Insulin Dose differences

[Sweet3x]

I'm currently living in France. For many years, when I was in the UK, I was on a dose of 26u per day of Lantus. When I came to France and found a specialist to visit, she was horrified and immediately reduced my dose to 13u, and has subsequently reduced it to 11u per day.

I have several diabetic friends in the UK who are and have noticed on these forums that the average dose for Lantus/Levimir is in the low 20's.

I just wonder why there is such a difference? My HBA1 is generally good (7%) and when I was on the increased dosage, I'd frequently run low over night sometimes resulting in fits. When checked on a fasting diet for 24 hours, on 26 my bs levels fell dramatically over night. When on the lower dose, they remain steady and my bs stays at 5-6 for the full 24 hours.

Is the insulin different in France? If I move back to the UK, will I need to increase it again? Why is there such a difference?

 

[Snodger]

No, it'll be the same insulin and you will use the same dose - I think you answer your own question in your post to be honest: you say you were having night hypos with fits when you were on the higher dose. So it was just too high for you. Same insulin, just too much of it. Good that you had a sensible nurse in France.
Everyone's different, so a dosage in the 20s might be fine for others on here. Personally I'm in the UK and am currently hovering around 15 or 16.

 

[Sweet3x]

Thank you Snodger
The first person I've found on less than 20
You've put my mind at rest, thanks again

 

[Geoff]

Hi Sweet, like Snodger I am glad that you are receiving good advice on you lantus dosage. When I was diagnosed type 1 just over six years ago, I was started on a dosage of 43 units of lantus and like you my bs was swinging up and down. I did not have good advice, so I studied my condition and found that I could reduce the number of units and still have a life!

I soon switched to Detemir for my basal insulin, which I split dose, today with improvement in my weight and fitness levels, I now only require 14 units per day and my av bs is 5.6mmol/lt, my last HbA1c was 6.0.

 

[phoenix]

For myself I used 16 units of lantus when I left hospital, that reduced a bit and now on a pump I take between 10 and 12 units of basal.
I think maybe that the difference is in the amount of care, rather than the amount of insulin.
As you say you're now not getting the potentially dangerous lows at night , this needed to be addressed.It's also telling thay you were on the same dose for 'many years'.
Sadly, we read a lot of accounts of people in the UK being left to fend for themselves when they're adjusting doses... some even directly after diagnosis. ( I'm sure there are people with good experiences but perhaps they're less likely to post).
The big difference seems to me that in other parts of Europe, they don't have nearly as many patients to deal with compared with the UK and I'm sure that makes a big difference. I
My local hospital in France has diabetes as a specialism so the ward has patients from a wide area but the 2 doctors and specialist nurse only have 300 diabetic outpatients between them. They have far more time to give me and that was especially true when I was first diagonosed and also when I moved onto using a pump. My specialist knows me as a person, rather than a set of notes put in front of her.
One of the specialists at the Good Hope hospital in Birmingham notes compared his resources to those of a colleague in Holland.

Part of the reason for poor care in diabetes in the UK may be cultural, both affecting patients and professionals, in accepting high glucose levels etc, and organisational (eg patients who do not attend are often left to their own devices).

But much of the reason must be resources: for adult diabetic patients we have 1 diabetes specialist nurse: 1333 patients, our Dutch colleague 1 diabetes specialist nurse: 365 patients. Similarly, his patients certainly have much better access to insulin pumps (about 40% of type 1 patients)

letter to BMJ http://www.bmj.com/content/327/7409/260/reply