease and get back into the drivers seat. Ten years ago, I was thrilled by the idea of an artificial pancreas. But now, for myself at least, I’m not interested because I can do a better job. Innovative technologies definitely have their place, but over reliance on doctors, medications, and fancy toys will never provide true control – until a cure is found, of course. I don’t mean to be overly pessimistic, but I don’t think the incentives for a cure currently exist.There is way too much money to be made through the sale of fancy toys and diabetes supplies.
Until there’s a cure, there is a solution.

Alcohol and Type 1

I wanted to briefly write about my recent alcohol experiment. For a decade or more, I have enjoyed a glass of wine or two with dinner each night. It was a ritual I looked forward to that helped me relax and unwind with my family over dinner. For most of this decade, however, I was dealing with some health annoyances that I was pretty sure were confounded by this ritual. First, my routine blood work run by my endocrinologist revealed elevated liver enzymes (AST and ALT). These enzymes were just above the normal range, but they still bothered me. A Second, I was waking up several times each night to urinate and overall sleep quality was poor. So I decided to run a little experiment. The results are not fully in yet, but I wanted to write this post because of one unexpected result.

I decided to eliminate any kind of alcohol for one month and then resume having a glass or two of red wine with dinner only on Fridays and Saturdays. As expected, sleep improved a little. Sleep didn’t improve as much as I was hoping, but it was progress. The unexpected outcome was a reduction in basal insulin from 18-20 units per day down to 14-16 units per day. Perhaps drinking less wine has contributed to better hydration overall or less inflammation. The exact reason for this bump in insulin sensitivity is unknown, but I simply wanted to report it here on this blog in case anyone is curious.

Possibly out of denial, I din’t think a couple glasses of wine with dinner would have any negative effects on swimming. However, since the beginning of this experiment in February this year, I have indeed noticed a significant improvement in my swimming performance during workouts. In addition, I have more energy and suffer less fatigue overall. Sleeping better, of course, helps with all these things so I’m going to continue my little experiment and I’ll share the results of my next liver enzyme test as soon as I have them.

Severe Hypoglycemia Using Lantus

Roughly 45 minutes after injecting 9 units of Lantus this morning, I experienced a severe low blood sugar. The paramedics measured it at 45 mg/dL, but I fear is actually got much lower than that.

Over the past five years, this has occurred three times. Each time left me feeling confused as to how my blood sugar could possibly drop so low so fast. I did a search online this morning to see if anyone else out there experienced anything similar following a Lantus injection and found a couple of posts by other people with type 1 diabetes. Apparently, if you inject Lantus (a long acting basal insulin) and accidentally hit a vein, the Lantus could hit your body like a freight train and deliver a large bolus of insulin that acts much faster than Lantus should, more like regular insulin.

After reading this information online, I contacted my doctor to let him know what happened and ask if there is anyway to lower or eliminate the risk of this happening again. I also tried to contact Sanofi, the company who makes Lantus. This is the bizarre message I found for their “contact us” form:

To contact us, please use this contact form.

Please note that this form is not to be used to report health concerns, adverse event notifications or to ask technical or medical questions regarding Sanofi products. In these cases, you should contact your personal physician.

  • For healthcare professionals: if you wish to report an unexpected adverse event which has occurred in a patient treated by one of our products, or for any technical issue, please use the current procedure in force in your country.

 

That second paragraph is a little scary. How are health care providers supposed to contact Sanofi? And, what are the “current procedures in force” in this country?

I want others to know this could happen. It’s very rare, but patients should at least be told. Doctors should tell their patients and a warning from the company should be more prevalent on the packaging.

Three Reasons to Consider Glucose Tablets for Hypoglycemia Instead of Sugary Foods and Beverages

 

I think we all agree that fixing low blood sugars as quickly as possible without rebound high blood sugars or deleterious health effects is a solid strategy. Therefore, reaching for a piece of fruit, a snicker bar, or a juice box  may not be the best way to manage hypoglycemia. What follows are three reasons why glucose tablets may be superior to sugar rich foods and beverages when attempting to correct low blood sugar with type 1 diabetes.

  1. Glucose tablets provide accurate amounts of the type of sugar your body needs most during a hypoglycemic event. I use 4g tablets made by Dex4. One of these chewable tablets will raise my blood sugar 15-20 mg/dL in 15 minutes. If my blood sugar is 50, I know I can put it into the 80’s with two tablets in roughly 15 minutes. Sugary foods, by contrast,  have a combination of  glucose, fructose, fiber, protein, and fat which may take too much precious time to metabolize when blood sugar is dangerously low. In addition, the amount of glucose in sugary foods isn’t clear which means it’s also unclear how much to eat of such a food to raise blood sugar back into you target range.
  2. Sugary foods and beverages often contain many gut irritants like grains and dairy which cause inflammation. Inflammatory foods make blood sugar control impossible.
  3. Sugary foods and beverages contain fructose which is a known toxin. Fructose has been shown to raise risk factors for cardiovascular disease and type 2 diabetes. Glucose, on the other hand, does not raise risk factors of heart disease or type 2 diabetes.

Glucose tablets contain a measured amount of a relatively safe monosaccharide that will raise blood sugar levels in a fairly linear and predictable way and do it quickly. Sugary foods and beverages may get digested too slowly, do not contain clear amounts of glucose, and may contain inflammatory and toxic ingredients like grains, dairy, and fructose. Since low blood sugars are part of life for people with type 1 diabetes, we should consider the use of glucose tablets instead of sugary foods and beverages.

Fasting With Type 1 Diabetes – My 24 Hour Experiment

Fasting seems to be really hot right now in the health and nutrition world. I’ve read how it can be helpful for insulin sensitivity, longevity, and even cancer prevention. However, as a T1D, I was nervous to try any sort of fasting for any significant period of time. I routinely practice intermittent fasting, but nothing longer than 16 hours. For example, my Saturday morning swim workout goes from 8 am to 9:30 am and I typically do this workout fasted. Thus, if my first meal of the day is after 10 am, this is roughly 16 hours.

A few weeks ago I decided to try a 24 hour fast, but I wasn’t sure how to manage basal insulin levels. I’m currently on 18 units of Lantus split into to two doses per day, 9 units around 5 am and 9 units around 5 pm. I had a routine blood test scheduled for a Thursday morning which required a minimum of 12 hours of fasting so I decided this would be the day. On Wednesday night I ate a normal dinner and took my 9 units of Lantus around 5 pm. On Thursday morning I had a glass of water and completely skipped my 5 am dose of Lantus. This meant I would be riding on half my usual basal insulin levels for the next 12 hours. Here’s what I found:

  1. My blood sugar hovered between 65 and 80 mg/dl all day long.
  2. I felt fine. I had no fluctuations in energy, no brain fog, and no insane cravings to eat an entire buffet.
  3. I didn’t know what to do with the free time meal prep and eating usually took up so I was very productive at work.
  4. I ate a normal dinner on Thursday night, thus a roughly 24 hour fast.
  5. I felt completely normal during my Friday morning swim workout.

All in all, I was a bit surprised how easy it was. The only confusing part was figuring out how to get back onto my split dose of 18 units of Lantus. This ended up taking about 5 days.

I’ve decided to do this once per week every Thursday. I’ll report back with updates, but all in all my anxiety regarding fasting was unnecessary. The most remarkable aspect to my experience was how unremarkable it was.

Functional Medicine

Maintaining tight blood sugar control is VERY difficult. Even if you weighed and measured every bite of food you eat, there are still a multitude of variables that are outside of your control. Perhaps you are fighting an infection that has made your body less  sensitive to insulin than normal. Perhaps you did an intense weight lifting workout in the gym this afternoon and your body is more sensitive to insulin after dinner than normal. There are countless variables at play when dosing insulin and most are outside our control. Perhaps, however, there was a way for us to discover foods that trigger large immune responses or inflammation. Perhaps there are supplements that could help balance hormones and thus blood sugar. Perhaps there are ways to help mitigate insomnia.

I have discovered recently that these are the questions best handled by a qualified functional medicine practitioner (FMP). An FMP should not replace your  current doctor(s). Last month, I discovered that I have some hormonal imbalances and some trigger foods that inflame my intestinal lining and are contributing to intestinal permeability. By following the diet, supplement, and lifestyle guidelines this doctor outlined for me, I’ve noticed slightly less variation is blood sugar swings. I fully expect blood sugar swings to minimize even further as treatment progresses.

The major downside of pursuing treatment with an FMP is the cost. Most don’t take insurance. If, however, you can find a competent FMP in your area, the upside could be life changing.

I found my practitioner at the Institute for Functional Medicine.