Lantus dose adjustment

[Revontuli]

Hello all,

In an earlier post by me, a few friends suggested that I should decrease my Lantus dose, which is currently 16, as I had lows 5 hours after NovoRapid.

I decided to try 16 dose a few days more to see what will happen and I've been having lows since yesterday. So, it's sure that I must take 15.

I started with 24 units during the first few weeks of diagnosis, then 20, 18, 16 and now 15.

I wondered why your body needs less Lantus and what affects it.

Thank you very much!

 

[Nicklenocky]

Hi, I cant help you out unfortunately as I am going through a similar thing myself. In just 10 days I have reduced my lantus gradually from 18unit to 14 units and still experiencing random hypos whilst carefully matching my short acting insulin to my food. I want to reduce the lantus further by another 2 units but I am not so confident and wondered whether there was a minimum amount of background insulin diabetics need...I have the feeling I could be reducing it forever and still get the hypos!

Sorry if I hijacked your thread....I will follow your thread closely and may post my own query in another thread.

Good luck!

 

[Revontuli]

Hi Nicklenocky,

Hijacking? Of course not! I'm glad you shared your experience too and there will definitely be helpful advice and information on Lantus

 

[Fallenstar]

Hi
I was always having to try and adjust my Lantus dose due to Hypo's then gradual highs and big drops on a night. I have changed to Levemir and cannot believe how steady my control is . I just did not get on with the Lantus over the last couple of years. Though I have been on it for years, it just seemed to all of a sudden give me poor control :?
Also splitting the Levemir dose seems to give me more flexibility instead of it having the 24 gr action which the Lantus did with me.

 

[Ausra]

It is a very good question.
My nurse gave me advise how to check if Lantus is good for you.
3 hours after a meal (when your blood sugar is stable) check your BG and take carb-free snack.
2 hours after the snack check BG again.
If it went up you probably need more background insulin,
if it's the same as 2 hours before everything is ok,
if it went low you need to reduce your Lantus dose.

For me personally to take this test would mean not to eat much in 5 hours, which is impossible task.
I managed to do this once and my results showed my Lantus dose is good for me. But probably to do it only once is not enough.
I experimented a lot with my Lantus dose. I was told to take 16 units, I took 6, then 8, then 10, went back to 8, to 10 again,sticked to it for a while, then 12, 14, and now I take 15. But still I am not sure if it's right for me. My weight went up 11 kg in 2 months when I started taking 15 units, which is a good sign but maybe a little too much. I am thinking now to reduce it again. I would love to know how much I actually need..if only my pancreas could talk....but I think it will take years to get it right and a lot of experimenting.

 

[moody1blue]

Hi Everybody, as my profile states, I have been a T1 diabetic for 35 years, a couple of weeks ago I actually found out that the Lantus can be taken at ANY time of the day :/, so I tried taking it in the morning, now this really affected my readings, I tried to change as i was so fed up of my sugars dropping a hour or so during the evening, but as far as i am concerned, it is better for me to take it in the evening BUT have a snack during the hours after administering the insulin, so this then stops the levels dropping to a irritating level lol a banana is good if you like fruit, as this brings the sugar up and keeps it at a good level for during the night.

 

[Revontuli]

Hello friends,

Thank you very much for your replies!

I don't have to change my Lantus to 15 units any more because my BS has turned to normal. Actually the idea of reducing it made me so happy but...Anyway! I believe I showed good progress in 4 months, going from 24 to 15, but still I have a feeling that the dose will never be less than this my whole life.

I'll still try the test your nurse suggested, Ausra. And I didn't know Levemir and Lantus would have different effects on each person. Lantus seems to work good for me but I'd probably need more time and experience to decide that.

I take my Lantus at 10 PM and generally have snack unless my BS is a bit high. I agree banana is a good choice to balance it during the night and milk/yoghurt with it. (and also tasty! )

 

[Ausra]

Good luck to you Revontuli, you are inteligent person and you will get it right. Maybe you did already..
Trust your senses, but listen what doctor has to tell you as well

 

[Otenba]

Unfortunately I need more information to get a clear picture of what is going on with you and your relationship with Lantus. Everyone's insulin needs are different so the more information you can provide the better. During the day blood results can be affected by the quick acting insulin as well as Lantus so you cannot judge on that alone.

When I was on Lantus (before I changed to Levemir) I used to hypo a lot. During my days of being on Lantus, I did the DAFNE course and I discovered that Lantus, despite having the reputation of being a 24hr insulin, I found that it ran out around 2pm every afternoon (I took it at 10pm at night). So I ended up split dosing Lantus; allowing the overlap to happen in the morning because I seemed to need more insulin at that time of day.

The best way to get a good idea on how well Lantus is working for you is to have a carb-free meal. Have an omelette with some salad... something like that, that shouldn't effect your bloods in a way that you need to take quick acting insulin.

Over night can be a great way too. Let your last injection of Novorapid have 5 hours to run out (say you had your dinner at 7pm - you'd wait until after 12midnight) and see what Lantus is doing on it's own. DAFNE recommends testing at 3am because this is often when the nighttime hypos occur. If you have a hypo - then your Lantus dose needs putting down by 1 or 2 units.

The goal at the end of the day is to sort out your doses so you don't have to snack to get through the night... it makes your life much easier as a result - one less thing to worry about! Best of luck!

 

[dani-a]

My advice to check that your background insulin is working correctly is to either have a carb free meal, ie check your BG before meal and correct if necessary (1u should bring your BG down by 2 to 3 points), have a carb free meal and if your BG is still on track at your next meal then your dosage is correct. Also you could always do the 3am test.
Hope this helps and not forgetting that when adjusting your Lantus you should wait for at least three days for this to take affect.

 

[Fallenstar]

Hi
I do wonder about this checking your Basal insulin dose suitability with just having a carb free meal, I'm a low carb follower and I find that I will still have to Bolus the same for a breakfast of 3 rashers of bacon and an egg as I would for say 2 slices of wholemeal toast.
Protein is still broken down into Glucose and I have found with me anyway at virtually the same rate..just not with the bigger spike you get with carbs...So I'm sure you would have to go the whole hog and fast to get a true evaluation.
I know on DAFNE you are taught not to Bolus for a protein only meal, which I did question this and it was "skimmed" over and I was told it was "too complicated", they don't want us having only protein meals :wink: But I have found I need to Bolus virtually the same for the volume of food shall we say,ie meal size ...whether it is made up of Protein or carbs...Just thought it may interest some people.
Then again I produce NO insulin now. I dare say in the early days I could have thought I was "cured"on a no carb diet :lol:

 

[Revontuli]

Hello all,

Thank you again for your replies.

Dear Otenba, my problem was that I was having really high BG for around 2 weeks, especially 2 hrs after lunch. But then again, some 4-5 hours after NovoRapid, I had lows at times. So I couldn't decide what to do with Lantus. Some friends on the forum suggested I drop it to 15 units. But I didn't need to do that.

Another thing was that I generally took NovoRapid right after lunch and that was probably the reason of highs. Now I take it before eating and no more spikes.

Luckily my BG has turned to normal and has been going on very well. I did that test of having a carb-free meal and the results were perfect.

Last week I had appointment with my nurse. She said I shouldn't get worried as it's pretty new for me and my results are really good. We also had a long discussion about Lantus. She asked me if I would think about switching to Levemir as it's much easier and flexible than Lantus.

I was really wondering what's the difference between those two but now I know why. It's really difficult to balance Lantus as it takes a few days until it shows affect. So, I'm planning to go on with Levemir, I will talk about with my doctor at my next appointment.

It'd be really helpful if I could find a course like DAFNE, but I'm an immigrant living in Finland and I'm not sure if they have anything in English for me!

Wishing you all a good and healthy day

 

[LaughingHyena]

It'd be really helpful if I could find a course like DAFNE, but I'm an immigrant living in Finland and I'm not sure if they have anything in English for me!

have you seen this online course http://www.bdec-e-learning.com/
not quite the same as meeting a group of other people but I've found it quite helpful.