[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.

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]

Originally Posted by 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.

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]

Originally Posted by Scratch

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.

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]

Originally Posted by mosherman1

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

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]

Originally Posted by mosherman1

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]

Originally Posted by Real4

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.

Originally Posted by Alice

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