Changing Lantus Dose?

[J1998L]

Hi,

I'd been doing pretty much perfectly with managing my big levels until around the start of this week. Since then, my evening and before bed reading have gradually got much higher (sometimes touching 15 before bed) and my day time readings have increased by around 2. At first I thought this was because my mealtime was too low so I increases the ratio and started testing two hours after my evening meal just to monitor it more closely. One night, my bloods two hours after my meal had risen by about three "points" (or whatever you call them) to 9.7. Then however, after another two or so hours (before bed an after eating nothing since dinner) my bloods where something around 14.5.

I'm starting to now think that it could be my Lantus dose that is too low as I take this at 10pm so it could be that it is wearing off too soon? I'm fairly newly diagnosed (December) and am currently on 6 units of Lantus each night but am considering raising this to 8 units tonight to see what changes occur. Would it be okay to do this without consulting my nurse or should I wait a few more days?

Any help would be much appreciated. I don't know how well I explained my problem so good luck!

 

[himtoo]

hi there
a good explanation

you could look at this http://www.salforddiabetescare.co.uk/index2.php?nav_id=1007
this is basal testing and is something we all should do when we see changes in patterns.

as you are so newly diagnosed it could be that your body is possibly starting to stop producing any insulin at all.
( called the honeymoon period. this varies from person to person )

it is definitely worth you speaking to your diabetic nurse as well - reviewing your results with her , she might see other things( patterns) in a larger amount of results than reviewed here in your post.

all the best !!

edit -- agree with posts below this and change my sentence above to read --

it is definitely worth speaking to your diabetic nurse first

 

[Mep]

I use lantus as my basal too and find the dosage wears off about after 18 hours... it's definitely not 24 hours. I hope you can get the dosage right.

 

[BooJewels]

I use lantus as my basal too and find the dosage wears off about after 18 hours...

I'm a T2 on insulin and only started on Lantus a few days ago, but it's clearly not lasting 24 hours with me either - seems to be about 18 hours for me too. I get a definite rise between my post-lunch reading and my pre-evening meal - which is currently my highest of the day. Ironically, I've changed to Lantus because my previous twice daily 12 hour basal was lasting about 16 hours and overlapping.

I know that T1s often split their Lantus dose because of this, so that might be an option to discuss with your DN too - for example 2 x 3 units might cover you more evenly than 8 at night. As I understand it, your morning reading is perhaps the best indicator of whether the actual dose is correct or not (as a quick and dirty assessment before you do basal testing as @himtoo suggested), as you don't want to increase it and have overnight hypos instead. What is your FBG, is that in your intended range?

Hopefully some T1s can give you more insight, but my immediate reaction was the same as @Mep, in that it's just not lasting the 24 hours, so increasing dose without supervision might not be the best solution - your DN is the best one to guide you.

 

[Mep]

ps... I really need to revisit my basal dosage as it isn't right. I can't do the basal testing though because I've been continuously sick with various things. It's one big pain in the butt. I had the basal right too and then it's just been crazy since I've been dealing with infections and migraines. I told my doc on Friday that it still isn't right and is very frustrating. So I'm using more bolus instead to try and counteract but not even sure that is working going by my crazy BGL numbers lately. I would love to split my lantus dose but my endo insists I'm not to do that. This disease is so frustrating when things aren't going smoothly. I'm thinking maybe my insulin resistance increases or something when I'm sick? Idk really. These are all the things you get to figure out as you go. I agree with BooJewels to speak with your med team about splitting the dose.

 

[diabetesedulk]

Hi J1998L , I had similar doubts about basal rate so many year after my diagnosis. It's very important to identify the Basal requirement at the very beginning. #himtoo's guidance is really good to identify the correct Basal. In my opinion you always don't have to wait for your next medical appointment to do small experiments as to improve ur results. start by small doses as you suggest.type 1 is very individual oriented condition.One suits for another patient might not work for you as anyone suggests(couldn't it be me or ur doc) I think you're pretty correct by saying ur Basal is starting to wear off close to 10pm and what happens is that it takes another 2 hours to take effect when you inject ur daily next at 10pm , during that time your BG rises.My suggestion is to have Bolus dose to cover that period or to split yr Basal in to 2 (As Dr.R.Bernstein advices- there are reasons for that!!) so one dose will over lapse the other so you won't have unavailability of basal insulin in the blood stream at no point.cheers!! - And do note that you can estimate yr Basal requirement according to ur weight and muscle mass also give it a read, but those again are very individualised(activity level, insulin sensitivity etc)

 

[diabetesedulk]

hi there
a good explanation

you could look at this http://www.salforddiabetescare.co.uk/index2.php?nav_id=1007
this is basal testing and is something we all should do when we see changes in patterns.

as you are so newly diagnosed it could be that your body is possibly starting to stop producing any insulin at all.
( called the honeymoon period. this varies from person to person )

it is definitely worth you speaking to your diabetic nurse as well - reviewing your results with her , she might see other things( patterns) in a larger amount of results than reviewed here in your post.

all the best !!

edit -- agree with posts below this and change my sentence above to read --

it is definitely worth speaking to your diabetic nurse first

Thumbs up for the link with thanks.was looking for such article for so long

 

[BooJewels]

This disease is so frustrating when things aren't going smoothly.

I hear you. I was ticking along nicely with a mixed insulin with pretty perfect numbers, then I had an HbA1c that was lower than expected, suggesting that I was spending quite a bit of time lower than my daytime numbers suggested - probably with unknown overnight hypos. Considering how badly I was sleeping at the time, it would suggest that was the case. So we started to tweak things and I've not been right since. I'm at least reasonably stable at the moment, just too high, so we're titrating my doses very slowly to try and get the whole series of numbers lower, without the hypos I was having on the last regime.