[Georgia]

Can anyone help me please? I have tried to get advice from the diabetic nurse but she is on holiday until 8 April & the other nurse is out! Today I started on Lantus & Novorapid...

8am B/S 7.3mmol. Took shot of Lantus. Skipped breakfast
11am B/S 6.0mmol
12:30 B/S 5.5mmol. Took shot of Novorapid. Lunch:2 slices of toast & a latte.
14:45 B/S 14.3mmol (eek)
16:00 B/S 4.7 mmol

When I saw the reading of 14.3 I didn't know what to do. Should I take more Novorapid to bring it down? Or wait until dinner? Or would the Lantus work on the high reading? But Lantus doesn't peak, right? So how come I've dropped 10mmol in just over an hour?

Sorry for all the questions but seeing as I can't get in touch with any diabetic nurse I'm feeling a bit lost. I have rung my doctor & left a msg for him to call me but that could be after 6pm & I'm concerned how quickly I've dropped (& could still be dropping).

Thanks

p.s. I have been walking a lot today.

[Georgia]

It's now 4:30pm & my B/S is 3.9mmol so it is still dropping quickly. I am eating an apple. But what do I do if my B/S then shoots up because of the apple?

[jen_slc]

How many units of Lantus and Novorapid are you taking? Are you taking a set dose of Novorapid at meals or do you use a ratio and count carbs? How much Novo did you take for your toast and latte?

First off, Lantus doesn't work on high readings. It's supposed to be a peakless insulin but in my experience there is a tiny peak earlier on... it seems to vary for everyone. You will eventually discover how it works in you. (Also, despite what Aventis repeatedly states, it doesn't tend to last 24 hours either but that will vary also). But anyway, it doesn't work on high readings, you use Novorapid to correct highs.

Seeing as how you had normal bg before lunch, a high bg 2 hrs post-lunch and normal bg 4 hrs post-lunch, I would guess that maybe your latte shot you high very fast... what was in it? Some food items do that. If I drink OJ for example, I shoot up very high at 2 hrs but return to normal at 4. I think maybe with these certain foods these rapid insulins just don't work very well in the 1-2 hr range. But they do work because you did return to normal, and seem to be dropping further.

Keep testing and try to follow the 15g/15min rule until you raise your bg and keep it stable... if it looks like you overdid it and bg starts shooting up again, stop eating! I would hesitate to say anything more about correcting without knowing if you have a correction factor worked out or if you use ratios.

[Georgia]

I took 36u Lantus & 6u Novorapid - this is what my consultant suggested. He said to tweak the Novorapid as needs be but to keep the same dose of Lantus each day. I don't think this is correct & plan to test my basal rate in a few days time.

I have not been told to use a insulin/carb ratio or a correction factor (I never had this before as I was on pre-mix) - I wanted to discuss these with the diabetic nurse.

My B/S is now 4.5 so I think everything is looking better - phew!

[rzrbks]

jen_slc

How many units of Lantus and Novorapid are you taking? Are you taking a set dose of Novorapid at meals or do you use a ratio and count carbs? How much Novo did you take for your toast and latte?

THose are the KEY questions.

Are you countng carbs?

12:30 B/S 5.5mmol. Took shot of Novorapid. Lunch:2 slices of toast & a latte.
14:45 B/S 14.3mmol (eek)

Generally bread is about 12-15 carbs per slice, although it can run Much higher. The Latte, well, it could be anything from 8-10 carbs to many multiples of 8-10, which would shoot your B/G through the roof.


My CDE and I use a 1:50/2.7 correction ratio----1 unit of NovoRapid brings down B/G 50/2.7 in 1 hour(aprox.)

Today I started on Lantus & Novorapid...

It's going to take you a while to get a handle on how your body reacts to Lantus and NovoRapid-----so if your #s are high at 2 hours but are back in the good range at 3-4 hours, I would take it over with the Nurse, certainly, but I'd guess that this is just part of learning how to bolus (cover) for meals and at what ratios to cover.

The normal starting point is 1 unit of NovoRapid for 15 gms of carbohydrates.
Thus you lunch of two slices of bread = aprox 30 gms of carbs =2 units of NovoRapid

Then you would also count the number of carbs in the latte and add the total # of carbs and divide by 15 = the number of units of NovoRapid to inject.

[Georgia]

Originally Posted by rzrbks

THose are the KEY questions.

Are you countng carbs?



Generally bread is about 12-15 carbs per slice, although it can run Much higher. The Latte, well, it could be anything from 8-10 carbs to many multiples of 8-10, which would shoot your B/G through the roof.


My CDE and I use a 1:50/2.7 correction ratio----1 unit of NovoRapid brings down B/G 50/2.7 in 1 hour(aprox.)



It's going to take you a while to get a handle on how your body reacts to Lantus and NovoRapid-----so if your #s are high at 2 hours but are back in the good range at 3-4 hours, I would take it over with the Nurse, certainly, but I'd guess that this is just part of learning how to bolus (cover) for meals and at what ratios to cover.

The normal starting point is 1 unit of NovoRapid for 15 gms of carbohydrates.
Thus you lunch of two slices of bread = aprox 30 gms of carbs =2 units of NovoRapid

Then you would also count the number of carbs in the latte and add the total # of carbs and divide by 15 = the number of units of NovoRapid to inject.

Hi

Yes I am counting carbs. When I was on pre-mix I'd have 40g carbs per meal & at lunch the bread = 27g & the latte 16g so I shot 6u Novorapid, but using your method it should be more like 3u

As yet I do not have an ins/carb ratio & was hoping the diabetic nurse could help me with this. I'm still waiting for the doctor to ring me & will ask him about it & also the correction factor.

Thanks

[seacomp]

Originally Posted by Georgia

I took 36u Lantus & 6u Novorapid - this is what my consultant suggested. He said to tweak the Novorapid as needs be but to keep the same dose of Lantus each day.

That Lantus dose looks high to me, especially to start. There was a thread about basal rates a while ago and most were between 14 and 24 U per day.
You are taking twice as much basal (Lantus) and bolus (Noverapid) insulin.
My own proportion is just about the opposite twices as much fast-acting as very long-acting insulin. I expect that's about what it is for most people.
With the proportions reversed, you'd expect exactly what you are seeing: a steady drop between meals, followed by a large spike after.
BTW: how much insulin did you take per day on pre-mix?

Let's hope you hear from the doctor and get thos straightened out quickly.

[rzrbks]

Hi

Yes I am counting carbs. When I was on pre-mix I'd have 40g carbs per meal & at lunch the bread = 27g & the latte 16g so I shot 6u Novorapid, but using your method it should be more like 3u

As yet I do not have an ins/carb ratio & was hoping the diabetic nurse could help me with this. I'm still waiting for the doctor to ring me & will ask him about it & also the correction factor.

I agree with seacomp, those amounts seem large, I know there are people taking large amounts of both, but that's generally after being raised to those amounts, not starting there.

Hope you and the consultant get together soon and get it straightened out.

You might ask the person why you were started out on such a high dosage of Lantus and Novorapid.

[Georgia]

Just had a hypo ( which points to too high a dose of Lantus. On NovoMix I took 36uam & 24pm so maybe I had a bit of resistance to the pre-mix.

My doctor called back & he said to ride it out for a few days & see what happens!

Tomorrow I'll start off on a lower dose of Lantus.

[Erin]

Also, is there a reason you're taking Lantus in the morning? Most people start off taking it at night, and switch to the morning if there is a problem. I wouldn't' advise taking it at night right now, b/c i think you're taking way too large a dose and will end up hypo in the wee hours of the morning, but i just wanted to know the reason behind it.

The bonus of taking it at night is,
1) if you are on the right dose and you go to bed with a stable blood sugar of 90, you will stay there all night (1/3 of your life with a perfect blood sugar, with no effort on your part!!) and
2) as Lantus tends to "wear off" toward the end of its action period, it's nice to have that be during the day, when you are covering with fast acting insulin. and
3) you can sleep as late as you want.

Just some food for thought. I'd knock that Lantus dose SIGNIFICANTLY tomorrow.

[seacomp]

Originally Posted by Erin

I'd knock that Lantus dose SIGNIFICANTLY tomorrow.

Agreed, then slowly increase the dosage until fasting BG is where you want it and BG is stable between meals. Slowly, means 1 or 2 u per every two days.
There more detail on how to fine-tune the exact amount and whether two shots would be better than one for you, but that can wait.

[Georgia]

Thanks for the info. Feeling a bit miffed that I've been given the pens & then left to my own devices, i.e. no help or advice. It's hard & frustrating but I will get there. When I finally manage to get through to the diabetic nurse I'll discuss re taking Lantus in the evening. Cheers.

[Georgia]

Due to delayed jet lag I have only just woken up (it's 12:15pm). But I have checked my bs & it is 4.8 so that's good. Now I need to decide how much Lantus to take...think I'll dial 20u & take it from there. There's nobody I can speak to today for advice because both diabetic nurses are on holiday & my doc yesterday said he isn't that clued up on insulin, he know more about tablets. Great eh!

[seacomp]

Originally Posted by Georgia

But I have checked my bs & it is 4.8 so that's good. Now I need to decide how much Lantus to take...think I'll dial 20u & take it from there. There's nobody I can speak to today for advice because both diabetic nurses are on holiday & my doc yesterday said he isn't that clued up on insulin, he know more about tablets. Great eh!

You seem to be getting the hang of it, sooner or later you become your own expert, whether you want to or not.

[jen_slc]

Originally Posted by seacomp

That Lantus dose looks high to me, especially to start. There was a thread about basal rates a while ago and most were between 14 and 24 U per day.
You are taking twice as much basal (Lantus) and bolus (Noverapid) insulin.
My own proportion is just about the opposite twices as much fast-acting as very long-acting insulin. I expect that's about what it is for most people.
With the proportions reversed, you'd expect exactly what you are seeing: a steady drop between meals, followed by a large spike after.

Georgia, usually an individual's total daily basal dose and total daily bolus dose will be similar, approximately 50:50. This thread has a post in it by Mick about how to calculate your TDD (Total Daily Dose). Of course it probably won't be perfect, many factors will affect your ratio of basal:bolus doses (metabolism, genetics, exercise, lifestyle, etc, etc), but 50:50 is a good starting point. If you're taking too much Lantus and not very much Novolog, your high Lantus dose is probably compensating for some of your food... likewise if you're not taking enough Lantus, your Novolog requirements for food will be higher. Ideally, you'd like to find the balance between the 2. For example, I take 16 units Lantus per day and ~20 units Novolog for a total dose of ~36 units/day. It's not bang on 50:50, but if I take more Lantus I experience many lows so I know I'm good where I am. And my TDD is a bit lower than what the formula predicts because I am pretty active. You will just have to experiment and see what works for you.