Need advice/input re:insulin switch

[Lea]

Hello all!
This is my first post, although I have been visiting the forum for a few months now and have gained much valuable info. I would love to have some feedback on my current situation. Sorry in advance if this gets lengthy.

I have had Type 1 diabetes for 24 years now. I have been pondering the idea of switching to the insulin pump for some time now, but have mixed feelings about it, so have decided to give lantus/novolog MDI combination a try first. Anything has to be an improvement over the NPH/Regular combo I have been on for the past 24 years---very antiquated, I know and I am just ready for a different way of life. After my doctor's appt. today I have also come to the conclusion that I need a new doctor, but right now I am forced to work with my current M.D. with these insulin changes, which brings me to my questions/need for input.

At MY insistence, my M.D. wrote me scrips for Lantus and novolog today. He wants to keep Regular in my regimen, so I agreed to this. He insists that with having diabetes for 24 years there is no way for me to do just Lantus and Novolog. I really don't think that this is necessarily true, but got tired of arguing with him about this, so agreed to use a combination of regular(1/3) and novolog (2/3) as bolus at mealtimes. I have just begun to figure out the whole carb counting thing (my idea, not his), but do not have a ratio yet.

My biggest question right now is where do most people typically start out with their Lantus dose? I feel like he has given my way too low a starting dose and am really concerned about where my blood sugars are at. I read in several different places (including the drug literature that comes from the maufacturer) that when switching to Lantus from NPH, the starting point is recommended to be 20% less than your total daily dose of NPH. My total daily dose of NPH is usually around(not less than) 25 units, thus a starting point for me would be 20 units of Lantus at bedtime. However, he told me to take 10 units tonight and call him Tuesday eve with the past 36 hours of blood sugars. My blood sugars have skyrocketed and I cannot seem to get them down ( thus awake and typing this at 3:30 am!!).

I took the Regular/Novolg (3u R and 8u Novo) combo at 6:15p.m before dinner (BS was 141 at this time, so I gave one more unit of Novo than he had recommended). Had a severe insulin reaction at 8:15p.m. ( BS was 27)--WAY overcorrected with OJ. Was still only 58 at 9:15. Was concerned about taking the lantus before bedtime, so ate a bowl of cereal and drank a little milk. At 10:15, I was 169. At 11:30 I was up to 263--I gave 2 shots at this time 10u Lantus and 2 uR and tried to go to sleep. Dozed off, woke up to check at 1:15, and I was 362; gave 4 u Novolog and laid back down. Got up at 2:30 and I was 283. Got out of bed and decided to watch TV/browse forum and at 3:20 I was 306. I am ready to scream! Looking for feedback! By the way, my total daily dose of insulin was close to 60 units of R/NPH and my last A1C ( one month ago was 6.8, far from ideal,but part of the reason I am changing things) Any and all feedback is appreciated. Thanks in advance!

Lea

[Georgia]

Hi Lea

I am in a similar situation as you & started the new Lantus/Novorapid regime last week, with no help from the medical profession. (I think Novorapid is the same as Novolog). I'm still trying to get to grips with the new insulins & last night I experienced a low of 1.8, which was rather scary. Have a read of this link as it may help you:

http://www.diabetesforums.com/type-1/9117-q-re-lantus-novorapid.html

Good luck - let us know how you get on :)

Georgia

[seacomp]

After my doctor's appt. today I have also come to the conclusion that I need a new doctor, but right now I am forced to work with my current M.D. with these insulin changes, which brings me to my questions/need for input.
Hello Lea and Welcome to the Forum, I hope we can help.
From what you describe you are trying to do something difficult without much help or understanding from your doctor, that's tough.
I'd suggest that the first thing you do is work out your Lantus dose. That is, forget the novolog for the time being, stay on your regular, and work on getting your basal dose right.
The first step to that is getting your fasting BG right or near right. Take your evening Lantus at the same time, increasing the dose by a small amount (1 or 2 units) until your FBG is near correct. Once that's done, you can move on to 1) fine-tuning the Lantus dose, 2) spiltting the Lantus dose, and 3) developing your ratios for use with the novolog.
It will take a few days before you can get the Lantus approximately right, then you can worry about the other things.
Good luck and we are glad to have you!

[Doetsch]

Hello Lea and Welcome to the Forum, I hope we can help.
From what you describe you are trying to do something difficult without much help or understanding from your doctor, that's tough.
I'd suggest that the first thing you do is work out your Lantus dose. That is, forget the novolog for the time being, stay on your regular, and work on getting your basal dose right.
The first step to that is getting your fasting BG right or near right. Take your evening Lantus at the same time, increasing the dose by a small amount (1 or 2 units) until your FBG is near correct. Once that's done, you can move on to 1) fine-tuning the Lantus dose, 2) spiltting the Lantus dose, and 3) developing your ratios for use with the novolog.
It will take a few days before you can get the Lantus approximately right, then you can worry about the other things.
Good luck and we are glad to have you!

I agree.

There is nothing harder then not knowing what is going on. You have switched to 2 new routines and you are not going to be able to figure out if it is the Novolog / Novarapid or if it is the Lantus that is messing with your readings. Your Basal is going to be more important at this time and you are going to need to get that tweaked before you move on to bigger steps. I do feel that this combination will be better for you once you get it tweaked. In the meantime just hang in there, be strong and check your BG a little more often than you normally do.

[Aftiel]

Hi Lea,

I am Type 1 also, for almost 30 years.

I switched a few months ago to Lantus/Novalog from NPH/Regular.

I can tell you that I wish I had made that switch YEARS before I did.

Best thing ever for me - my BG control is the best it has ever been.

I have had no side effects, etc. and the transition was flawless.

Most Doctors say to take Lantus at night, but I (and some others) take it in the morning, which for me works perfectly.

- Aftiel

[Aftiel]

Lea said:

He wants to keep Regular in my regimen, so I agreed to this. He insists that with having diabetes for 24 years there is no way for me to do just Lantus and Novolog.

That is not true. I went to a new Endo, she switched me immediately after being Type 1 almost 30 years.

Best thing any Doctor has ever done for me.

- Aftiel

[Aftiel]

Last reply here :) I keep thinking of things.

I take 22 units of Lantus in the morning, along with 4 units of Novalog.

I take 2 units of Novalog at lunch.

I take 2 units of Novalog at dinner.

- Aftiel

[Lea]

Thank you for all the quick informative replies. I agree--basal should probably be my first priority.

Georgia--thanks for pointing me in the direction of your prior post and thread--that has been helpful. You're right--sounds like we are in similar situations.

Aftiel--a few questions for you if you don't mind. What was your total daily dose of insulin prior to the switch (NPH/Reg)? Where did your Lantus dose start out at? You mention your transition was pretty smooth--did you have any out of whack high blood sugars with the switch?

I was 268 at 5:00am and totally exhausted. I took an additional 3u of Reg. and went to bed. Now at 11:00 I am 72 (yea!) and am getting ready to eat lunch soon. Wish me luck for the rest of the day figuring out my boluses! Thank you for all the support!

Lea:shakehand

[Shotokan]

Lea said:

He wants to keep Regular in my regimen, so I agreed to this. He insists that with having diabetes for 24 years there is no way for me to do just Lantus and Novolog.

That is not true. I went to a new Endo, she switched me immediately after being Type 1 almost 30 years.

Best thing any Doctor has ever done for me.

- Aftiel

I have been Type 1 for 29 years and been on Lantus & Novolog for several years without Regular. It worked fine for me (A1C = 7.0), but now I'm switching to a pump. Frankly, I would advise you to find a new endo. Your present endo has complicated your regimen by keeping the Regular in it but has not given you the information you need to manage it.

[rzrbks]

Shotokan

Frankly, I would advise you to find a new endo. Your present endo has complicated your regimen by keeping the Regular in it but has not given you the information you need to manage it.

>>>in his best drag-Queen voice<<<<
Frankly, deary, I would say the same thing.

The hodgepodge Lantus/Regular/Novolog is going to make it very difficult to find a working dosage.

[Lea]

Shotokan and rzrbks---I totally agree that I need a new doctor. I stated in my initial post that I had already come to that conclusion. The problem is that I need help now and that's why I posted. Sorry, don't mean to sound defensive. I really do appreciate the support and feedback.

Lea

[lgvincent]

I'm going to try to switch to Lantus soon and I'm kind of worried about getting the correct dosage, too. Guess I'll soon be in the same situation that you're in now.

[vrocco1]

I started my Lantus dose very close to what my total NPH dose was when I made the switch. I can't imagine that 10 units is going to be enough for you, but what you will find is that very samll adjustments can have a huge effect on your overall control. I made the switch from NPH/R immediately. Input from a doctor is very important.

Another good starting point is to take 50% of your total daily dose of insulin before the switch. You can then increase your Lantus as needed very slowly, and compensate for high BGLs with your novalog.

I found that it took me about three months to get my control back, but it was well worth the switch. Also, don't snack before bed, unless you are going to bolus to cover it. You won't get the peaks from lantus that you used to get from N. A high carb snack (cereal) without a bolus will drive your BGL through the roof as you have found already.

[stella117]

Hello all!
This is my first post, although I have been visiting the forum for a few months now and have gained much valuable info. I would love to have some feedback on my current situation. Sorry in advance if this gets lengthy.

I have had Type 1 diabetes for 24 years now. I have been pondering the idea of switching to the insulin pump for some time now, but have mixed feelings about it, so have decided to give lantus/novolog MDI combination a try first. Anything has to be an improvement over the NPH/Regular combo I have been on for the past 24 years---very antiquated, I know and I am just ready for a different way of life. After my doctor's appt. today I have also come to the conclusion that I need a new doctor, but right now I am forced to work with my current M.D. with these insulin changes, which brings me to my questions/need for input.

At MY insistence, my M.D. wrote me scrips for Lantus and novolog today. He wants to keep Regular in my regimen, so I agreed to this. He insists that with having diabetes for 24 years there is no way for me to do just Lantus and Novolog. I really don't think that this is necessarily true, but got tired of arguing with him about this, so agreed to use a combination of regular(1/3) and novolog (2/3) as bolus at mealtimes. I have just begun to figure out the whole carb counting thing (my idea, not his), but do not have a ratio yet.

My biggest question right now is where do most people typically start out with their Lantus dose? I feel like he has given my way too low a starting dose and am really concerned about where my blood sugars are at. I read in several different places (including the drug literature that comes from the maufacturer) that when switching to Lantus from NPH, the starting point is recommended to be 20% less than your total daily dose of NPH. My total daily dose of NPH is usually around(not less than) 25 units, thus a starting point for me would be 20 units of Lantus at bedtime. However, he told me to take 10 units tonight and call him Tuesday eve with the past 36 hours of blood sugars. My blood sugars have skyrocketed and I cannot seem to get them down ( thus awake and typing this at 3:30 am!!).

I took the Regular/Novolg (3u R and 8u Novo) combo at 6:15p.m before dinner (BS was 141 at this time, so I gave one more unit of Novo than he had recommended). Had a severe insulin reaction at 8:15p.m. ( BS was 27)--WAY overcorrected with OJ. Was still only 58 at 9:15. Was concerned about taking the lantus before bedtime, so ate a bowl of cereal and drank a little milk. At 10:15, I was 169. At 11:30 I was up to 263--I gave 2 shots at this time 10u Lantus and 2 uR and tried to go to sleep. Dozed off, woke up to check at 1:15, and I was 362; gave 4 u Novolog and laid back down. Got up at 2:30 and I was 283. Got out of bed and decided to watch TV/browse forum and at 3:20 I was 306. I am ready to scream! Looking for feedback! By the way, my total daily dose of insulin was close to 60 units of R/NPH and my last A1C ( one month ago was 6.8, far from ideal,but part of the reason I am changing things) Any and all feedback is appreciated. Thanks in advance!

Lea
It's very individual. I would dose with Novolog at whatever carb:insulin ratios you were using for Regular--although you can inject right before you eat (or even after if you're low to start) rather than injecting 30 minutes prior.

For Lantus, most docs start off at 10 units injected before bed. Adjust upwards to get BG levels under 110 at waking--downwards if you experience hypos. Many people find that Lantus does not last a full 24 hours and to get the best coverage, they split the dose and inject twice daily. It takes at least 6-8 weeks to get it adjusted. Actually I started on Levemir (switched from Lantus) at the beginning of February and am just NOW feeling like I've got it down.

Another rule of thumb I found from reading this forum is to take your weight in kilograms divided by 2.2. That's approximately what your Total Daily Dose would be. 40-60% of that is your basal. Another rule of thumb is .2 units to .4 units per kilogram. My Levemir dosage is @ .25 units per kilo. I find I needed less Lantus.

[Shocked]

As others have mentioned, insulin requirements are very individualistic.


Here's my story...
I've been on lantus/humalog since mid september. My endo started me out at 15 units Lantus at night and a humalog:carb ratio of 1:15. Initially, i was taking 5-8 units of Humalog to cover meals without correction 2hrs later. My endo suggested adjusting my Lantus by 2-4 units every 5-7 days until my morning bg was below 110. I couldn't handle that drastic of a change. For me, it's 1 unit up or 2-4 down. as my Lantus use went up, my Humalog needs went down. Up until recently, I was taking 26 units of Lantus at bedtime and coving meals with 1-2 units of Humalog.

Of course now that the seasons are changing, I've backed off my need for Lantus to 22 units at bedtime. my Humalog needs remain the same.

[Lea]

Thanks to all who have posted; this information has been very helpful.

I'm having a better day today. I increased my Lantus dose last night to 13u and was 190 this morning. Bolused for breakfast and added addn'l for the 190 BG; however, was 263 2 hours later. So, I know my basal is still not right, but I know this will come with time. It also does not seem that my insulin:carb ratio is correct. I'm using a 1:6 ratio ( i know this is high). Will this ratio come down when my basal dose is correct?

Shocked-- If you're only taking 1-2 units of Humalog for each meal how many grams of carbs are you eating per meal? I guess you're really not using a ratio then? Perhaps I'm misunderstanding.

I'm determined to keep at it and figure this out. Thanks to all for input and support!

Lea

[seacomp]

I'm using a 1:6 ratio ( i know this is high). Will this ratio come down when my basal dose is correct?
It's good to see that you are getting a handle on this. :flowers:
Your ratio may come down as your basal dose is corrected. It is pretty high for a T1, which I believe you are, so it's likely.

[Georgia]

Hi again

Glad to hear you are having a better day. I think I've just about cracked my basal of 22u & I am now focusing more on how much to bolus for each meal - starting with a 1:15 insulin:carb ratio. As all foods are different it's an ongong battle isn't it. But we'll get there I'm sure ;)

[Shocked]

generally speaking, I eat around 35-40 g carbs per meal. Sometimes lower.

[Aftiel]

Lea,

Sorry for the delay in my response, work has been nuts.

I originally took:

20 units NPH in the morning.
8 units of regular in the morning.

Afternoon would involve random shots of random units of regular trying to keep my BG somewhere near stable.

10 units of NPH at night
4 units of regular at night.

During the day it was all over the place. NPH would peak, regular would peak, I'd chase my food with regular trying to keep my BS stable, etc. It was a complicated mess.

Lantus is long lasting, and for me does not have the "peaks" of NPH. Novalog acts fast, and also does not hit me with "peaks."

Be patient and get your Lantus dose dialed in - then the Novalog will act as a perfect supplement.

Trying to integrate regular insulin in with that would really throw me - I wouldnt want to try it.

To give you an idea, my A1C dropped from 10.5 to in the 7's in a 3 month period.

Please feel free to ask any question, I will gladly answer what I can.

- Aftiel

[Doetsch]

Thanks to all who have posted; this information has been very helpful.

I'm having a better day today. I increased my Lantus dose last night to 13u and was 190 this morning. Bolused for breakfast and added addn'l for the 190 BG; however, was 263 2 hours later. So, I know my basal is still not right, but I know this will come with time. It also does not seem that my insulin:carb ratio is correct. I'm using a 1:6 ratio ( i know this is high). Will this ratio come down when my basal dose is correct?

Shocked-- If you're only taking 1-2 units of Humalog for each meal how many grams of carbs are you eating per meal? I guess you're really not using a ratio then? Perhaps I'm misunderstanding.

I'm determined to keep at it and figure this out. Thanks to all for input and support!

Lea

You might want to think about splitting your lantus dose. 50% at night and 50% in the morning. It seems that you are spiking in the late afternoon and then are having a problem of trying to correct. This may be due to the fact that the Lantus is wearing off. I think that your ratio will definetely need tweaking pretty soon. Just the fact that you spiked so high after a meal.

A Few Questions:

1) What is your Target BG?

2) What is your Correction Factor? (I.E - 1 unit of insulin will drop your BG how many points?)

3) Are you failrly comfortable with adding your carbs or are you winging it?

I surely hope that you get everything under control, stay strong :)

[jen_slc]

Your ratio may come down as your basal dose is corrected. It is pretty high for a T1, which I believe you are, so it's likely. Yes, if you up your basal, it's likely your bolus needs will come down, but keep in mind Lea that even when you do find your correct basal, you may still require more insulin to cover breakfast - quite a few of us do. I go back and forth between 1:5 and 1:6 for breakfast while I use 1:10-1:12 for every other meal/snack.

[leslie91879]

been there done that when I was 12 (after 11years of using beef/pork R and L i was changed to humalin R and L stayed on that till I was 17 when I started the pumped and was changed to humalog. all my changes have been effortless for me

[Lea]

Just thought I'd post an update. Everything seems to be working out well with the Lantus and Novolog (I scrapped the idea of working the Regular in). I have settled for the time being on a dose of either 16 or 17 u of Lantus at bedtime and have had fasting blood sugars in the morning fo 102 ( with 16u) and 73 and 80 (on 17u). I seem to do better the following day with a dose of 17 u. 17 units seems to require a snack at bedtime. My insulin:carb ratios have not come down ( still dosing 1:6) for meals. However, I don't think I can increase the Lantus anymore. I suppose I could always try to split the dose. Right now I am pretty pleased with the results I am achieving. I feel like I am finally getting a life back! Life on NPH and R had become pretty difficult for me. Thanks for all the ideas and suggestions. The input from this group is invaluable.:biggrin:

Lea

[Cyborg]

Glad to hear things are getting better for you and that you have taken control rather than letting that "doctor" dictate your treatment. You got some good advice from everyone here.

I was on Novalog/Lantus before the pump and I'll never go back. Maybe we'll see you posting in the pumpers thread some day... Wishing you continued success.

[Tokyo Cate]

Happy you have found your rhythm with Lantus, Lea. I switched from the pump to Lantus/Humalog last fall. My starting dose was 10 units of Lantus at bedtime and I increased it based on fasting glucose readings until I reached my current dose of 14. I am thinking I may have to increase it again, but am not sure.

I hope the rest of your transition goes well and you see a noticeable improvement in your A1C (mine went from 7.5 on the pump to 6.5 on MDI with Lantus/Humalog in two months).

[seacomp]

Everything seems to be working out well with the Lantus and Novolog ( That's very good to hear!:flowers:

[Georgia]

Glad to hear it's working out for you. I've had a blummin cold so my bs have been all over the place :(