Well, I never thought I’d say this, but it’s a great week to be a person with Type 1 diabetes. With all of the bad news surrounding the Type 2 drug Avandia (rosiglitazone), it’s a relief to know I don’t have to worry about it. I recommended you read my colleague Tara’s blog entry (“Type 2 Drug Avandia Linked to Increased Risk of Heart Attacks”) for the full story.
That’s one of the first times in my life I’ve referred to someone as a colleague. What can I say? It’s just not a word in my describe-a-friend/coworker vocabulary.
While all of the controversy surrounds Avandia, I’m way over in Type 1 land contemplating whether or not to lower my daily dose of Lantus (insulin glargine). I’ve just started a brand new bottle of Lantus and I’ve been taking my normal 15 units in the morning and then eating a rather normal breakfast and lunch, but I’m still going low in the midmorning and early afternoon. This happened Monday after eating Brussels sprouts and whole-wheat pasta for lunch and only taking one unit of rapid-acting NovoLog (insulin aspart) to help out the Lantus.
I’ve known for a while that my body is sensitive to insulin, but lately it’s been a little more sensitive than usual. I took 13 units of Lantus yesterday and my blood glucose was 86 mg/dl before lunch.
I often wonder how much of an adjustment two units of Lantus is. While I’m very much locked in on an insulin-to-carbohydrate ratio with my NovoLog, it’s a bit tricky to judge how much the longer-lasting insulins affect your blood glucose. Is there a chart for your Lantus dose? I seem to remember something from when I was diagnosed. I wonder what Google will tell me to do.
I realize that Lantus doesn’t have a true peak the way some of the other insulins do, but sometimes it sure feels like it’s working.
Last night I had dinner with some friends at a great Italian place in Greenwich Village called Maremma. I took one unit of NovoLog for the few bites of bread and the polenta served with my entrée. Over the span of the meal I had a salad, two braised short ribs, a bite of sausage, a small side of polenta, and two glasses of red wine. I took my insulin right at the table and I think everyone was right in the middle of conversation and never noticed my sly little stabbing before dinner. I often feel pretty slick when this happens, though it is very unlikely anyone would ever say something if they did witness me shooting up. The other side of the coin is those who worry too much. I wonder if anyone who knows I have diabetes ever thinks “I haven’t seen him take his insulin, and those potatoes are really high-carb!”
Back to the story—when I got home an hour after dinner, my blood glucose was 81 mg/dl. I had a few bites of granola with a small glass of milk before going to bed. I often find it a little frustrating when I go low at night because the last thing I feel like doing after eating a big meal is eating more right before I go to sleep. Not that 81 is a really dangerous blood glucose level, but I prefer a small snack before bed if I’m in the 80’s. While it’s great to be in tight control of your blood glucose, sometimes a piece of fruit or a small glass of orange juice is not really what I’m looking for to put me to sleep. Especially if I’ve already brushed my teeth.
All right, I think I’ll search YouTube for Lantus and see what comes up.
I also take lantus once a day but I take it at about 10:30 PM before I go to bed. IF my BG is less than 100 I only take 8 units, if greater than 100 I take 9 units. However I notice that it seems to cause a dip in my BG about 7 hours later. My A1c run about 6.3%. I do take humalog before each meal and I do test at the same time. In your article you mentioned a very large meal with 2 glasses of wine, the sugar in wine will push your bg up but the alcohol will tend to lower, wine is trickey for diabetics and not a good choice. Hope this info helps
Posted by bernie Spector | May 30, 2007 at 2:56 pmWhen I was on Lantus I was all over the place and I stopped taking it after a couple weeks of numbers from 3 to 23 and back in one day, I am in Canada and use the other units of measure. However, when I was trying to regulate my BG my nurse was playing more with my Rapid/Bolus (NovoRapid in Canada, I think it the same as your Novolog)than the Lantus. Later when I went back to NPH she continued that way, my basal rates rarely changed.
Although you seem to take very little Rapid insulin compared to me- I have a units/grams of carb ratio and I would take 7 units per meal on average- you may not have the room to play with your Boluses like I do.
I was assimilated last fall and use a pump now and I have reduced my daily insulin intake by almost 60%!! I still adjust my boluses more than my basal rates. I have a different ratio fo evey meal. I don’t bottom out nearly as much as before.
Good luck with your adjustments
Posted by Joelle | Jun 01, 2007 at 11:42 amI’m Type 2, but thankfully I never took oral meds. My Dr and I elected to start me on insulin right away instead. Now I believe that is best, instead of using insulin as last resort.
I take 40 units of Lantus every morning. I bolus ONLY if I hit 150+. My pancreas does still work and usually all I need is the Lantus, so my pancreas doesn’t OVERwork.
Studies that I’ve read show that Europeans treat this way, with insulin from the beginning, and they tend to have fewer complications later than Americans, who start with oral meds alone.
I think our Drs need to rethink this strategy. How many people have had heart attacks due to the mindset that insulin is a last resort medication?
Posted by Ephrenia | Jun 02, 2007 at 10:35 amWhoops. I forgot where I was originally headed with my first post. :-)
Andy, I’ve been taking Lantus for about 2 years now. One thing I’ve noticed is that I have to reduce my dose in the summer months. Does the heat make me more sensitive? Do I eat less? Do I drink more water? (Yes to that one for sure) I don’t know the reason, maybe some of all three? But whatever does it, I have to wtch for the changeover and reduce the dosage, then in the cooler months it has to go back up.
Posted by Ephrenia | Jun 02, 2007 at 10:52 amI’ve taken Lantus for at least 6 years. I was told to take all the Lantus at dinner. My problem was that I would “bottom out” at night but be high mid morning. The solution was to take 10 units at dinner and 3 units at breakfast. That has worked much better for me. I didn’t come up with the solution on my own but was told to do that by a nurse who is also a diabetes educator and my endocrinologist agreed that was the best method.
I still take novolog at mealtimes and I do carb count.
Betsy
Posted by Betsy Hardin | Jun 05, 2007 at 2:56 pmHi Andy- I am another person in Type 1 land. I take Novolog on a sliding scale and take Lantus at 9:00 p.m. the opposite of you.
Posted by Simons | Jun 09, 2007 at 5:50 pmYou made the commet that you are very insulin sensitive- so am I. Often times a half a unit change is all that I need.
But my bs’ can just go wild sometimes and I never willunderstand what makes that.
Oh, I have been type 1, insulin dependent for 64 years.
I am new to blogging.
Simons
Hi ther! I am new to the blogging thing too AND I am new to Lantus. Unfortunately I do not have insurance and even les $$ so I depend on what I can (I know this sounds terrible) ’scrounge’ up! I get a lot of my stuff from my Diabetes educator (what a God send!) and then in the building I live in there is a gentleman with type II who always has an abundance of insulin. Ok, back to my initial thought, since I am new to the lantus (formerly an NPH gal) so I am unsure on amount. I have been taking 15-17 in the am and my quick acting (Novolog now) on a sliding scale and so far it has been working ok. I haven’t had the best Ha1C #’s and I am working to get those down but I feel I am on the right path. I have been Type I since age 16 (will be 39 in a couple of weeks) and I have always kinda been all over the chart. Since I have been seeing my educator (under the table) things have been turning around and it is the first time I have really counted insulin:carb. Thanks 4 being here! Steffi
Posted by SteffiOr68 | Jul 17, 2007 at 6:24 amI am just a newly diagnosed diabetic, type 1, and am taking 7 units of lantus in the evening and take about 4-6 units of humolog before each meal. Since I was having a problem bottoming out around 10pm unless I ate a large supper, I will take the recommendation of some of the blogs I read about splitting my lantus dose between supper and breakfast. My bs run low unless I get too much carbs of the wrong kind.
Galen
Posted by Galen | Jul 04, 2008 at 12:19 pmHi I too am taking Lantus and Humalog. I do not have insurance and it is VERY hard to get control on my diabetes and I also seem to have BP problems with it spiking pretty high I am fairly young (i think anyway) I will be 31 in Nov. And know that I have to get a handle on my health. Can someone please tell me how to do the insulin/carb ratio. And give any advice that may help me get control. I avg really HIGH BG readings.
Thanks, Angie
Posted by angiep010 | Aug 06, 2008 at 8:51 amHi Angie,
Dietitian and diabetes educator Amy Campbell actually just responded to another reader’s questions about insulin-to-carbohydrate ratios in the comments thread at “Carb Counting.” You may want to go check it out for some guidance on how to use these ratios. Hope it helps!
Posted by Tara Dairman, Web Editor | Aug 06, 2008 at 9:33 amI’ve been in Diabetes “hell” since 2006, and found a happy medium about two years ago. then my health care ran out and I have been without my insulin for over a year now. I am on disability and will be getting my medicare starting next month, so I am going to be on an insulin roller coaster starting next month. I have not been to the dr. since March ‘08 when my funds ran out and don’t have a clue where to start on the search for what will work for me now. I was on a huge dosage of Lantus at bedtime and also Novolog before meals. By huge, I mean like 240 units. I was also doing about 30 units of Novolog pre-meals. I don’t know what will work for me now after so long. I always thought that was too much Lantus but the doctor and pharmacist said to take whatever worked for me and those were the levels I got results with. Should I seek a second opinion on the meds? They are the only two insulins that ever seemed to work for me, except before I was diagnosed and was thought to be gestational diabetic when I got pregnant in 2002. I was on different insulins then and got good results but after my pregnancy I took a turn and refused to acknowledge my condition. Lantus and Novolog were prescribed in 2007 and worked after trying orals and some other injectible meds with poor results. What do you suggest, anyone? I am looking for any and all opinions from others who have experience with these insulins. Thanks!
Posted by Candice | May 17, 2009 at 10:26 pmP.S. MY A1C levels were fantastic while on these dosages… never above a 4.6 in a year. Think these dosages were good or bad in the long term? I am afraid they were causing other underlying problems like my super advanced proliferative retinopathy in both eyes. Any ideas? Have felt better after being off of these meds for a year than I felt while on them and lost all of the weight they caused me to gain, as well. My eyes are fine after three eye surgeries and no more retinopathy issues since the last surgury in 2008… before my medical coverage ran out and I stopped all the meds. ANY IDEAS?
Posted by Candice | May 17, 2009 at 10:32 pmMy husband has been a diabetic since 1965. He is 85yrs old. Originally he was taking NPH, but in 2005 doctor put him on Lantus. He had an episode in 1992 (diabetic coma)where he bottomed out about 5am to below 40. He did make it, consequently he has had a fear of this happening for years. The doctor had him take the Lantus in the a.m. because he understood about the fear. Since then he has become a kidney transplant (has it for 12yrs), has HBP, High cholest. Takes 14 kinds of pills that add up to 20 a day. He now has bad dementia with terrible short term memory loss and night sleep anxieties. He is on the exelon patch and shortly will be on Namenda for combination theory. He has been hospitalized twice within 2 mos.as he his body is having fluid retention in lungs and legs. He weighs 156lbs..6ft tall…While in the hospital they took him off Lantus, which gave him very high BS. Could not get staff to understand he only reacts to the Lantus. Originally he took 13-17 units, but slowly have increased to 17-25 as his BS fluctuates, either low all day, or high all day. Watch all his foods carefully…Yesterday a.m was 91-85-102-136 (snack) low day…next day 80-72-145-128-212..30 day avg on meter reads 137…Have lowered his dosage to 22 units. Wonder if I should go back to 13-17…He has a very good appetite and eats well. Portion controlled. When he was in rehab for a week, all foods were carb controlled and his sugars were off the wall with Novolog. One days his readings were 139-279-297-324….Needless to say I pulled him out of rehab because they had no understanding of transplant meds. It has been an unbelievable turn of events in our lives. I guess I have not come to any point with you and maybe just needed to type out some of my feelings.
Posted by Roses | Jun 20, 2009 at 11:48 amHe has not heart problems..echo card..heart spec. has a very strong heart as they thought it was a heart problem when retention began. We have home care now and I try to get him to exercise other days, but very difficult as he could sleep all day if I allowed it. Thanks for listening…because there is so much more I could go on forever on this posting..with errors made in hospital and rehab center…
I would say that if 13 units had you running at 86 then you should more than likely stick to that and if you realize that you are running higher after meals then take like 1.5 with meals. the reason that the lantus seems as if it has peaks is because at different time of the day there is more or less glucose being broken down. for instance during the day my basal rates are a 1 unit/hr and at about 2 in the morning they are .6 units/hr. so it is natural that you will feel “peaks” because you cannot fine tune the lantus like you can a pump, and even on pumps it varies from day to day. but good luck with everything and i would say that if the 13 units seems to be working stick with that and then in a month if you determine that you are getting high throughout the day then go back to 15. good luck!
Posted by smileyR | Jun 25, 2009 at 2:08 pmHi..
I have to say that i am NOT a diabetic, but am researching the effects of an “over prescription” of Lantus. I find it both fascinating and somewhat alarming that people can regulate their doses of Lantus, seemingly without professional backing ..and purely by “feeling” effects of their own body and metabolism. How safe is this? and have any of you informed your G.P’s re:your actions?
Someone very dear and close to me has recently found out that she has been over prescribed her Lantus dosage “in relation to her height/ body weight etc”
Theorhetically ( spelling?) overdosing on any drug will have side effects and create symptoms of a seperate ailment, surely…. if then that “ailment” is also “treated” then surely the individual will not only feel anxious about having develop another ailment but will also become “dependant” on the new drug??
Correcting the dosage of Lantus should then negate or remove the “new ailment” but at what point will the new drug be withdrawn ? … immediately the over prescribed Lantus has been regulated..? or will the individual need to be weaned off the newer drug ?
I was wondering … did anyone actually find a chart which depicts dosage to body mass ratio ?
I am wanting to learn.. I need to feel as though I can actually help and understand and be able to acknowledge and monitor behavioural patterns… moods, tiredness, crankies .. y know…because i care and would like to understand.
Any help or pointers would be welcome..
Good health to you all and God bless
Jules ~ x ~
Posted by jules | Jul 02, 2009 at 2:38 pmhey, i am recently diagnosed and brand new to this site…i was diagnosed in dec 08…i currently take 10-12 un of Lantus at night and Humalog before meals…i try to eat low carb stuff during the day and let the Lantus cover those meals and take the Humalog before a dinner meal, when i tend to eat a few more carbs…whats been happening with me, and its really frustrating, is that ill go to bed with a sugar in the 120’s or 130’s and then ill wake up around 230 or 3am and test and, more often than not, its around 200…any ideas? ive read about dawn phenom but is there a treatment?
Posted by tim | Jul 07, 2009 at 11:17 pmDear Tim:
Thank you for your comment. Your best bet would be to speak with your health-care team about the high blood glucose levels you have been experiencing during the night. They can help you determine if the dawn phenomenon is indeed causing the issue and can recommend further testing and changes in your meal, exercise, or insulin regimen to alleviate the problem. To learn more about the dawn phenomenon, see “Dawn Phenomenon.”
Sincerely,
Posted by Diane Fennell | Jul 09, 2009 at 1:25 pmDiane Fennell
Web Editor
Jules,
Posted by Certified Diabetes Educator | Sep 23, 2009 at 3:16 pmNot sure where to start but I would like to address your worries about overdosing Lantus and about a chart that you can use to dose it. First I will give you the guidelines that ADA (American Diabetes Association) recommends from the Diabetes Education Desk Reference.
For someone that has Type 1 diabetes or are within 20% of ideal body weight their insulin requirements are usually 0.5-1.0 units per kilogram of body weight per day. You would then divide that by 2 and use half for short acting insulin and half for long actin (Lantus).
For someone that has Type 2 diabetes usually has higher insulin needs because of the insulin resistance (0.7 to 2.5 units per kg per day). Again divide that by 2 to get the amount of Lantus.
Now that is just a starting point. It is based on weight not height. At our office we use “Rule of 1800″. We usually start at the lower amount and increase as needed based on the blood sugars. If you overdose the “ailment” would be hypoglycemia and the way to fix that is decrease the amount of insulin. You wouldn’t prescribe something else to fix the “ailment” which really isn’t an ailment.
Your friend should be seeing an endocrinologist who should be following their blood sugar trends and adjusting the insulin based on the blood sugars.
There really isn’t a cap on the amount of insulin you can take if it is controlling your blood sugars(and not causing hypoglycemia), although there are other medications you can take to decrease the insulin resistance(one would be Metformin but that would be for someone with Type 2) or the amount of insulin (look up Symlin).
Hope this helps!
Hello there…I’m only 35 years old and just recently been diagnosed with diabities. I currently am taking 70 units of Lantus at bedtime and before meals I take Novalog (based on what my blood sugar is on a chart written by my doctor). I wake up in the morning and even before my morning cup of coffee with sugar in it my blood sugar is still up as high as 352, and this scares the hell out of me and it really makes me wonder if the Lantus is working at all?? My doctor wrote a chart for the Lantus and I seemed to have misplaced it. Does anyone know what chart I’m talking about and where I could find it on the web? Also, is there anyone else out there with this problem? I really wonder if it’s working at all and I’m afraid not to take it with my sugar being as high as it is to test out whether or not it is working. Also, when I take the novalog and check my sugar at the next meal time it seems to be really close to what it was in the morning before I eat. Unless, the Novalog lowers it for such a short time that it goes back up to where it was before I ate. Hmmm it’s a mystery to me. I told my doctor my sugar was high and also had Diabetic Ketoacidosis not too long ago. I had a urine screen come back positive and I haven’t drank alcohol in over 3 years. Pretty scary, also I haven’t been able to keep my eye’s open, can’t catch my breath it seems and NEVER could have enough to drink actually been so dehydrated that my skin is ashy and dry as hell…So, watch out!! It could happen to anyone who is diabetic. Well a hint to find the Lantus chart would be great. Also please let me know if you think the Lantus isn’t the medication for you. I want to know if I’m crazy LOL…Take care fellow diabetics, Michelle
Posted by Michelle | Oct 02, 2009 at 1:29 pmMichelle,
My diabetes has been out of control for some time now, despite working on it. I am about 240lbs and 6 ft tall, so ‘obese’, and my doc really hammers me about losing weight, but I’m pretty resistant to exercise and my modifications to diet have been pretty weak too. However, my diet also seems to have relatively little effect from what I can tell, based on experiments with meals, testing sugars with that, etc.
My doc put me on Lantus a little over a month ago. He started me on a few units once a day, but I am now up to 32 units twice a day. I see fluctuations in my fasting tests between 190-235 and don’t feel like Lantus has made any difference in those numbers. It sounds like he’s going to keep bumping me up by about 8 units every few days until I get to where he wants me to be. The only other diabetic med I take is Metformin.
Is Lantus working? Not that I can tell so far. I expressed my concerns to him, and he essentially reinforced that I need to lose weight, and that we’d keep working until we find the right dosage. I feel like I could be taking 100 units a day and see no change at this point, but I’m trusting my doctor and going with the program.
Posted by Rich | Oct 07, 2009 at 6:49 pmOh, btw, I also had urine tests come back with very high protein, but kidney ultrasound found no problems at all.
Posted by Rich | Oct 07, 2009 at 6:50 pm