Hello Everyone!
Has anyone ever experienced this? My sister accidentally injected herself with Lantus instead of insulin. We are currently trying to get a hold of her doctor for advice.
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Keep an eye on her numbers and be prepared to treat if she goes low.
Your insurance card may have a number for a nurse advice hotline - you might reach them faster than your doctor’s office.
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Lantus is a type of insulin that normally releases over a period of approximately 24 hours - I used it years ago before getting a pump. So it is sort of like a basal insulin you can’t turn off once injected, but given you’re dividing the dose by 24 for an hourly basal rate, it’s not likely to produce an emergency. Just keep track of numbers and eat more carbs if necessary, maybe adjust other insulin doses accordingly…
They had intended to give short acting insulin instead? In that case, doing lantus instead may actually produce a high… we may need more details to understand the situation.
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When I took Lantas I took 14 units once a day. It was background insulin to keep me stable - especially through the night. I don’t think it would have worked correctly for a bolus. I’m guessing she’ll need some kind of bolus of her regular insulin for her food. Until you hear from her doc- maybe give a small bolus to cover her meal. I assume she gave less Lantus than her usual dose. I never take 14 units as a bolus. It will take a little coordination for the 24 hours following. I will be thinking of you all!
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As someone strictly on pens, that’s an extremely scary situation. Try to keep her calm, the last thing you need is panic, I suggest that you keep juice and other fast acting carbs at the ready until you can get to qualified medical advice from a doctor and or nurse. Treat this like you would any other emergency. With patience and caution. I understand you may have not noticed that it wasn’t her meal time insulin. Honest mistake. It’s going to be a rough day, but just keep a close eye on her numbers. I suggest blousing less for her next meal and giving the rest of her Lantus at night if the doctor agrees. It takes 3 days for most people’s bodies to adjust from one insulin schedule to another, according to my endocrinologist team. Just be calm, patient, and treat this with discipline. A licensed doctor or nurse should be able to walk you all through all this. Be easy on her today, because like I said, today is going to be a tough, rough day most likely.
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@arodric5002 The others have it! Lantus is a basal type insulin, effects build up over time. The problem would be how much was administered and when. @wadawabbit hit the nail on the head, if it was administered as meal time dosing and the amount was low (a few units) it shouldn’t be a significant problem; the meal probably drove her high, she’ll need to watch her numbers for the next 12-24 hrs depending on dose, and she’ll need to be wary of giving a scheduled full Lantus dose for the next 12-24 hours.
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How are things going now @arodric5002 ? Hopefully everyone is staying calm and watchful. If you don’t mind my asking, how old is your sister?
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Thank you all so much for the information! My sister is young, (teenager) and mixed up her fast acting insulin for Lantus when she was going to have lunch. I’m not sure how many units she gave herself. However, after my mother spoke to the nurse, they adviced for her to eat her lunch without taking any fast acting insulin. Naturally, her blood glucose went up to 300. They advised that when that occurred, to just correct it with fast acting insulin. As for the Lantus, the doctor said to not take anymore until tomorrow night.
Tonight is probably going to keep all of us on our toes. Lantus sometimes makes her blood glucose lower at night, as low as 50. So I’m not sure what will happen tonight. We will definitely be at high alert for the next 24 hours of blood glucose numbers.
Again, thank you all!
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Okay that makes sense. If she skips her Lantus dose tonight, most likely she will not have lower blood sugar from this, given that the Lantus doses are usually larger than the doses of fast acting insulin to cover a meal.
What’s even worse, and I did once, is accidently giving the short acting instead of the Lantus at night. Woke up an hour or two later from my heart racing with a major low, and ate thousands of calories of sugar, including jelly from the jar - which of course overshot my blood sugar, but with lows like that the hunger is insane.
If night-time lows are an issue, I do think that the tandem pump with dexcom (for example) is very helpful. What’s nice about pumps is they can turn off the insulin temporarily when the blood glucose goes below target (it’s called control IQ on mine), allowing it to come back up. I was resistant to switching to pumps for a long time, but once I heard there were pumps that could talk to a continuous glucose monitor and adjust things for you, I knew it would help with my control and quality of life.
Of course would need to talk to the endocrinologist about it, healthcare coverage can be an issue. A simpler fix might be a different dose of lantus or taking it at a different time of day. I would always experiment with these things myself, but the safest bet is to talk to the endocrinologist or their PA.
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Keep doing what you’re doing. If she uses a CGM the alerts should be reassuring. I was going to make some suggestions about the overnight lows but @Tephros best me to the punch. Adjusting the Lantus dose or time could help with that. Or if she takes an infection with a bedtime snack or dinner, that might need to be adjusted. Topic for discussion at her next appointment, if not sooner.
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One other suggestion. I was afraid of taking the wrong insulin. I took my Lantus at bedtime so I wrote “BED” in marker on that pen. It saved me many times!
I’m now in an Omnipod pump. I highly recommend a pump if ever an option for her.
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Good morning. I hope things went well last night and your sister is doing okay.
Is she on the forum? She might enjoy it - there are teens here she can connect with if she wants to and everyone has suggestions and experiences to share.
By the way, does she keep a glucagon kit (injectable) or Baqsimi (the inhaled version)? It’s for lows so severe the person can’t or won’t take anything orally. I think we can usually treat lows in our own or with a little assistance before getting to that point and I’m sure this isn’t likely to happen again; but keeping some on hand might give additional peace of mind. Prescription required.
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@arodric5002 BTW, she is not the only person that’s mixed up the two types of insulin. While it doesn’t lessen the significance, it’s happened numerous times, albeit probably only once or twice to the same person. I personally use Novolog pens (blue) and used to use Lantus pens (gray). I kept them together in the same “go” kit. On going to bed one night (congratulating myself BTW on how I was managing this new diagnosis), I was supposed to take 14 units of Lantus (single dose per day), but picked up the blue pen, dialed the 14 units, dosed myself in the thigh…and immediately went “Holy @#&$*#(@ that was the blue pen!) My wife and I stayed for a couple of extra hours eating/drinking all sorts of taboo things from the frig. The blue pen was banned from the bedroom and hasn’t made its return, the gray pen was banned from the “go” kit except during travel, instead kept in the nightstand drawer. Please let her know she’s not the only one…
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Thank you all so much for your stories and suggestions! @wadawabbit we have a glucagon at all times. A couple of months ago she had a seizure so we had to use it. It was definitely a scary time, but she recovered very well. Also, I will definitely suggest to her, that she joins the forum.
My sister also uses a CGM. Which has been absolutely amazing. The pump is definitely the next step for her. A couple of months ago my sister decided that she is ready to take that step. However, the hospital isn’t going to make the process simple. In order to have the pump, she is required to attend 3 classes that will educate her on the pump. This isn’t easy, as we don’t live near her endocrinology team. So we think it’s going to be quite some time before she has access to the pump. This week we will find out how much the insurance will pay.
From now on, we will definitely be separating her Lantus from her fast acting insulin. They will be stored in two separate places to be safe! As one of you had predicted, her blood glucose has been high. The whole night she was about 150 and peaked up to 224. So since yesterday at lunch her numbers have definitely been on the higher side. Hopefully after today, her glucose will be more under control. We will definitely continue to monitor her numbers.
Thanks everyone!
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Those numbers aren’t so bad considering what happened. Do you have to do training at the hospital? When I got my pump - nearly 30 years ago - I had training at my doctor’s office: part of it was an introduction to diabetes, where I learned things I hadn’t known even though I’d had diabetes for about 20 years by that time; as well as training on how pumps work and how it is different from injections. Training on the actual pump was done by a rep from my pump company.
When we actually went live on insulin (a couple of other patients started at the same time) we did it in hospital - 2 nights and I went home the third day.
It’s good she already has a CGM - I think some people start on both at the same time which I would think would be a bit overwhelming. All the best to her! Her pump rep should be able to recommend a supplier that works with her insurance. She might ask the rep of she can get samples of the different infusion sets to see if she has a preference (not applicable if she goes with Omnipod).
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@arodric5002 First, glad she’s ok and didn’t suffer any significant consequence… Live and Learn! Second, I’m not sure where you live and how insurance works for you, that will dictate what pumps are available to you. I recommend finding that out and researching what she/you/caregivers want, vice what the hospital decides is best; albeit, insurance coverage will dictate some of that as well. Here in the US the pump manufacturer often does the training, though sometimes it may be the Dr’s office/staff. Mine was done over the phone by a manufacturer regional rep; the rep and I spoke a few times after the initial session, but I was pretty much on my own after the first call where we set it up with Dr provided parameters (basal rate, ICR, CF/ISF). So, find out what you can about the proposed pump, take advantage of any training, and ask any questions she/you have. I quickly learned the starting numbers weren’t what were needed and researched how to test for the correct basal rate (small doses of fast acting insulin from the pump instead of a slow acting insulin like Lantus), then how to test for an appropriate insulin-to-carb ratio (ICR), and lastly correction factor (CF also called an Insulin Sensitivity Factor[ISF]). These are probably like “speaking greek” right now, but they will become second nature. It sounds/is intimidating at first, but as she (and her close family) works on it for a while, it becomes second nature. I’ve been on my pump for about 18 months; I’m now using Dexcom 6, Omnipod Dash, and a DIY app called Loop to control it all; that’s fairly advanced compared to some and an absolute neophyte for others. Take it one step at a time, learn the ropes, and take the next step when she and whoever is helping her are ready!
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To go a little further with this very important point - the doctor will establish some initial pump settings but don’t expect them to be right from the very start: they’re a starting point and as time goes on they will more than likely be tweaked before finding the best ones. It may be frustrating at first but remember it’s a process.
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@Tlholz, @wadawabbit
Thank you both so much for the information. We spoke to my sister’s doctor just yesterday and they showed us 3 different pumps and a very basic overview of how they work. My sister decided to go with Omnipod 5. Specifically, because she is not a fan of the tubing on the other two. Right now we are waiting to hear back from the pharmacy to see how much insurance is going to pay. After we get back from the pharmacy, we will start training with a rep from Omnipod. After that, we must attend 2 more classes at the hospital for more training. Knowing that there is so much information is intimidating for us all. But like @Tlholz said, with time all the pump components/settings will become second nature.
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@arodric5002 Sounds like you’re off to a good start, have looked at the options, and made a decision. I hope the O5 works out for her; if not, adjust fire and try again. I didn’t give you my normal “be your own advocate” spiel, but after you and she get your feet back on the ground and gain some experience, it’s ok to experiment a bit. Doctors have knowledge, but often aren’t as up-to-speed unless they are T1s themselves. Don’t hesitate to ask any questions you have of your docs, here and other T1 fora, very little is off limits. You may get some conflicting perspectives and that’s OK, YDMV (Your Diabetes May Vary) is very real thing, and you/she will inevitably find the multiple takes more helpful. No one has a lock on “the” answer, and if an approach doesn’t work now for her, it may help in the future. Please keep us posted on progress….
Congratulations on making a choice! I used Tandem for several years and switched to Omnipod5 almost exactly a year ago now myself! I had intended to just try it out but ended up really liking it. I’ve shared some of my experiences on the Forum - some of them humorous as I got to knew the system. I’m really pleased with it - Omnipod 5’s algorithm seems to work better for me than T-Slim, which was also great.
If your sister would like any advice about the pods just tag me. If course I can’t give medical advice but am happy to share things I’ve found helpful.
A few tips to start:
- The tape holds nicely, but if she wants a little added protection I find Simpatches are great. I suggest the one without a strap - they’re easier to manipulate. Here’s a picture of one I use with my Dexcom. There is a shield for Omnipod too but they’re optional.
- I asked my trainer if I could try a couple of pods with sterile saline before starting on insulin (I did that with my very first pump) and she said that would be fine. I did the online training, got my “starter set” and got some sterile saline to use. I took some saline boluses with meals at the same time I bolused insulin with my Tandem pump. It was helpful to practice filling and delivering that way first.
- Invest in a backup controller (also known as a PDM). I had to pay out of pocket for mine but it won’t hurt to ask if he insurance covers one. I think mine was about $150 at the time but that was last year. If you have a problem with your controller they will send a replacement, but you’re stuck until you get it so I like having an extra one on hand. Hopefully she’ll never have to use it, but better to have it and not need it, then need it and not have it.