Lantus question

[mosherman1]

I am a diabetic now for 3 + years (37 years old) With recent sudden fasting BGs out of site and a 10.6 a1c my doctor has prescribed Lantus.

He started me on 10 units. wait 2 days watch fasting # up 2 units if numbers are not good. Follow this up 2 until the numbers are good.

I am at 14 units and my fbg this morning was 353. :mad:

What is your experience with Lantus? I need some reassurance that this is going to get better. I am not over weight and am currently starving myself! In onther words the diet and exercise is no the issue. I eat very healthy and right size portions.

What is a typical Lantus dose?

I am not thinking about any radical changes I am just looking for some light at the end of the tunnel. I am very frustrated and confused.

Thanks

[xMenace]

I have 1u an hour as the standard for men. It seems a little lower for women. That's a totally anecdotal observation. Some take much much more though.

As you get close, which you certainly will, do some 2 or 3am tests to be sure you aren't bottoming out!

[art]

Before I got on Janumet I was on Lantus,
40 units twice a day backed up by Novalin if required.

But that was just me.

Art

[Scratch]

I am a diabetic now for 3 + years (37 years old) With recent sudden fasting BGs out of site and a 10.6 a1c my doctor has prescribed Lantus.

He started me on 10 units. wait 2 days watch fasting # up 2 units if numbers are not good. Follow this up 2 until the numbers are good.

I am at 14 units and my fbg this morning was 353. :mad:

What is your experience with Lantus? I need some reassurance that this is going to get better. I am not over weight and am currently starving myself! In onther words the diet and exercise is no the issue. I eat very healthy and right size portions.

What is a typical Lantus dose?

I am not thinking about any radical changes I am just looking for some light at the end of the tunnel. I am very frustrated and confused.

Thanks

Couple things here --

Have you had c-peptide and GAD antibodies checked? Age 37, if you're not overweight and active, if I were a doctor I would be thinking 1.5 is a definite possibility and more probable than type 2.

Now, one thing to keep in mind that a high blood sugar in the morning may result if the Lantus dose was enough insulin to push your blood sugars down far enough that the liver kicked in to bring you back up. The only real way to check on that is to do what all of us type 1s just love doing, settting alarms on the hour or every 1.5 hours to check the blood sugars. If you go to sleep, get up, find your blood sugar is going down rapidly, then you might see why there is this seemingly paradoxical effect going on.

Again, though, I'd highly recommend that if you haven't been checked for GAD antibodies, do so.

[mosherman1]

Couple things here --

Have you had c-peptide and GAD antibodies checked? Age 37, if you're not overweight and active, if I were a doctor I would be thinking 1.5 is a definite possibility and more probable than type 2.

Now, one thing to keep in mind that a high blood sugar in the morning may result if the Lantus dose was enough insulin to push your blood sugars down far enough that the liver kicked in to bring you back up. The only real way to check on that is to do what all of us type 1s just love doing, settting alarms on the hour or every 1.5 hours to check the blood sugars. If you go to sleep, get up, find your blood sugar is going down rapidly, then you might see why there is this seemingly paradoxical effect going on.

Again, though, I'd highly recommend that if you haven't been checked for GAD antibodies, do so.

I get drawn for the GAD and cpeptide tests on Wednesday. As for the bg it makes absolutely no sense. Here is an example of my problem

9 AM 303 (FBG) Low carb meal oatmeal beef eggs, tom juice @ noon
Went shopping walked around all afternoon
5:PM 309 BG 5 hours after meal

7PM Dinner Salad Chicken pasta all in proper portions (maybe a little extra chicken)
9PM Lantus 14units
10 PM BG 289

Nothing to eat after 7 (Nothing!)
1AM BG 396
8AM BG 353
9:40 AM 315

I just ate breakfast Oatmeal, small apple, yogurt smoothie coffee no sugar.

Confused about the increase at night with no food.:confused:

anyone?

[Scratch]

Those numbers it looks like you aren't getting much effect at all. Which could be insulin resistance. There are also possibilites of the Lantus isn't working -- the vial is bad or there may even be a few people for whom Lantus doesn't work.

Your numbers are really high though right now which may be contributing to the problem. Basically, your metabolic thermostat of sorts is out of whack some probably because of the prolonged time of elevated blood sugars. Definitely get your blood drawn for c-pep and GAD, you might also want to pester your medical resources about some more intensive monitoring and work on getting those blood sugars down to more normal glycemic range.

[Alice]

I've never heard of the one unit per hour standard...I thought it was based on weight and sensitivity. Everyone is different. A while back someone posted a "formula" that rang pretty true for my weight...sorry, I don't remember who posted it...Regardless, Lantus will always be shifting a little. I just increased mine this morning a couple of units upward...after a long spell of decreased...we are always changing on the bolus side. But, you will work out the "range" very soon. Don't assume you are "resistant" until you give it a chance. Docs always start you out (hopefully) on the low side...so I'm sure you will need to slide upwards. Just take it slow so you don't have a big problem.

[BlueSky]

... Confused about the increase at night with no food.:confused:
It looks like you need a lot more Lantus. 14 units is a relatively small dose. You probably also need to inject Novolog/Humalog/Apidra before meals. Test before you eat and 2 hours after you eat to get a better idea of how food affects you.

[Real4]

I am not over weight and am currently starving myself! In onther words the diet and exercise is no the issue. I eat very healthy and right size portions.


If your definition of "very healthy" is what is pushed in the popular and cheap scientific press, you are not doing the job for a diabetic. A healthy diet for diabetes is a diet low on carbohydrates and high on protein.

[Alice]

Don't use me for a direct comparison...but an example. I am very insulin "sensitive" and I still take 23-25 units per day. Only changing one unit up or down for me is felt immediately within 24 hours.

So, don't feel like increasing your dose means that you are insensitive to Lantus...you just have to find out what ballpark you are going to play in! I originally started at about 17 units and have increased slowly through the years...I am about 10 lbs heavier now than when I started Lantus...but losing weight I notice I'm watching it daily again...so please know that is normal.

[tammyc]

I was dx approx 2 yrs. ago.....started on Lantus 10 u....doc said same thing "increase by 2u until a.m. BG reading are below 110". Got up to 34u at bedtime....BG is better now; anywhere from 108-120 in a.m. Doc added Metformin along with Lantus a couple months ago because a.m. BG was 200 or so....am presently taking 21u Lantus at bedtime....GOOD LUCK!

[grace girl]

You can't really compare, but I'm 39, fairly sensitive to insulin, not overweight, and I take 20 units of lantus a day. They tend to err on the side of caution when they first start you, and 10 units is the prescribed starter...it can take a few days to your level.
I'll be curious to hear your bloodwork results. Doesn't sound like type 2 to me.

[RobiJo]

If your definition of "very healthy" is what is pushed in the popular and cheap scientific press, you are not doing the job for a diabetic. A healthy diet for diabetes is a diet low on carbohydrates and high on protein.
Very much an opinion. It depends on your treatment choices. There is no "diabetic" diet to follow. We need to eat healthy balance vegetables, carbs, and protein choices, and low amounts of fats and sweets just like anyone. See a nutritionist or dietitian to come up with a meal plan that works best for you. High amounts of protein will still have an effect on your bg, just much later than your meal and/or for an extended amount of time.


So, don't feel like increasing your dose means that you are insensitive to Lantus...you just have to find out what ballpark you are going to play in! I originally started at about 17 units and have increased slowly through the years...I am about 10 lbs heavier now than when I started Lantus...but losing weight I notice I'm watching it daily again...so please know that is normal.

Likely 14u are not enough for you. Given your numbers you need to be in the 30-40 range, about double what you're taking now. Keep logging your numbers and your dose increases, and soon you'll start seeing a difference. If meals are affecting your numbers your doctor may suggest a fast acting insulin as well.

[mosherman1]

Thanks for all of your help. I am greatful and am glad to hear that there is a light to look forward to. I tend to generalize but if it helps I will add detail.

My other meds include Starlix (before meals) Avandamet (2xperday) as well as the usual suplements (cinnamon, omega 3 etc.) This keeps the number stable around 300 FBG, 2hrs after meals etc.

As for the "very healthy" diet I had alot of success with my initial treatment 3 years ago. I developed great eating habbits including a balanced diet of around 1800-2000 cals. Its a good mix of dairy, protiens, vegis, fruits, and grains. I stick to low GI/GL grains and use no external fats, salts, sugars, etc. I walk some every day. Play with the kids work on the new house etc. I really just want to feel better. I hope the Lantus works.

Thanks

[mosherman1]

What will the numbers do?

Right now I am increasing 2 units every 2 days. My numbers are not affected at all.

Will there be a noticable shift as my dose gets closer to my needs or will the change be gradual?

thanks

[BlueSky]

The numbers will start coming down. Watch that fasting number the closest. But numbers during the rest of the day should come down too. It could take a few weeks to get your Lantus dose up to the required level.

[xMenace]

What will the numbers do?

Right now I am increasing 2 units every 2 days. My numbers are not affected at all.

Will there be a noticable shift as my dose gets closer to my needs or will the change be gradual?

thanks

If we could predict that, we wouldn't need to be here.:stupido:

You may very well need some daytime help with a rapid acting. Keep that doctor in the loop.

[tammyc]

What will the numbers do?

Right now I am increasing 2 units every 2 days. My numbers are not affected at all.

Will there be a noticable shift as my dose gets closer to my needs or will the change be gradual?

thanks
Mine was a gradual reduction as I increased the insulin.

[Alice]

Also, keep in mind that Lantus is designed to use as a "basal" insulin...not for use in dropping meal/snack carbs. So, if you are elevating your glucose with untreated carbs, then overall, your numbers will be higher...even in the morning if you ran very high the night before at dinner.

So, watch your carb intake since you are not taking a fast-acting meal insulin...if you are, I apologize and have missed that info.

[Eddy]

Like the others, I'm wondering about type 1.5. GAD antibody and c-peptide tests should tell more.

FWIW: I'm 84 kg (70 at time of DX), and have a basal rate of 33U/day. Each 1U of insulin will cover 15g-CHO, or drop me 35mg/dL.

[Catcount]

If your BS are not responding to your Lantus it maybe that you need to take a larger dose. Remenber that Lantus is a background insulin and for it to work continuously for 24 hrs you need enough units. We are all different ,in my case I started on a large dose and worked down. Initially it was 60 units and then split 30 am 30 pm. Then I realised through the forums here that maybe I needed a rapid insulin to beat the highs. I then went to 30 units lantus am and Novorapid based on my carb count, which usually was about 30 units before my evenning meal. The Lantus 30 units seemed to get me through the day ok. What I did learn, when I was recently hospitalised and needed careful BS monotoring, was, that my diet, which I thought was ok , was in fact not ok. and not rotating my injection site was adding to the insulin not being as responsive due to tissue scaring at the injection site.

The solution was to strictly adhere to a the basic prinsiples of diabetic eating as monitored by my doctors in hospital. (eat 6 meals a day 3 being snacks, plus breakfast, lunch and evenning dinner and count those carbs). In addition I started rotating the injection sites.

The results, now a heathier life style and Lantus down to 15 units am and beween 15 and 20 novorapid in the pm.

What I learnt from this experience was that I may not have been as honest about my eating habbits as I should have been and I eventually paid the penalty,

Catcount, so called T1.5

[mosherman1]

Thanks For the info I met with my Nutritionist and DE on Wednesday. She said everything is good except she wanted me to eat more?? Who would have thought. I added 2 small snacks to my schedule.

I am at 20 units and My FBG has finally dipped below 200 Yeah!! It looks as though I am not so type 2. Blood work was on Wed. I am awaiting the results.

Thanks

[msdee]

Hi, I thought I was the only one having problems with Lantus, I am so happy to be in this site. After reading your post, it appears to me also that 14 units of Lantus is a pretty small dose to be using. Lantus insulin is suppose to last at least 24 hours, but in some of us it doesn't. It's a long acting insulin, so they say!! But sometimes it according to what insulin you're taking during the day also. I take 60 units of Lantus at night, and then during the daytime I follow a sliding scale of Regular insulin, along with pills, and for once in my life I think that my sugar are getting under control. ;)

But I see that you are also taking some medications during the day too, and you're seeing a Nutritionist, which is very good. It's very good that your fastings are now under 200, my fastings use to be all over the place, I thought I was going to die, but sometimes we have to do the "trail and error" thing, and have a doctor that we really trust. You are getting a lot of advice from being in this site, I'm new too so I hope to get a lot of information from this site too.

My fastings are finally under 150, and I am so very happy. But my problem is my numbes in the evening time, no matter what I eat, and even if I don't eat, I still always have numbers over 250. I always have to take extra insulin during the late hours. We just have to keep trying with the Lantus, and the meds that we are taking during the day. My problem is the evening, but we are all here for you, and I hope someone could help me out also. One!

[xMenace]

But my problem is my numbes in the evening time, no matter what I eat, and even if I don't eat, I still always have numbers over 250. I always have to take extra insulin during the late hours. We just have to keep trying with the Lantus, and the meds that we are taking during the day. My problem is the evening, but we are all here for you, and I hope someone could help me out also. One!

Are you splitting your dose? Typically someone injecting in the evenings can experience this when their Lantus runs out before 24 hours. Splitting ensures you are always covered.

Have you tried lowering your food intake at dinner? That may help quite a bit.

Adding another insulin might be the best way.

I'd recommend you try some basal testing. This will isolate the Lantus so you can better determine what's happening when.

[msdee]

Are you splitting your dose? Typically someone injecting in the evenings can experience this when their Lantus runs out before 24 hours. Splitting ensures you are always covered.

Have you tried lowering your food intake at dinner? That may help quite a bit.

Adding another insulin might be the best way.

I'd recommend you try some basal testing. This will isolate the Lantus so you can better determine what's happening when.
Thanks for reading my reply, but no, I'm not spilting my dosage. There was a time when I was spiltng my dosage of Lantus, I was taking 30 at night and 25 in the morning, but that didn't work out too well. Now I'm going to a new doctor and she wants me to only take the dosage at night. Another thing to think about, my sugar levels are always pretty decent in the day hours, but as soon as 7pm hits until about 12mid. my levels go crazy. I thought that maybe it was something I was eating for dinner, but it goes up even before I eat dinner. Whether I have eaten or not the levels always go up about 7pm., we just can't seem to figure this out.

Today my levels were under 170 all day, I ate breakfast and something around 2pm, then I went out to go somewhere. I got back in about 8:30pm, had nothing to eat, but my count was still 303. This is crazy. One!

[BlueSky]

.... my sugar levels are always pretty decent in the day hours, but as soon as 7pm hits until about 12mid. my levels go crazy. I thought that maybe it was something I was eating for dinner, but it goes up even before I eat dinner. Whether I have eaten or not the levels always go up about 7pm., we just can't seem to figure this out. ...
Lantus has a pretty flat action profile. And it sounds like your basal insulin needs increase sharply in the early evening. Lantus can't cope with this, so maybe you should consider using another insulin. Some NPH injected at lunch time should do the trick. It peaks at 6-10 hours, and will give you the extra cover you need from 7pm to midnight.

[mosherman1]

Lantus seems to be working great. 26 is my stable # My FBG is around 130 and before meals are under 100. I must say it feels kind of strange, my sugar being normal. I have alot of energy and am back to my never sit down always busy self. Yeah!! My C-Peptide came back and it's .6 What does this mean? I would ask my doc but they charge for everything:mad: They also did a Ferritin (273) and a Lipase (472) Anyone know what this is for?

Thanks

[Eddy]

My C-Peptide came back and it's .6 What does this mean?


What is c-peptide? What do c-peptide levels mean? (http://www.faqs.org/faqs/diabetes/faq/part1/section-10.html)

[Alice]

I've just gone through an interesting week with Lantus. I lowered my dose, gradually and a few days at a time, from 25 units down to 21. My basal has really dropped for some reason but I'm not surprised since I've now learned that your Lantus needs will definitely go up and down...but this has been a big drop for me. My numbers are near perfect. They were good before, but I was feeling the "edge" of that basal power. So, I know when to lower.

I don't fall into a low so easily if I eat a low carb meal...or just fewer calories. Not that I was relying on basal to handle meals, but I do think after a while, your basal starts affecting how your meal doses are decided.

I try to "get back to the basics" every now and then to separate the two. Took me a long time to figure this out. But, this is my biggest drop in a while.

It also reaffirms my earlier intuition than my endo was raising my Lantus too quickly. My 25 units was a "compromise" on her "30" recommendation which I never could handle. I could handle 25 a while back, but not now.

Does anyone else take note of a big drop of basal like this? Only big difference is that I've lost about 4 lbs. which isn't much...but noticed on a short frame.