Fixed doeses and Lantus dose

NadineV said:

Hi All, I know I should ask the doctor but we will talk to him in 6 weeks and would like to be ready then to discuss this with him....
My son was diagnosed only on Saturday; discharged from hospital today. When diagnosed his BG was over 30.
HBA1C was 11% (or 97 mmol/mol (normal between 20-42).
He is now on fixed doses 9 units of insulin before meals and 32 units of Lantus before night.
He is 15 years old, 66kg.
From reading this forum I believe that his Lantus dose is too high is not it?
Do you think it is because he is newly diagnosed or because he is the teenager and still growing?
I hope this can be lowered in the future, however I have concerns why is Lantus so high?
I would rather have his body to 'try to work' rather then being on high doses from the beginning?
What are your experiences and thoughts on this please?
For how long would we have to be on fixed doses? is it until honey moon period will be over?

Another question is - how we can be sure that he has T1 and not T2? We have insulin resistance in our family/at least 5 people
but not T1 at all. They did not check his insulin at A&E and gave him inslune straight away. How can we check that he has T1 and not insulin resistance?
Thank you very much in advance for every opinion!

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Hi @NadineV

It is difficult to answer questions about insulin doses. Firstly, the standard advice that we are all different applies - what works for one person may not work for another. Secondly, it's really against forum rules to be too specific about medication.

It is fairly normal to start on fixed doses, I think mainly because it's a relatively easy regime to get started with. The honeymoon period would also complicate the issue because if he raised his dose for a meal and then his pancreas produced some of his own insulin he'd have a problem. Once you have some confidence that you know what the insulin is doing to your body and everything is stable then is the time to start thinking about variable doses.

I would think it highly unusual for a minor to have T2 - it is generally associated with an older age group. There are tests that can be done to check but they are not always fool proof - especially the GAD test.

I won't go into all the details but have a look at this at your leisure........
https://www.diabetes.co.uk/Diabetes-screening-test.html

His age group and build would have been used as indicators of his diabetes type and he 'probably' got insulin straight away to get his glucose levels down as quickly as possible.

15 and thin he is type 1. he needs the high dose to bring his bg down to between about 5-7 . the few hundred type 2 kids are fat. cant really pretend its not true. him needing hospitalization is another tell tale. what where his ketones.

type 2kids are a product of our fast food/junk food lifestyles. they did not happen until recently.

1 was on 38 units of lantus and 36 of nova rapid. and im not a very high insulin injector. everyone is diffrent. i imagine you will be seeing the diabetic nurse within the next week or so. the other issue will be to insure he does not get ill ie flu or spewy bugs for a few weeks. it can make his bg go up.

NadineV said:

his ketones were 0.8 on admission and went down later.
I was reading in this forum that Lantus dose is recommended 0.2 unit per kg, so that's why I asked, as he is getting twice of recommended dose, is not he?

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everybody reacts differently. he is in the urgent get his bg downstage. so they will dose to his bg levels. later they may reduce it 13.2 units is not likely to be enough to bring down his bloods. honestly dont worry they know what they are doing.

the l

Antje77 said:

I would think that if he's not having hypo's all the time, the dosing is right. That's how you work out how much insulin you need; you try to find the amount of insulin needed to get your blood glucose to an acceptable level.
If he is type1 (highly likely I would say, for reasons other people have already mentioned), their is currently no way of getting his own body 'try to work', as his own body is losing the cells that produce insulin. Without those cells it's impossible to make your own insulin.
I'm sorry I can't tell you a better story. I hope you all start to cope with your sons diagnosis and the changes in your lives it will bring. For a lot of people, including me, fitting the diabetes in your life works quite well after the first few months. Take care, and don't forget to be nice to yourself as well!

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Lads at 30 at the moment. dont think hypos are an issue at the moment. once he is around 10 im guessing they will start switching things around.

nadine did they talk to you about if his bloods drop to low. im sure they did.

1) it's very unusual for children to be diagnosed with type 2 diabetes unless they are morbidly obese. If your son is a normal body weigh 15 year old, he doesn't have type 2.

2) you son wasn't "just thirsty". His hba1c was 97, that's an average blood sugar over the last three months of 14.9, or three time what is normal.

3) your son had ketones on diagnosis. It is really very unusual for type 2 diabetic because ketone are caused by a lack of insulin and type 2 diabetics have too much insulin.

4) a cpeptide test doesn't test for insulin. It tests for cpeptide which I waste product of endogenous insulin production. Being on insulin has no impact on the accuracy or validity of a cpeptide test.

If you have concerns about insulin dosages you should get in touch with your DSN for advice. There is no "too much" insulin unless the dose is causing hypos.

NadineV said:

he was 30 when admitted, but.... since it went down and I would say also because he is on diet (not only because of insulin).
He had 5.1 at 5pm and 10.1 after dinner tonight, which is quite 'normal' is not it?.

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watch that lower figure. you dont want to drop too fast. possibly stop the diet just for now you need to reach a stable figure the 5 point jump is not usual. what did he have for dinner. so you have some jelly babies. the glucose paste and the jab if he falls very low. in fact who put him on a diet.

NadineV said:

are we sure about 4)?

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I don't know if "we" are sure, but I am. Cpeptide is accurate and valid even if you are taking insulin.

But, a honeymooning (i.e. newly diagnosed) type 1 may have a pretty normal cpeptide level, because the honeymoon could mean they retain normal insulin production for a while.

NadineV said:

what about MODY? https://www.diabetes.org.uk/diabetes-the-basics/other-types-of-diabetes/mody

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If you and/or his grandparents don't have diabetes that would rule MODY out.

NadineV said:

I would agree that my son has a diabetes, but not sure if type is correct, as there is so many?

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There aren't "so many". There's type 1, type 1.5 or LADA (which are both type 1). There's type 2, which does not get diagnosed in teenagers unless they are obese. There's type 3c, which is caused by chronic pancreatitis or Whipple procedure. And there's MODY, which is genetic diabetes.

Everything about your sons diagnosis says type 1. There is no reason to question his type of diabetes. If there is no reason to question his type then there is no reason to to cpeptide, antibody or genetic testing.

Should your son have problems with his insulin regiem and hypos then there may be a reason to investigate with these tests.

Is there a different between Lantus and Levemir in terms of their metabolism profile? How are they selected? And why do some people get advised to take a single daily basal injection whilst others are advised 12-hourly?

well that explains the jump spuds are very heavy in carbs. perhaps a little more meat. what was his night time reading. if over 6 you not need to feed him. unless low say in the 4s leave off the bread. remember we are trying to not spike the bg too much. his diet can be as normal has he wants but some food will raise it. he will learn what over time.

ok type
type 1 is normally seen in children and teens some older people can develop it. usually high bg and ketones
type 1.5 or lada usual develops in 30-50 year olds is slower onset than 1 and may resemble type 2
type 2 is mainly found in 40 plus caused by insulin intolerance it is found now in some obese teens and children. type 2 can have high bg but tend not to have ketones.
type3 not your son its Alzheimer’s disease
type 3c injury/surgery or pancreatic illnesses cause the death or removal of the insulin producing cells.
Maturity Onset Diabetes of the Young affects 1-2%of diabetics it runs in families

• Mild to moderate hyperglycemia (typically 130–250 mg/dl, or 7–14 mmol/l) discovered before 30 years of age. However, anyone under 50 can develop MODY.[10]
• A first-degree relative with a similar degree of diabetes.
• Absence of positive antibodies or other autoimmunity (e.g., thyroiditis) in patient and family. However, Urbanova et al. found that about one quarter of Central European MODY patients are positive for islet cell autoantibodies (GADA and IA2A). Their expression is transient but highly prevalent. The autoantibodies were found in patients with delayed diabetes onset, and in times of insufficient diabetes control. The islet cell autoantibodies are absent in MODY in at least some populations (Japanese, Britons).[11]
• Persistence of a low insulin requirement (e.g., less than 0.5 u/kg/day) past the usual "honeymoon" period.
• Absence of obesity (although overweight or obese people can get MODY) or other problems associated with type 2 diabetes or metabolic syndrome (e.g., hypertension, hyperlipidemia, polycystic ovary syndrome).[12]
• Insulin resistance very rarely happens.[13]
• Cystic kidney disease in patient or close relatives.
• Non-transient neonatal diabetes, or apparent type 1 diabetes with onset before six months of age.
• Liver adenoma or hepatocellular carcinoma in MODY type 3[14]
• Renal cysts, rudimentary or bicornuate uterus, vaginal aplasia, absence of the vas deferens, epidymal cysts in MODY type 5[15]

The diagnosis of MODY is confirmed by specific gene testing available through commercial laboratories.

these are the main types to confirm if its type 1 or lada a gad test is done it takes a few weeks to come back. mody requires a dna test and takes awhile. of the types 2 effects 90% of diabetics. type1about 10% mody and lada below 5% each.

we really can discount type 2 he does not fit the pattern. he fits type 1 does not have lada to young. mody is rare and usually is lower your sons 30 reading does not really go along with it. if there are no others in your family with mody its unlikely.

So your diabetic consultant will deal with the main issue and thats what they have done. its most likely to be type 1 so thats the treatment. later they will do the tests for antibodies to confirm it. if not they will test for mody. but for now he needs this treatment. the insulin will do him no harm even if he was mody and does not need insulin in the future.

i hope this helps im not trying to lecture you. sorry if it comes out that way.