Diabetes Self-Management Blog

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.

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Comments
  1. 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 |
  2. When 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 |
  3. I’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 |
  4. Whoops. 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 |
  5. I’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 |
  6. Hi 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.
    You 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

    Posted by Simons |
  7. 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 |
  8. I 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 |
  9. Hi 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 |
  10. Hi 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 |
  11. I’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 |
  12. P.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 |
  13. My 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.
    He 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…

    Posted by Roses |
  14. 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 |
  15. Hi..

    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 |
  16. hey, 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 |
  17. Dear 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,
    Diane Fennell
    Web Editor

    Posted by Diane Fennell |
  18. Jules,
    Not 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!

    Posted by Certified Diabetes Educator |
  19. 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 |
  20. Michelle,

    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 |
  21. Oh, btw, I also had urine tests come back with very high protein, but kidney ultrasound found no problems at all.

    Posted by Rich |
  22. lantus 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 |
  23. I 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 |
  24. I 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
    combination 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

    Posted by Sujata |
  25. 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 |
  26. This 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 |
  27. This 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 |
  28. I 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 |
  29. Dear 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 |
  30. My 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?
    Thanks!

    Posted by Amy |
  31. 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 |
  32. im 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 |
  33. Hi Bonnie

    Are you type 1 or type 2?

    Posted by Ron |
  34. Also, 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 |
  35. oh, I found this site that may be helpful too

    http://www.diabetesnet.com/diabetes_control_tips/carb_factor.php

    Posted by Ron |
  36. sorry guys ive been in running for 28 years im 6ft2 and i also am a type1 Diabetic now on 2 insulins. let me tell you its in the genes more than the weight. the weight triggers it. even running 5 miles 6 days a week and doing AIKIDO my sugar would still run some what high. carbs like bread , pasta, milk, are bad eat sugar free oatmeal its great with yogart. i take 25 units of humolog before each meal and 30 units of lantis at night you have to play with it and learn how to adjust your insulin needs thats what i did. excercise walk great. its very hard to control uncontrolled Diabetis im 45 6ft2 196 pounds you have to exsperiment with insulin but do it in slow doses and give it a week before changing your units. walking is the key or running if you can. god bless.

    Posted by nathaniel |
  37. I have had type 1 for 51 years. I am on the pump which is a wonderful device, However, after 13 years on the pump, I want to experience some freedom from an attached device, I am going to try 15 units of Lantus in the morning and 15 at night. I will supplement with a bolus injection of Novalog with each meal based on my pump setting of 1 unit of Novalog for every 9 grams of carbs. I will let you all know how this goes after 1 week.

    Here goes……

    Posted by Doug Klein |
  38. Hello =) we found out my daughter has type 1 in oct just after her 6th bday. I have been trying to get a grip on her levels because they seem to go all oveer the place. I give anywhere from 4-6 units of lantus at bedtime. She is on a sliding scale and we have to count carbs. There is no pattern with her, way too high or way too low and I am at a loss. Am I missing something (obviously) Right now we are trying to start over in another state and I have been having family send her meds from our old pharmacy. Her A1C was 7.8, which I know is high. We visited the endocrynoligist a couple weeks ago and they didn’t tell us much. I’m just wondering if anyone has any advice on what I can do. I know kids are always growing and are sick but its like we get 1 good day outta the 7 and its nerve racking. I feel like I’m shortening her life cause I can’t get control or just a grip of it.

    Posted by Erin |
  39. Hi Erin,
    I was reading all the comments and they are very helpful and encouraging.

    I just had a 24 hour stomach flu with vomiting, chills and fever and my BG levels are way too high and still not coming down. Still experimenting with higher doses.

    As a mom, I know how you must be feeling, being the responsible person for your daughter’s well being. But please remember you are doing your best. That’s all one can do. Is your daughter learning about her condition as you try and deal with this? Diabetes is the one disease where our BG levels are ultimately up to us.

    Are six year olds too young for the pump?

    Don’t get too discouraged and keep looking. There has to be some doctor who can help your family. How about a diabetes educator? I have gotten some great ideas from mine.

    Good luck, Sharon (Type 1 for 16 years)

    Posted by Sharon |
  40. Bailey - You clearly need greater/better attention from your doctor or get a new doctor - an endocronologist. You are very scared I know - but you are also strong and smart and are willing to do what it takes to be healthy. These are qualities that will get you a long life. BYW did you know that Nick Jonas has dabetes. check this out http://www.mtv.com/news/articles/1592251/20080806/jonas_brothers.jhtml

    Posted by Dani |
  41. HI Erin,
    My daughter was diagnosed in Kindergarten and she’s 9 years old now. First off 7.8, while a bit high isn’t anything to be afraid of. Over time you and she will have ups and downs. Don’t treat each number or A1C as an emergency.I have found that certain foods will trigger highs that last all day and sometimes longer. Cow’s milk, bagels, and pizza were the first three I discovered that would trigger highs that wouldn’t respond to insulin. She now drinks low carb coconut milk and sometimes almond milk and it didn’t take her long to get used to it. Research the paleo diet on Google. Water with fresh lemon squeezed in can lower blood sugar(sometimes dramatically so keep an eye on her).
    The two most important things you can do is to avoid the foods that trigger highs while incorporating fresh veggies(I know it’s hard to get a child to eat veggies).
    And eventually you may need to find a new Dr if your Dr isn’t communicating well with you. The Dr. I have now for my daughter doesn’t say much or give me much support either but I know how to take care of my daughter now and just use her so that I can get the insulin.
    Another helpful resource that may give you inspiration is the Blog called Naturally Type 1.
    Best of luck- hang in there. It’s tough but you will find a kind of balance in time.

    Posted by JanieG |
  42. I am presently on the pump. But as of the end of this week, I will not be using the pump due to Medicare will not pay for the supplies. I will need to return to using needles for my diabetic management. I spoke to my ENDO today and I be using novolog and also Lantus. I have been instructed how I am to count carbs and administer the insulin. But I am concerned that I was instructed to inject 80 units at night???? I verified this twice, it seems to be a large amount????My A1C was 8.1 in september and I average large amounts of insulin and bolus daily. Does 80 units seem a great deal???? I will follow my ENDO advice, but is there anyone reading this that would be using this much Lantus. I thank you appreciate your reply or advice. Thanks Bill

    Posted by bill cornwell |
  43. Hello Everyone

    I was diagnosed with type 2 diabetes in 1993 and I had been on the Avandia drug for some time and suffered heart failure as well as cardiomyopathy. After receiving a AICD implant I was taken off the oral medications and placed on insulin. I seem to be developing a immunity of sorts to the insulin. My lantus intake is 130 units at night and humalog is between 30 and 35 depending on what my meals are like. I have two questions. How much insulin is unreasonable? The drug metformin was added to help keep my sugar levels down without going any higher with the lantus. My second question is this. Is there a forum that has good information about Avandia?

    Posted by Dan Kenison |
  44. Hello all:
    I was diagnosed with T2 diabetes May of 2010. My blood sugars have fluctuated quite a bit. Initially, I was taking Novolog before each meal and 22 units Lantus before bedtime. Since being diagnosed, I have changed my eating lifestyle completely. I have to say I am diligent in eating well and weigh myself daily. I have limited sugar, reduced sodium intake drastically, cut out diet soda and alcohol.I only drink seltzer water and decaf unsweetened tea. I also each less processed foods and eat out less. I keep a food diary of everything I eat and the doctor has kept me to 1200 calories daily. I was testing before/after each meal and at bedtime. I have lost approximately 65 pounds since May and am down to 241 pounds. My highest weight was 347 a year and a half ago. I am still considered obese for being 5′6″ but my blood sugars have improved as I’ve lost the weight. The doctor has taken me off of Novolog altogether and he has reduced my Lantus to 8 units from 22 units. My fasting sugar readings in the a.m. are 100-108. I feel the weight loss and healthy eating have helped control my sugar readings. I walk with a cane so the weight loss is with little exercise. I am now working very hard at walking daily and try to walk 3/4 to 1 mile a day (with the cane). I keep a notebook with my food diary, before/after meal sugar readings, etc. and I have found it to be very helpful and I bring it to the doctor’s office with me so that the doc can see my sugar readings over a period of time and the food I eat. If it’s helpful, I can share. I know everyone is different but I hope these comments are helpful.

    Posted by SharonL |
  45. a month and a half ago i was prescribed lantis
    i was to do 10 plus 2 on the syringe and check gluecose in mornings .then after 3 mornings if
    095/110 is not the reading add 2 which would make the dose 10 plus 4
    /
    and my projected target would be 095/110 meter reading–the next morn it was 157
    — the second morn was 129
    — the third morn was 129
    any way my morning readings keep going up.
    iam now at 24 dosage and reading 184/194
    can i drop my dose back to 12 plus 4 ?

    Posted by ROGER BLACK |
  46. Neat. Comments on lantus.

    I am on a mixed bag - humolog in am - one shot 21 units, metformin around clock; starlix in afternoon (lunch and dinner); lantus in evening varying 6 to 20 units.

    my A1C in november was 6.9. my bs meter averaging out at 166 while A1C test daily number was 155.

    For me, I have to watch at night until dinner starlix exhausted ( 3.5 to 4 hours after ingestion.)

    I then calculate number of units of lantus to drop BS to 120 from current level delta change divided by 3.3. I do not want to trigger liver emergency add by banging number downd in one fell swoop. i may end up with one to two cycles - 1 hour apart to punch bs down so that evening bs is 120 or thereabouts for bedtime.

    i find my digestion system is usually dribbling out glucose around 11:00 pm to midnight.

    my goal is to get to 150 or less in am wakeup.

    as a note I try to eat so that starlix at end of time has sufficient oompf to drag bs sub 140 at lunch afternoon and dinner starlix.

    obviously, iam typw 2. hormone signalling to liver messed up so that if left to itself, dawn effect used to whack am glucose to 238 to 248 every am
    and emergency sugar add (bs sub 70) 278 to 311.

    A1C was 13.3 under that nonsense. And yes, much as
    i have to measure all the time to catch lows, i would prefer to do other things

    Posted by jim snell |
  47. step back kids i take 112 units of lantis split 56 in the morning and 56 at night. i also take Humolog 120 units as well 40 3 times a day before a meal. im 6ft2 210 no im not fat or over weight. I was running about 3-5 miles a day for 27 years never missed a day when i came down with type2 after bad spine surgery in 2009 i had to stop running and played the walk game. in 2010 i came a type 1 Diabetic. i have been a Diabetic for 14 years now. trust me when i say its in the Genes. my Grandmother was shooting Insulin when i was about 7 years old. now all my brothers have it. all 5 and 2 sisters. 3 are on insulin and 4 aint yet anyways. well good luck. remember the bigger you are the more insulin you might need.

    Posted by nate ackley |
  48. the trick people is the carb counting. thats why its good to join weight wachers and buy the low carb food. thats the trick.

    Posted by nate ackley |
  49. Nate:
    You mentioned carb counting is the trick. How strict are you about that? I’ve lost alot of weight counting calories really not eating many carbs. Still have very few but does the carb counting keep you on an even keel? Any info would be greatly appreciated. I was diagnosed Type 2 less than 1 yr ago so your experiences would be helpful.
    Sharon L

    Posted by SharonL |
  50. I’m really confused and concerened now. I logged on to see ifI was taking too much lantus , guess what still confused.
    I take 150u a nite, no thats not a typo I said 150u. I have asked my gp for something like novalog my sugars are 300 or above in the morning and only go down maybe to 240 all day.
    I need some advice plz. Thank you

    Posted by Alisa LoDolce |
  51. Hi I have type 2. I take Januvia 100mg, glimepiride (2×4mg) and Metformin (2×1000mg) each day.

    I started taking lantus 30U per day 3 months ago.
    My A1C just came back 9.2 and 3 months ago it was 8.2!

    Now I’m taking 50U Lantus once each day.

    My question is about the initial reaction to increasing the dosage of Lantus. My first 50U injection had very immediate positive effects. I suddenly had normal levels of energy that I haven’t had in years.
    But the next day 50U had very little effect.

    Is this common when using lantus?
    Or does this mean that I should increase the dosage again until I feel “normal” again?

    My guess would be to keep increasing until my BG
    is below 100.

    Can anyone confirm through their own experience?

    Normally my BG is all over the place. It was 180-200 after meals for a while and then it flared up to 280-320 for 2 weeks. Then it was back to 180-200. Now with the 50U it’s 140-160.
    I really just want to feel energetic. Somewhere around half normal would be great. Is there any hope?

    Posted by HC |
  52. Why isn’t this forum divided between type 1 and type 2 diabetics? It is like comparing apples and oranges, and could cause a serious, even lethal mistake in someone who does not know the difference. Incidentally, it is generally only the very few people who have type 1 who do know the difference.

    Posted by donna s |
  53. Donna S:

    Interesting comment.

    I believe you are on a valid important point. Worst off much of what is being promoted and described reall is watered down treatment approaches from type 1.

    This is not to be unrespectful but my sense after 30 years on wrong treatment watching my body rot out under the type 1 approach - just throw tons of insulin against it and with the excess insulin booted out and liver now under control, we really need separate approaches here. Both diabetes types are deadly and pain in rear but type 2 insulin resistance diabetes not a monolithic single organ pacreatic disease but a multi organ - gut/intestine, liver, kidney, thyroid and multi hormone signalling systems all affected by aging , degredation, diet and needed medicne tuning and extra hearty exercise. Yes, throwing experience of type one at problem was one place to start but inadequate today.

    We are living up to the complaint of Dr. McCoy of the Star Ship Enterprise that 20th century medicine will kill him. (Chekof in Search for Spock)

    The classic question - will cinamon fix my type 2 diabetes? How the heck do I know given the implications of that question honestly asked.

    Posted by jim snell |
  54. I have beeen a diabetic type 1 since I was 16 years old, I am currently 28 years old. I had a major struggle with adjusting my sugars and wanting to inject myself. Over the years I have over-comed the scare and troubles of being a diabetic and have learned to accept it rather going against it. With that being said me taking control of Diabetes and not allowing it to control me :).

    However I take the NPH the orange cap similar to the look of Novolog clear Insluin container. I have found that my sugar was higher with Lantus than NPH.In the morning I take 10 units of Nph and anywhere from 8-10 units of clear insulin before meals and 3 units during snacks even if that snack is 10 chips or 10 skittles I have to or something that little will shoot up my sugars. At bedtime I take 10 units and when I wake up in the morning my sugears are anywhere from 90-110 which is great.

    Remember every Diabetic is different from another Diabetic. What works on one Diabetic may or may not work on another diabetic this is so true just by the look of the threads.

    If you are not sure on how much insulin to take but want to get in control of your blood sugars. I have became my own guinnea pig and skipped what the doctor says and do what I knew made my body feel good cause thats all the doctor is doing with each and every diabetic upping or lowering so dont be afraid to try.

    When my sugars would run High on the meter when I was younger I would practice and do a test trial. If the doctor had me on 15 units before meals but then 1 hour later after eating breakfast, lunch or dinner sugars would go up to 300, 400 or higher I would add 2-3 units to the 15 that my doctor would want me to inject and give mysely 17 units and when that didn’t work I would go to 20 units until I found my zone.

    After maintaing my sugars for so many years I went from a person injecting 50 units of clear insulin every 3-4 hours going down to 5units of insulin a total amount of 20-30 units of insulin in a day compared to when I was a teen and non-chalant about my health I was injecting about 350 units of clear a day and going through a vial in a week so I hope this helps REMEMBER every DIABETIC is DIFFERENT you must do whats best for your body and not try to mimic other DIABETICS REGIMENS that work for them.

    Posted by Monica |
  55. Also I have found that sometimes you can be a better Doctor than the doctor your seeing to control your diabetes on your own.

    I have been to so many Diabetic Doctors that I even had a doctor tell me once that your guess is just as good as mine with managing your Diabetes cause it was so out of control.

    That I began to stop putting my faith into doctors and started to realize some of these doctos are as clueless as you are and just quick to swipe your insurance card and get payed but aren’t doing anything for your health with managing your Diabetes and yet you feel like crap everyday.

    Which is nothing but a(man)or(woman) that have learned about Diabetes from college books and people hands on but have never lived a day in a diabetics life by feeling and knowing what we go through with this disease, because they went to school for it but we live in it, feel it and struggle with it, which is a totally difference for a doctor that has no clue what you are feeling unless they are Diabetic themselves.

    Do what you know what makes your body feel good, if your A1c levels are great and your sugars are stabilize then do your plan your the one living with it and not the doctor you will be amazed how you can manage your own diabetes by stepping out of fear.

    And practice on yourself by doing trials, doodling jotting your sugars down and seeing what happened from last week results compared to this weeks results with moving up 1 or 2 units.

    Remeber having faith with God and praying to ask the Lord to give your mind the wisdom it needs to overcome this battle and lead you into the direction you need to be to feel better will help out alot.

    I have found when I pray to God and open up my heart and faith and ask God to direct me with my journey with Diabetes he has walked with me and led me never forsaken me through all of the battles I have been through.

    With low blood sugar and flopping on the floor like a fish he was there to bring me out of It and save me when my son was an infant and no one there to call 911 in the house and me hearing him screaming form his crib when I could do nothing for him.

    When my sugar was high and I didn’t know I was diabetic and went into a coma at 16 years old he brought me out of it like nothing.

    The infections and poneumonias he has brought me out of it so greatfully and peacefully.

    He has sprang forth 2 beautiful children in total protection as a mother with diabetes to be given the opprtunity to know what it is to be a mother despite the doctors telling me to never have children because of my diabetes, my children are perfectly fine I have a 7 year old son and a 1 year old daughter yeah I’m through for good lol!!

    I am a living testimony with poor manage of diabetes to excellent management with diabetes, that I feel it is with love to share my testimony with all diabetics here on this site to let my fella sister and brother know to don’t give up for the battle is the Lords and he will never leave you knor forsake you and the battle is not over until he says its over.

    For what ever is IMPOSSIBLE for Man to do All THINGS Or POSSIBLE with GOD

    P.S.

    I named my son Immanuel which means in the bible “God IS WITH US” because all through my pregnancy in the first trimester 2 doctors recommended me to have a medical abortion and I resisted and was told he may be born with birth defects and so on from receiving radiation from my thyroid cancer that I went home and ask the Lord what should I do and I heard him speak to me and say child I will never tell you to kill a child a seed that is from I. For do you not know, It is I who have placed this child here in thy womb with that being said I listened and went with what I heard and that night I opened up my bible and said speak to me Lord for my heart is troubled and weary and in fear he told me fear is of the Devil to have faith and there is no fear with I your Lord. Do you know as soon as I opened my bible and asked the Lord to direct my scriptures that I will began to read I started in the book of Mathews and the first chapter said IMMANUEL which means “GOD IS WITH US” I knew that was my sons calling to name him and I trusted the Lord despite what the doctors told me of him possibly being born with retardation and aborting him that he was perfect and I named him Immanuel because God was with us and he is 7 years old today Thank you Lord for how sweet your name is and power that is in your name !!!!!!!!!!

    Posted by Monica |
  56. Thankfully, my Dr. talked me into immediately going on insulin when I was diagnosed with Diabetes 2. She recommended that any dose of Lantus over 50 units be split into 2 doses. We later added fast acting insulin before meals with carbs.

    I currently take 100 units of Lantus a day, 50 in the morning and 50 before bedtime. We are working to cut the Lantus back now that I have a handle on counting carbs.

    Posted by Diane |
  57. Hi people,
    I am type 2 , 63 years old, diagnosed when I was 42 years old. Although, I used to faint as a young boy, nobody ever bothered to find out why. And I used to make myself a sugar sandwich every day on my way back from school !…
    Anyway…. been using drugs like glucophage and glucotrol and metformin right after I was diagnosed. Nothing seemed to work until I got fed up and started exercising and loosing 35 lbs. I did that in two months. Blood sugar went back to normal. I threw away the meds and kept active.
    Later on in my mid fifties, I became sedentary again, and was put on Lantus. Blood sugar was in the 260. Brought it down to 110 using 35 units of lantus. I like Lantus because it has less side effects than the rest of diabetic drugs. I feel that it is more natural than drugs, since your body produces it to start with.
    So…. in my case, I just regulate the amount after taking my fasting blood sugar and keep the dosage when below 100. ( right now it’s about 40 doses per day).
    Bottom line is loosing the extra cheese and exercising daily. As mentioned in several posts above, I think it is the most effective remedy.
    Try to find something you enjoy doing. I ride a bicycle myself, starting on flat roads, and working it harder each day.
    It works, it’s free, and well worth it.
    Good luck to all of you out there.

    Posted by Alain |
  58. Here again: excellent info on why exercise is critical.

    Insulin does burn off glucose; only hearty exercise can.

    Also, inuslin may be needed in cases where body/pancreas age and a boost is needed.

    Excellent feedback.

    Posted by jim snell |
  59. I meant to say insulin does NOT burn off glucose; only hearty exercise does.

    Posted by jim snell |
  60. hi everybody im going be 30 years old and i been diabetic sence i was 16 and lately i been having diabetic highs at night time and lows at morning time i take 60 units of lantus every night at 12am and well it seems my blood glucose level aint working well with it so im planing on going to a diabetic edicationer to fix my levels and all that and i was told i should go with the little pump stick to my stomach but if any of you have the same problem be happy to post on here and i will read it ok and goodluck on your diabetic reasons:)

    Posted by sidney |
  61. That was a really interesting article that you wrote but the whole thing is really confusing to me. I must admit that I have been in deniel and did not want to face the facts about my diabetes. I am a diabetic. I have been a type two diabetic for several years, I am 62 years old and really I thought that I had everything under control until about a year ago and my A1c level started climbing and my doctor became concerned. I had some instances when I felt very tired and experience increased weight loss and excessive urination, I tried to handle it with oral meds but I found that I could not control my blood sugar and finally I was forced to go to insulin. I have been taking Lantus for about a month now and I admit I feel better but I am still in the dark as to what I am doing. My doctor started me on a dose of 10mg at night before bed and for me to continue to take the metformin 500 mg twice a day, but I recently really started to check my blood sugar and became alarmed when I saw that in the morning, fasting I was running around 220, I got so scared that I took another dose of lantus and waited about two hours and noticed that my sugar went down to 195 and then continued to drop. I was working and went about my day and I felt pretty good but I realise that I need to get back to the doctor and get my sugar under control. I appreciaten this blog and a chance to talk about it with people that are on the same journey, wish me luck.

    Posted by michael |
  62. I have been type 2 for about 14 years. and recently got on Lantus from the oral meds. I still take the Oral meds but to get numbers down took 35 U at 10:00pm. I test twice per day, and find that the main fluctuations are tied to my lifestyle. When I eat, What I eat, how much work or exercise I get. have I properly hydrated (enough water). I feel so much better and usually can figure out when my numbers are higher or lower then normal. What a balancing act. My first A1c is about 3 weeks away, I was in the 11’s when I started Lantus, but testing every day rather then once a month keeps my lifestyle and diet much healthier (I think) with no insurance I love the Reli on brand test strips at Wal — Mart at $36 per 100. I still have money to take my wife to a movie once in a while :)

    Posted by Myron |
  63. Have been on 40 U. Lantus at 10:30 pm for a year. Dr.started me on Humalog and I got into diabetes educ. classes–am now counting carbs and using the Humalog per their directions, at meals. I recently reduced my carbs to try and loose weight. I noticed I was then feeling dizzy during the day–a bit shaky..yet was not realy in low blood sugar ranges. I wondered if I was taking too much Lantus..so over the last few days I reduced my Lantus dose to 34 and when I got to 34 Units, those symptoms stopped.

    Anyone have any thoughts?

    Posted by Sandy B. |
  64. im a highly resistant type II taking 100 (yes, 100) units at bedtime. (lantus)

    10-15u humolog when bg is between 150-175

    first time, this am…woke up to a 30 bg…amazed i could function enough to gulp down some oj and bounce back.

    whenever i wake up my “comfort” is in taking an immediate bg to avoid a low crisis.

    a diabetic coma doesn’t seem appealing.

    Posted by bill s. |
  65. When I was first diagnosed I had awesome health care insurance and was admitted to the hospital with Diabetic Ketoacidosis with ketones in excess of 3,500. I started immediately on insulin because the doctors determined that oral meds would not work for me. After 2 years I finally convinced them to change me to oral meds. Since I no longer have insurance, my health care costs are exhorbitant but I can more easily handle a small out-of-pocket than the thousands they want to insure a diabetic!

    Anyway, I was on oral and not feeling very well so I decided to spend the $100 to go to the doctor. I found out that I am Type 1 and I should never have been put on oral meds in the first place because my pancreas does not make any insulin. So I was in DKA again and this time it was so bad I was dehydrated, severely depressed and exhausted.

    So what does all this have to do with Lantus? I was on 100 U BID (morning and night) with 30 units on a sliding scale of Novolog and my A1C was still rising from 9.6-11.6. I was worried that this much insulin is not normal. My doctor assured me it is and this forum has further calmed my nerves because there are a few who actually take this massive dose like I do. 30-40 units of Novolog 3 times a day just made me really nervous. Thanks for being there since those of us without health insurance have no where else to turn.

    Posted by Mary Jane |
  66. I am 38 yr old Latina female. Diabetes runs in my family. I was diagnosed with Type II in March 2007. A month ago my Dr started me on insulin for the first time in my life. I have learned to eat healthier and exercise more, and I test myself regularly and always take my meds Metformin 1000 mg in the morning and 1000 mg at nite. Glipizide-2 PILLS in the am and 2 pills at pm. Atenolol at bedtime. Losartan for my hi blood pressure. My cholesterol med. Also I take St John Wort for depressikn as well as pain med pills with sleep aid at nightime to help me sleep. This is one horrible and very inconvenient disease. Please try to avoid it. Also started taking psyllium for colin health and sun chlorella as well as garlic pills for colon and liver health. Dark chocolate with sip of wine in moderation on rare occassions. Try to avoid eggs. Paint and listen to favorite music for relaxatio. And Meditate to cut down on stress.

    Posted by Maria |
  67. Did you take your BS before you ate, what was it?

    Then decide on insulin - or no insulin

    Posted by beth logan |
  68. I am an eighty-six yr old type 2 diabetic who had been diagnosed in 1995. I was using Metformin & Gluconorm since then. 2 years ago my family physician added Lantus and NovoRapid to my medication without changing the dosage of the Metfromin (2500mg per day) My glucose readings normally run in the 5.5 to 8 but sometimes as high as 13 mmol (Canadian measurement). I have an appointment with a Diabetic dietitian Oct 22 and wonder if I should go over this dosing rate with her. By the way my insulin dosing is 12 units of NovoRapid prior to supper. only, and 16 units of Lantus(penfill cartridge)at bedtime (as originally suggested) I am wondering if we discuss “carb counting” as a means of more acurate controlling glucose levels

    Posted by Peter J. Butler |
  69. I am 45 i was diagnosed with type 2 diabetes about a year ago my first reading was 864 when i checked into the hospital because my vision was blurry my a1c was 11.4. I was taking 3 shot of 8units of Humalog and 2 shots of 20 unit of Lantus 1 in the morning and 1 at bed time plus Metforman and a Cholestarol pil. I really cant deal with sticking myself so i started exercising walking 1 to 3 miles a day. Since doing that my B.S. have only reached over 200 twice and it stay in the range of 100 to 140 no matter what i eat or when i eat it. But i still take my shots sometimes just not as much even when it normal just to protect myself. IF you exercise and drink plenty of water you will see the biggest change in your health. Everyone tips have been helpful. So thanks everybody and Good Luck!!!!!!!!!!

    Posted by Melvin |
  70. Some times I feel weird about my dose’s after reading all these comments on the internet at different sites. I was diag. Type II about 6 years ago. It did not take long to realize I need’ed ALOT.!!! SOooo all these years I’ve been taking 100 units a day. 50 in the morning and 50 at night. My blood sugar still runs about 7.6. Checking A1C every 3 month’s.
    So even I would like to know, “What is a normal dose??”

    Posted by Clay |
  71. I have been adjusting the Latina for my wife IAW her BS reading at bed time. Today her Dr stated for her to take 27 units ever day and i am a little concerned about that because her bed time readings will run 100 - 250

    Posted by jesse |
  72. I have a problem, gettingn contact with my dotor is impossible.
    I currently changed from taking 10mg of glipzide to taking LANTUS insluin, so my DR prescribes 10 units at night and 1000mg of metformin 2 times daily.
    I have been taking 10units for the last 4 days and my Blood sugar has been 250 ish in the am after fasting for 8 hours and goes between 275 to 325 after eating, obviously the lantus amount is not adequate. I am 6′1 and about 375lbs(171k) no clue why the DR said 10units, with the problem im having getting ahold of the DR does any one have any Suggestions till i can get into a new doctor in 10 days

    Thanks

    Posted by Kaj |
  73. oh my i wish i could take only 8 units of lantis i am on 32 units of lantus and still have counts of 352 to 285 every morning why isn’t this working for me. been on it for 3 weeks and watching what i eat. I feel like i have something wrong with me cause the lantus is not working and also taking junevia 50 mg .

    Posted by patty |
  74. Hi. My name is Scott, I’m 45, weigh 170 pounds, am in very good shape, and have been a type 1 for 26 years. I take 17 units of Lantus before bedtime and am on a sliding scale with Novalog.

    I was wondering if 17 units was “normal” for me, so I looked it up at http://www.lantus.com/hcp/dosing-titration/dosing-calculator.aspx

    By the way, their formula for pounds (divide by 2.2) equals about 5 times what it should be! It tells me to take 77 units. Their formula for kg (multiply by .2) is much better: 15 units for me. Fortunately, their calculator also gives a correct answer.

    So my problem is that I can go to bed at 105 count (for example only) and sometimes wake up at over 200 and even over 300 on occasion. My count stays pretty even when I don’t eat, so I think the Lantus dosage is about right. I think it’s going up because what I’m eating at dinner and after dinner sometimes hasn’t been fully digested. I would appreciate any thoughts.

    Posted by Scott |
  75. Hello,
    I’m 240lbs. Type 2 and my A1C 7.1 I take 45iu Lantus twice per day along with 3 850 Metformin, 3 Acarbose and 3 Glybride. When using Lantus, you must use a starting dose for a minimum of 5 days. More so if you are “stacking” twice per day. Then increase as needed. Do not use i.e 35iu in the morning and 25iu at night. Use equal amounts for 5 days, then as you go up, use the higher amount twice per day for 5 days. My A1C was 15+ when I first learned that I was diabetic. I was thirsty all day for 12 years so god knows how long I had it. Lots of damage done because of this. All is well now. I take my meds, shoot myself twice per day and things are getting much better. Humilin 70/30 did nothing for me. I took 130 iu 3 times per day and still had BS of 300+. I’m so glad that I found Lantus. For me it peaks in about 4 hours then quickly tails off. After 8 hours, there’s no benefit. THIS IS NOT TRUE WITH EVERYONE. ALWAYS check with your Dr before making changes.
    Thanks for reading my story..

    Stewart

    Posted by Stewart Embrey |
  76. Hi I am using lantus solo star. My doctor started me at 4 units once a day and told me to go up 2 units a day until sugar was between 85/ 120 well I,m up to 70 units now and my sugar is still around 175 fasting. My question is how much is to much insulin . And can the higher dose cause problem with other things like my eyesight .

    Posted by Cathy Barton |
  77. Wow. I’ve been sitting here reading all the storys and I’m scared for some of you. I’ve had type 2 for 18 yrs.i controlled it with diet and exercise. I lost 50 lbs while trying to stay alive. My SL started to get out of control this year, no matter what I did I couldn’t get under 200 for a fasting. When I say tried everything I did. I ate plain vegys plain chicken, and water three times a day! Then I went to my doctor, she proscribed 1-2.5 mg Glyburide , well it got my day time SL down to 200 but my fasting was the same. Now I’m on 8 units of lantus and still taking the Glyburide. My sugar levels have been fantastic!! It stays between 90 & 140. I eat no sugary treats or sugar at all. I don’t manage my diabetes I manipulate it. Eat what is good for you, dont eat the sugar and junk and expect the insulin to fix everything. Please love yourselves. Eat vegys, meats drink water and enjoy life.eventually you will be able to add berries, and a variation of healthy foods. Good luck:)

    Posted by lorianna |
  78. Recently diaged with type 2 (february)
    initial meds
    a1c was at 16 and BG around 300
    Lantus 10 units (morning/night)
    humalog 3 units before meals
    januvia 100mg morning
    metformin 500mg (breakfast/dinner)

    after 3 months

    aic 5.4
    bg avg 135

    lantus 20 units night
    humalog sliding scale (if under 151 none)
    metformin 500 (breakfast/dinner)
    januvia 100 morning

    lastest ( september)
    aic 5.1
    bg 122

    lantus 20 night
    humalog (rarely take)
    metformin 500 night
    dropped Januvia

    Last 3 weeks my Bg has had several spikes in the 180+ range and my BG avg is 145. I dont want to start the januvia again (just nasty potential side effects and warnings). have had to take 3-5 units humalog on several occasions.

    Considering lantus 10 units breakfast/dinner
    and getting more aggressive on carb intake.

    Posted by Terry M |
  79. Hi just found this blog and I’m rather pleased to see diabetics posting some of their concerns and some of their successes. I’m also glad to see Canucks on here as well I myself am one and our scale differs from the US one and it makes things a little hard to crunch the numbers but that’s ok. I’ve been a type 1 since 1976 and have recently changed to lantus and humalog from humalin.I had to make the change and I’m pleased that I did because humalin was never a good fit for me. I was taking one dose daily of lantus but found I couldn’t run a good baseline with it so just changed to lantus twice daily and humalog to cover carbs at meals. I will say that I find summer drains my sugar levels the same as someone else posted. I do have a question after all this. Being pre menopausal has proven to be arealchallenge for me. The added hormone swing makes my stars low trending for half the month and high trending for the other half of the month. Being a woman sucks. Does anyone have any tips for management in this silly period? It seems this pie menopause stuff is longer and as hard as puberty was for me. I’d appreciate any advice.
    PS I feel horrible for many Americans here who don’t benefit from health coverage like we have in Canada. I really wish it was drudge and I’m not being political just concerned for others health.

    Posted by Debbie |

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