Switching from NPH to Lantus

[Dimes]

Hi, I wanted to get some opinions about making this swtich. I just switched last week.

Did you take more, or less, units of Lantus compared to NPH? Did you have to make any other adjustments to make the switch? How do you find the right dose of Lantus?

I took NPH at night, now I'm taking Lantus in the morning. I've also been really sick the last 3 days, and while I don't think this is due to the lantus, I have been really fatigued so it's making me think.

[Subby]

I took Lantus for about 3 years. I never noticed an issue at the start, but increasingly I suspected it caused a lot of fatigue and strange mental "downer" effects. On going off I had it confirmed very strongly, the issues I suspected cleared up the day I stopped Lantus. And the effects returned strightaway when I went back onto Lantus for a weekend later.

There do seem people who get these side effects (searching this forum would show a few discussions) but many who don't. Where does that leave you, I really don't know. Last thing I would want is to scare people off Lantus for whom it works well. I suppose, wait and see if things clear up and settle down for at least a week, would be what I would do.

If it you do over time increasingly suspect the insulin though, know that it has caused fatigue and other issues in others, and insist on trying something else.

As for dose I'm afraid I can't remember how it compared to NPH. I'm not sure you'll see a really useful correlation with your previous shot of NPH. For a start they have quite different action times and are therefore doing different things. Rather than worry about that, you could work from where you are. Do you feel your dose is wrong? Are you being high or having lows?

Basal testing is one of the best ways to establish a good basal dose. You can do a search here at the forums and on the web, to get instructions on how to basal test. It can be taken at whatever pace you like.

[BlueSky]

The usual advice when switching from NPH to Lantus is to reduce the dose by 20% initially. When I switched, I kept the dosage the same and it seemed to work pretty well. The main difference between the two is that Lantus is more consistent (the level of action does not vary as much from one day to the next) and it has a smaller peak. The graph and figures below show this. Lantus is glargine insulin, and CV stands for "cumulative variation" (Lantus action is less variable than NPH action,but Detemir is the best).

http://i288.photobucket.com/albums/ll181/stratplan/basalinsulincomparisonandvariabilit.jpg

[TommyC1]

Only Lantus?
I was having lots of scary hypos and lousy control with NPH. Got switched to Lantus and Novalog last summer with no complaints so far. My TDD (Total Daily Dose) is roughly the same or less than what I was taking with NPH depending my carb intake.

Tommy

[notme]

I switched from NPH to Lantus in 2000. I found that I used less Lantus than NPH and it was much better for me as far as my numbers go. The problem I had with Lantus was it didn't last the 24 hour period as promised. I took mine at bedtime. By 6 pm. my numbers were soaring and I would have to pick up the slack with Humalog.

I didn't have the issues that subby describes, but I do believe that it effects many people in different ways. I had the issue of weight gain and the changes I made to help with morning numbers were tiny increments. It is hard to draw up .5 of a unit with a needle, but that is the small amounts that wold make a big difference for me. When you make changes, make sure that you try very small dose changes.

[Dimes]

Thanks guys! I'm starting to like it.. I had my first morning reading significantly under 10 in about a month.

I also take humalog. Having the lantus is good in that something is always working. I think i may have overshot on my dose, and the lantus was working a little too well, but overall its helped regulate my #'s the past couple days. Taking the NPH at nighttime meant nothing was happening basal-wise for me after lunch and into dinner.

I'll probably end up keeping the same dose for Lantus 25 units as NPH.

I think I'm gaining a bit of weight with it too, but that's a good thing, i was starting to get a little gaunt, probably a result of having too many highs in the last couple months.

[Subby]

Good stuff, it's exactly what I found way back when I went to Lantus, good morning numbers became possible (with NPH is was either high in the morning or hypo in the night no matter what I did.)

Keep aiming for tighter control, your body and mind will thank you :)