[HeatherP]

Nice to see you Mick, how are you doing? Hope you and your family are well.

I have to thank you for that formula, I've used it myself and passed it around to a number of other folks. It's come in very handy!

HeatherP

[JasonJayhawk]

I take 16 units of Lantus at night, and 18 units in the morning. If I go any higher with the nightly Lantus dose, I'll usually hit a low. I also adjust by a couple units for the nightly dose based on if I've had a high-fat meal for dinner, so it really varies by 2-3 units a day.

---------------------------------------
Dx'ed March 2004, at age 27... also hyperthryoidism (Graves')
Most recent A1c's at 2 month intervals: 12.4%, 6.4%, and 5.1% (most recent)

[gettingby]

JasonJayhawk, Way to go on the A1C's !!!!!!!!!!!!

[LauRa Lu]

I take around 10 units each day. It varys though... maybe thats my problem

[sparkle9]

I take 18 units a day (divided AM and PM). While my control on lantus is generally better than it was on NPH, I find my bsl's fluctuating a lot when I exercise more or am more active than usual. I've been told that a change in lantus dose takes 3 days to take effect. So....my question is, how do y'all adjust your lantus dose for activity? I've tried snacking on active days but have still had some bad lows, especially at night or the next day. Any suggestions?

[Mick]

In general, basal dosage (Lantus included) only needs to be adjusted due to a weight gain or loss, not for increase or decrease in activity or food. Once established, basal dose should remain the same. In fact, with lantus, the body does NOT react the same during exercise as it does to short-acting or other long-acting insulins. IF (big IF here...!) you have no active bolus in your body at the time of exercise (in other words, at least 2 hrs or more past your last humalog (or novolog) injection), THEN exercise will have absolutely no effect on your blood sugar. It can't--activity can only affect glucose levels if there is insulin active in the body. Exercise ALL BY ITSELF cannot lower the blood sugar level of a type 1 diabetic without insulin active in your body. Lantus does not work that way--there is not enough insulin active at any time to cause an exercise low. I've done some experiments on this--fasted all day, taken no insulin and no food (other than my lantus the night before) and do some very hard work--running 5 miles, for example. My blood sugar remains constant. I have also done the reverse experiment--taken a small bolus of humalog, then eaten the amount of carbs which would have necessitated it, then exercised--my blood sugar drops like a rock. Lesson learned--once you have gotten your basal dose correct, stick with it unless you see constant, throughout-the-day rises or drops in your sugars. Check your basal dose twice a year by fasting. Leav it alone. Adjust your bolus dosages, and time your exercise to not overlap that action.

Michael

[rzrbks]

So....my question is, how do y'all adjust your lantus dose for activity? I've tried snacking on active days but have still had some bad lows, especially at night or the next day. Any suggestions?

I don't adjust my Lantus.

I just have more food available, check my B/G every 15 minutes and shove any needed carbs into my waiting and eager mouth-----this I do while exercising.

For the next several days, I tend to drop my Novolog/Novorapid rate to 20:1 rather than 15:1---------and I have to eat more and more often

The extra eating Really bothers me

[MarkMunday]

sparkle9,

I agree with Mick and Rzr that you shouldn't adjust Lantus for exercise. But I have also had difficulty arriving at a rate that gives me stable BS levels. The solution I found was to ensure that I do at least a moderate amount of exercise everyday .

Exercise increases your sensitivity to insulin, both during and after doing it. Exercise also increases your metabolic rate for up to 36 hours after doing the exercise. Both these effects have a depressing effect on blood sugar. And the effects of an irregular exercise schedule can become very confusing.

This was a problem for me when I was a "weekend warrior" it would take the rest of the week for me to get back to normal, after intensive exercise over the weekend. I have sorted this out by ensuring that I get some exercise (walking for 1/2 hour) every day. The result is that my sensitivity to insulin and metabolic rate are kept on an even keel. And I have been able to fine tune my Lantus dosage.

Cheers,

Mark

[LauRa Lu]

Originally posted by LauRa Lu
I take around 10 units each day. It varys though...

Sometimes i think I really must be the dumbest person I know. I don't take 10 shots of lantus ever! In fact I dont even take lantus!!! where the heck was my brain when I wrote this... I take levimir... and i take 8 shots every evening without ever changing the dose!! I think I'm turning loopy

[sparkle9]

Thanks for your suggestions, everyone. I'm going to follow your advice about exercising, keeping lantus doses the same, and adjusting boluses and see if my control improves. I have an appt. with a new endo next month and will ask for his advice also. I hope he's a little nicer than the last one...had to fire him!

[bac4uw]

I take about 7-8 units in the morning and 7-8 units in the evening. MY question is: when are they going to FINALLY make Lantus available in pen-form!? It'd be nice to not have to buy syringes anymore... just pen needle tips.

[Brent44a]

The analytical guy that sits on my left shoulder, and whispers in my ear, tells me that it makes sense that I should not vary my dose of Lantus. The the voice of experience, you know the one on the other shoulder, says "yea but on Saturdays I can reduce the dosage with no effect and the injection is less painful when it is a smaller amount." I am leaning to the left in the last few days I will take Lantus (pump class Tuesday). I guess one reason I spend so much time on this forum is that it helps me to figure which one of those little guys to listen to! Seriously, there is some great information here that applies to pumpers and those on injections. Thanks for a great thread. And yes, I believe those guys do have horns.

[simstash]

Bac4uw - they are available in pen-form, at least in Croatia. They have been available for at least a year and a half, at least here. Where do you live?

I've just started on it the day before yesterday, with 10 units. I'm a bit confused now with Michael's post because the leaflet i got about Lantus recommends to adjust the dose if after 2 days blood glucose is not as it should be, that is to increase it by up to 8 units if glucose is above 10.0 mmol/L (180 American system). My blood glucose has been running up to 20.0 mmol/L (360) so i've been thinking what to do - should i alter the dose on my own? I am going to phone up my diabetitian first thing in the morning but i'm concerned over all this as i'm only starting - what do others think?

I have always been adjusting my own doses but Lantus is different and Michael's post got me thinking. In fact, i was going to increase my dose from 10 to 14 tonight but now i'm thinking better not?

[MarkMunday]

With such high blood sugars, it sounds like your Lantus dose need to be increased. And, with 15 years of experience under your belt, I am sure you can handle it on your own. But take it slowly. As Michael points says, it takes a while for dosage changes to settle down.

I wouldn't increase the dose by more than 2 units at a time and no more frequently than twice a week. And while you are increasing it, test often. Like 10-15 times a day. I find that Lantus does peak, although not as sharply as NPH. So watch out for this. You may need to split your dose if this happens.

Cheers,

Mark

[simstash]

Yes, it will go up tonight although doc said to start taking 16 units. It is 6 units more, but with sugars that are this high going gradually probably wouldn't help much. Plus i do need to increase it by more than 2 units as i've already got ketones in my urine and i woulnd't like to end up with ketoacidosis. Will set my alarm clock to 2 and 4 a.m. though to check it!