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 pmlantus works for me and even more so when I get up and walk even 3 miles a day. exercise plays such an important part in the life of diabetics so don’t give up there.
some comments I have read today have alarmed me.
One person taking care of a diabetic husband who seems to sleep all day long with very high levels.
severaql other stories have alarmed me .
we all tend to look for that magic bullet to fix this problem and take pills one after the other or use insulin like lemonaid,I know I do.
what has realy helped is the simple basics,proper diet and daily exercise.
get moving! honestly lets not kid ourselves.
even if in wheel chairs move about,hands, arms,
legs.wiggle jiggle anything is better than nothing.
to those alarming situations as mentioned previously please get help right away these are signs that the body is in distress.
Posted by Gene | Nov 15, 2009 at 11:52 amI am a diabetic. I am 13 years old and I am having a very tough time with all of this. My brother and sister for a short time used to critisize me; call me a diabetic brat just for helping out around the house more than they did. That only makes it worse. I am supposedly very talented in music. I can sing very well and I play clarinet and piano. I havnt been noticed yet and it is my DREAM to become a star as famous as Hannah Montana, Selena Gomez, Jonas Brothers… (etc.). But I am afraid I will not be alive long enough for my dream to come true. I used to live in Texas and had an awesome doctor, Dr. D. (I’m not going to reveal his true name.) Unfortunetly, I have recently moved to South Carolina. My doctor here is a little mean and has taken me off of my diabetic pump I was given to by Dr. D. I am now back on syregnes (shots) about four to five times per day. Every time I take a shot, it hurts. Now when I check my bloodsugar, my meter ALWAYS says “HI”. I am not sure exactly how much NOVOLOG to give myself to lower this. I usually only give myself 7 units. But I am very afraid of over/under dosing. Please help me.
Posted by bailey | Dec 09, 2009 at 10:05 pmI am Type 2 DM since last 25 years.Was taking Huminsulin 30/70 36U before BF and 32 U before Dinner.But my HB1Ac was 9.6 last month. S.Urea and S.Creatinine was also high.So my Doc. put me on Basal-Bolus regime.Taking Lantus bed time 34U and Humalog before each Meals.18U,22U,16U.But Blood Sugar is not controlled. Have shifted to Lantus-Huma
Posted by Sujata | Dec 10, 2009 at 10:21 amcombination only last month. All oral Diabetic Medicines stopped. Was taking Glimepride 2mg plus Metformin 1000mg twice a day since last 3-4 years.
But due to Kidney problem these oram medicines can not be given. Only JALRA(Sitagliptine) can be prescribed one daile at lunch.Could any body guide me to 1. Is high dose of Lantus harmfull to body if it regulates blood sugar?
2.What is Lantus dose chart.
Thanks
India 10.12.09 JAIPUR
I am making three posts to address three issues. I am addressing my Type II diabetes. The single most important thing that you can do is test. Test, test, test, test and test. You should be testing more often than you are taking insulin–six times a day or more. Ideally you should test first thing in the morning for a fasting blood sugar then immediately before every meal or snack, one hour after every meal or snack (if using rapid insulin) and once before bedtime.
Testing can be expensive. If your insurance pays for it, wonderful. I do not have insurance. Choosing a meter that takes cheaper test strips is important to me. I use TrueTrack. These are sold as store-brand meters, such as Rite Aid, Walgreens, CVS, etc. or may be sold as a TrueTrack. The best price that I have found on test strips is $37/100. In stores, it’s $50/100. I did an internet search and bought mine through Amazon.com, of all places.
The meter is also cheap and you may find a deal where you get a free meter for buying 50 strips, which is how I got mine–I have two, both bought the same way.
It is most important to test and correct your blood sugar just before bedtime. If you go to bed with a high blood sugar, you will wake up with a high blood sugar. One third of your entire day will be spent with a high blood sugar.
Your metabolism slows down while asleep. Lantus is for background blood sugar only and will not correct an already high blood sugar. Your liver produces a steady stream of sugar and Lantus is for regulating that steady stream.
Posted by Dale | Dec 23, 2009 at 12:29 pmThis is my second post. I will be addressing Lantus. Your baseline insulin may be different but the results are the same.
As mentioned before, Lantus is for baseline blood sugar control as your liver makes available a steady stream of sugar. Dosing is started at 0.2U/kg and adjusted upward of 2 units at a time for an average fasting blood sugars above 140 three days in a row. Again, your blood sugar must be normal at bedtime to determine this. If it’s high at bedtime, it will be high in the morning.
Cost may be a problem for you. Especially if you don’t have insurance to pay for it, like me. Lantus is non-prescription and cheaper in Canada. So is Humalog and Novolog. Google it.
Your final insulin dose may become twice, or even three times your starting dose depending on your resistance to insulin. There really is no maximum dosage if you are adjusting your insulin properly and are not experiencing hypoglycemia.
Most doctors prescribe 10U daily and then adjust from there without giving the patient the education to adjust their own dosage. I don’t know about you but I don’t weigh 50 kg (110 lbs). Most Type II diabetics are overweight (like me). At this rate, you may go years without a proper Lantus dosage, depending on how often you see your doctor.
Using this scale, my initial Lantus dosage should be 21U/day (know you know how much I weigh). Depending on your insulin resistance, you may take twice or even close to three times this much. Lantus is usually taken once per day, has no peak and has a duration of 24 hours. If large dosages are uncomfortable for you, you can divide the dosages into two and inject into two different sites. Even though it is a 24 hour insulin, it is acceptable to take some at night and some first thing in the morning. It is usually recommended to take 60 percent at night and 40 percent in the morning.
Always remember, should you gain or lose weight, your insulin needs will increase or decrease. Also, any change in metabolism will change your insulin demands. Your insulin demands may change when you are sick or start an exercise program. Test, test and test again.
I have tested myself before and after exercise. When I do a brisk walk, after the first 20 minutes, my blood sugar drops one point for every minute of exercise. A one-hour brisk walk will reduce my blood sugar 40 points. If I could exercise enough, I would not need insulin at all. I would also probably be a proper weight and not be a diabetic either.
Loose weight and loose the insulin. I know this. We all know this. But we also all know the problems with loosing weight once you are a diabetic. Insulin makes you gain weight. High blood sugar makes you feel less energetic. Diet pills can kill a diabetic and may have other unwanted side effects.
Posted by Dale | Dec 23, 2009 at 12:56 pmThis is my final post and I will be discussing how to empirically derive a custom sliding scale exclusively for you. I will be discussing using rapid acting insulin such as Humalog and Novolog. This information is for Type II diabetes ONLY. Humalog is a little cheaper and both are non-prescription and much cheaper from Canada.
Many doctors use the same sliding scale for insulin for every patient regardless of their size, metabolism and insulin resistance. Often this scale may never be adjusted or, if it is, only after an office visit. It may take years to get a proper sliding scale. Patients should be given the information to custom derive their own sliding scale empirically. This requires a lot of testing and log keeping. As I have said in my previous posts…test, test, test, test and test. You can never test too much. You can never overdose on testing.
For “normals”, blood sugar should be between 80 to 120. For diabetics, 140 is the maximum that can be considered normal. (I personally prefer to consider 120 my maximum. This is not recommended.) For our initial scale, we will consider one unit of insulin capable of reducing your blood sugar by 40 points.
We are going to calculate our initial scale. Beginning at 140 and using this scale, 140-180 would be one unit. (Later this scale may need to be adjusted to begin with 2 units instead…mine did.) 181-220 is 2 units (or 3 later), 221-260 is 4 units (or 5 later), etc. WRITE THIS DOWN!!! I had thought that I could just calculate it when I needed it. I soon found out that I cannot do this simple calculation when my blood sugar was high.
If you test your blood sugar 60 to 90 minutes after a meal and it is high, take your insulin to correct this based on this scale. If it is still high after 60 to 90 minutes later or before your next meal, you may have to apply a multiplication factor. Do NOT make a scale change based on only one reading. It must be consistently high for two to three days. Increase your multiplication factor by 0.5 at a time only. In other words, first use 1, then 1.5, then 2.0, then 2.5, etc. Don’t worry about half units, you can go to the next unit or drop to the next lowest, it really doesn’t matter.
I personally don’t like to use more than 30 units in one dosage. When the blood sugar gets too high, the scale is no longer linear. For safety reasons, if the scale requires more than 30 units, I take 30 units and then test again in about an hour. I will then take another dose depending on that second reading. If it’s time for the next meal, you can just use your correcting dose along with your carb dose. You may wish to keep a small digital kitchen timer in your diabetic pack to help you keep track of the time intervals.
You may find that your low dosages are not quite enough. You may have to begin the scale at two instead of one and then apply your multiplication factor. I am very insulin resistant even though I am also taking pills to make me more sensitive to insulin. My scale begins at two and my multiplication factor is 3. YOUR results will be different.
Make new scales each time. Print them out and keep them with your diabetic kit. This scale will change as your metabolism changes due to being sick or exercising. Be prepared to make adjustments and keep testing and logging. Test, test, test, test and test.
If you start an exercise program, your insulin demands will change. It will be different on days that you exercise and days that you do not. It may even be different on the time of day. The only way to be sure is through testing and logging. You may find that you need a different multiplication factor or scale for morning verses evening based on your job and activity. You may even have a different scale for weekends and you most certainly will have a different scale on exercise days.
This method requires a lot of testing, a lot of logging and a lot of injections. If you don’t like getting stuck, this is not for you. If your health is most important to you, then this is the way to do it. The single most important thing that you can do to manage your diabetes is to test. The single most treatment for diabetes is lose weight and exercise.
I hope that this helps some of you out there. As always consult your doctor before beginning any program. I have studied extensively before I found this method. I makes since and it works.
Remember in my last post I told you to test 60 to 90 minutes after each meal? Now you will do correcting dosages here.
Posted by Dale | Dec 23, 2009 at 2:23 pmI know that I said that I was making three posts and my last post said that it was my “final” post but I had actually decided to break that post up into two parts. Unfortunately the previous part got lost, so I am replacing it. This one is now my final post.
I wanted to address carb counting and how to empirically derive a custom custom insulin scale just for you, based on how your body reacts to carbs and insulin. This is similar to my “custom sliding scale” post. This is for Type II diabetes ONLY. I will be addressing rapid acting insulin Humalog and Novolog. You may use R only if you have nothing else available. Any slower acting insulin is not appropriate. (You should also be using Lantus for baseline insulin.)
These insulins are also known as “meal-time” insulins because of the way that they are used. The onset is 10 to 15 minutes and peak in about 30 minutes. These insulins are taken immediately before or after a meal. I choose after because I may decide to not finish my meal or go for seconds. (I’ve just started a raw food diet so I am strict right now. I MUST lose weight.)
You MUST be testing often and keeping a good log. If you read my posts then you have seen me say over and over to test, test, test, test and test. This is particularly important when you are developing your scales. You can read my post on testing. As you get good at this, you may reduce your testing since you will know how your body will react. For right now you cannot over test. As always, consult with your doctor.
Except for fiber, all carbs become sugar. Non-diabetics think that diabetics must only watch or avoid sugar. Now let’s talk of carbs.
Carbs, even fiber, are complex forms of sugar. Humans do not contain the enzyme necessary to break down fiber into its simple sugars so fiber is the only carb that does not affect our blood sugar, but it is still a carb and it is still listed in the total carbs reported on labels. All carbs will turn to sugar but the rate of conversion may be different for more complex carbs. Pure sugar will hit our blood stream and peak our blood sugar the fastest since absorption of sugar begins in the mouth even before we swallow. Complex carbohydrates, especially whole grains, will break down more slowly and peak our blood sugar much later. Nonetheless, gram for gram, all carbs are turned into sugar.
This brings us to the subject of label reading. You MUST read labels and MEASURE your food. Don’t think that you know how much a cup is. When you are hungry, what you think looks like about a cup is a lot bigger.
Also watch the label to see what they consider to be a portion size. It may surprise you. One way to make a product to appear to be lower in carbs, calories or fat is to make the portion size small.
Sugar alcohols are a carb but only half is converted to real sugar. (Splenda sounds like a sugar alcohol but it isn’t. Splenda and Nutrasweet have no impact on blood sugar.) Sugar alcohols are often used as artificial sweeteners.
Most doctors today prescribe a particular amount of insulin and then want to you eat specific meals. Adjustments to your insulin, if any, comes only after the long periods between doctor visits when he sees that you are not successful in controlling your insulin. He then wants to blame you. The problem lies in that you are not taught how your body works and how to control your blood sugar. It may take years to finally gain control over your blood sugar, if ever.
This is what I call prescribing the meal instead of the insulin. This only works if we eat the same thing each time in the same amount. I don’t know about you but this is not how I eat. In carb counting with adjust the dosage for the meal we eat, not the other way around.
To arrive at the carb count, subtract the fiber and half the sugar alcohol from the total carb. Divide this number by 10 and we have the initial dosage in units for our meal. For example, if you eat 180 grams of net carbs, you take 18 units of insulin. But this is only where we start. Your actual insulin requirements depend on your weight, metabolism and insulin resistance. Your metabolism may change due to illness or exercise and your insulin resistance may change based on your medication and with time.
You should be testing as described in my previous post. Let’s assume that your test right before a meal is normal. You then eat 180 grams of net carbs and dose 18U. After 60 to 90 minutes you test again and it’s high. You take an adjustment dose and test again before the next meal. If testing before the next meal is high, add your adjustment dose to your carb dose and take together after (or before) that meal. Keep a record.
If you are consistently high then you are more resistant to the insulin and have to increase your dose. Do NOT change your dose based on just one reading nor should you base it on the average readings of just one day. After about 3 days, if you are consistently high, multiply your dose by 1.5. continue this for about 3 more days with repeated testing. If necessary, increase again by multiplying next by 2, then 2.5, etc. If you are accurate in counting your carbs, you should be able to test normal, or very near normal, 60 to 90 minutes after a meal and certainly normal right before the next meal.
If you are really tiny or skinny (say less than 100 pounds)this may be too much insulin for you. Start with a multiplication factor of 0.5. Adjust to 0.75, then 1.0, 1.25, etc. until you arrive at your multiplication factor.
Exercise, being sick and a change in medication can modify your insulin requirements by changing your metabolism or your sensitivity to insulin. If you have an exercise program, you may need to make a separate calculation for exercise days. If you lose weight, your sensitivity to insulin may change. Always test and be prepared to make changes.
Your multiplication factor applies equally to your carb dosage AND your correction dosage (sliding scale). If you are carb counting correctly, you will find that you can even predict about how much a particular quantity of carbs will raise your blood sugar.
If you are eating out, many fast food restaurants have nutritional guides or they are available on the net. You will get better at estimating as you get used to this. If there is no nutritional guide or you are not sure, guess at the number of carbs and take an amount of insulin you know is less than required. Test again after 60 to 90 minutes and take an adjustment dose based on your empirically derived custom sliding scale. For safety reasons only, if my calculation requires a dosage greater than 30 units, I take only 30 units, test after 60 to 90 minutes and then take an adjustment dosage based on that reading. For comfort, you make take larger doses as two separate smaller doses in two different injection sites.
Remember, read labels, watch out for serving size, measure, test, test, test and log your results and meals, and most importantly lose weight and exercise.
My information came from lots of different sources. My posts are for informational purposes only. As always consult with your doctor.
Posted by Dale | Dec 23, 2009 at 5:52 pmDear Bailey.
Your post has motivated me to make a series of posts which I just sent in. You seem to be genuinely concerned about your health, and you should. The pump is by far the best of diabetic control, if it is set up correctly. You are only 13 so you must consider your body size and metabolism. If you are small, your insulin requirements may be less. You may have to begin your multiplication factor at 0.5. Being younger, your metabolism may be higher. Again this would mean a lower multiplication factor. This is all determined by a lot of testing and logging.
You MUST be willing to test a LOT and take shots often. You can do just a sliding scale without carb counting but your blood sugar will be constantly going up and down like a roller coaster unless you are on a long lasting insulin like NPH. Since you said that you have Novolog and are NOT on a pump, I assume that you do NOT have long lasting insulin, but you did not mention it. This is a problem. I hope that you have Lantus or another equivalent for baseline insulin regardless of what else you are on. With the pump, you do not need Lantus.
If you are on NPH, then you are not using the carb counting method. You are using what I referred to as “prescribing the meal.” Novolog can still be used to control blood sugar spikes however when NPH fails. One would test 60 to 90 minutes after a meal and take an adjustment dose. You still have to derive your sliding scale. You still have to test often. My post is NOT for those taking NPH. Your scale will be less if already taking NPH. You basically will be taking Novolog to boost the NPH for sugar spikes.
You still should have been provided some type of sliding scale. If your meter says HI, and you are an average or overweight 13 year old, then 7 units would probably hardly make hardly any impact. Test again 60 minutes after you take your correction dose.
I personally would seek out another doctor. I know that you may not have much of a choice there. Try to get back on the pump. Read my testing post and test and log everything, including meals, adjustment doses and all. Bring this to your doctor to show him that it isn’t working. Print out my posts and ask for his approval before starting this method. Most of all, try to get back on the pump. I wish that I had a pump.
You said that your meter reads HI. This is very bad. Most meters go up to 500. Above 500 will read HI. (Yeah, I know. It should be HIGH, but that’s what they read.) A reading above 500 requires IMMEDIATE medical attention. This means that every time it reads HI, you should go to your doctor or emergency room. You should NOT drive yourself. (You probably don’t drive at 13.)
In reality if my meter said HI and I’m still mentally with it, I would take 30 units and test again in 60 minutes. That is because it is MY body and I know that I am highly insulin resistant. Without testing, no one can know how resistant you are. 30 units probably is far too much for you. (I’m heavy and old.) A high blood sugar is less dangerous (in the short term) than a low blood sugar. A low blood sugar is immediately life threatening.
But I am a Type II diabetic. You did not say if you are Type I or Type II. The method that I described is for Type II diabetics only. Type II diabetics are resistant to insulin. Type I diabetics require much, much less insulin. Type I diabetics must be more strict with their diet. The carb counting and sliding scale is used beginning with a multiplication factor less than one. Their final multiplication factor is more dependent upon their size as they are not generally resistant to insulin. Type I diabetics still should be testing as often as I described. Type I diabetics MUST use insulin with every single bite (of carbs) that they put into their mouth. A Type II may get away with a small amount without having to take a shot. (I can sometimes take up to about 15 grams carbs without affecting my blood sugar, depending on the type of carb.) This means lots of shots. Even with Type II diabetes, using this method means getting stuck A LOT!!! I don’t mind the shots as much but the testing hurts. If you want to have control over your diabetes, then you must be willing to be a pin cushion.
Posted by Dale | Dec 23, 2009 at 7:10 pmMy husband was taking two different kinds of Insulin. Lantus in the evening and Humalog three times a day. He ran out of the Humalog and hadn’t had it filled yet. Since he has not been taking the Humalog his blood #’s have been excellent. They numbers have been in the upper 90’s to low 100’s and he has much more energy and feels alot better. However, the doctor thinks he need to be on both. Should he get back on the humalog?
Posted by Amy | Jan 08, 2010 at 10:48 amThanks!
Hi, I have been alot of trouble with my BG dropping in the middle of the night after taking Lantis and I was wondering if there was a chart somewhere, where I could regulate my Lantis before betime. Also A Humalog chart would be nice too cause i take both of them. I believe my doctor has me on way too much insulin plus I take Metformin 500 mg 3x day. Humalog 8u 2x day before breakfast and lunch and then Lantis 24u before bedtime. And my sugar is all over the place. I get out somewhere and i have to eat candy bars at the store cause it falls below 50 and in the middle of the night i wake up and it will be like 46 and this scares the hell out of me.I have also been having alot of trouble with kidney/bladder infections. And my doc dont do nothing. Please if someone can tell me where i can get a chart for this would be appreciated. I am currently looking for a new Diabetes Doc to take over my other doc. Thank you!
Posted by Bonnie | Feb 11, 2010 at 10:45 pmim sorry i guess i should add that I am 75 yrs old and I am only 134 pds and my weight keeps dropping daily so i dont know if this should adjust how much insulin i take too. If anyone can help I would appreciate it. Thank you again
Posted by Bonnie | Feb 11, 2010 at 10:50 pmHi Bonnie
Are you type 1 or type 2?
Posted by Ron | Mar 09, 2010 at 9:50 pmAlso, when do you take metformin, is it XR, and how much do you eat at the same time as taking it?
If XR it is important that it is taken at night with dinner. It is slow release by the fact that you have food to work on and your metabolism slows at night.
As I see it, your humalog accounts for 10g of carbs at both brekky and lunch. Not a lot. None at dinner means you should have an increase in BSL. What are your readings before bed (3 hours after dinner)?
Are you taking any drugs for sleep?
I’m not a doctor but i have a fair bit of experience. Always see your doctor before making any changes.
Posted by Ron | Mar 09, 2010 at 10:06 pmoh, I found this site that may be helpful too
http://www.diabetesnet.com/diabetes_control_tips/carb_factor.php
Posted by Ron | Mar 09, 2010 at 10:24 pm