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Lantus

Discussion in 'Diabetes Medication and Drugs' started by stoney, Mar 17, 2011.

  1. stoney

    stoney Parent · Well-Known Member

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    Hi Again Everyone

    Can someone tell me how Lantus doses are calculated. The DSN at the time put James on 16 Units, then adjusted to 14 and now on 15 which is at 10p.m. each night, but just wondered how this is calculated.

    Also any more advice with regard to easing this painful injection which is really getting him down and makes him tearful.

    Other than that folks Bg's are settling down and we seem to be on the right road. Time will tell now when he next has his HbA1C which I assume will be done in his appointment on 19th April with the Dietitian and hopefully someone who has replaced his DSN. :)
     
  2. SophiaW

    SophiaW Type 1 · Well-Known Member

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    I'm not sure about how to ease the pain. If it really is a problem for him perhaps you can consider using Levemir instead? I know Jess never had a problem with stinging when she was on Levemir.
     
  3. janabelle

    janabelle · Well-Known Member

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    Hi,
    is it just Lantus that is causing the stinging pain on injectiion? Some people get stinging with Lantus and others don't but it's easily explained; Lantus is very acidic on injection with a PH of around 4, it releases itself slowly (apparently) by being neurtalised in the body. Normal body PH is above 7.
    The only way to solve this problem is to change to another long-acting of which there are plenty to choose from besides Lantus & Levemir.
    I can't advise about doses, as for me it did something different everyday for no apparent reason :?
    Jus
     
  4. ZACNEMMA

    ZACNEMMA · Well-Known Member

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    Have you thought about pumping?
     
  5. noblehead

    noblehead Type 1 · Guru
    Retired Moderator

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    stoney,

    Once over the insulin calculation when diagnosed was worked out by your body weight in pounds divided by 4, for example a 12 stone man (168 lb) would require 42 units of insulin (168/4=42). Basal insulin (lantus in your case) should account for 40-50% of the total dose and the rest would be your QA insulin to cover meals.

    This calculation if still in use was only a rough guide and I found I needed a little less than my dsn recommended as a starting dose when first diagnosed.

    Nigel
     
  6. stoney

    stoney Parent · Well-Known Member

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    Thanks Noblehead

    So if James weighs 7 stone = 98lbs divided by 4 = 24.5 am I right.

    James was put on 16 to begin with, then 14 now back to 15. He is now beginning to have great readings throughout the day apart from breakfast and as I have said before, he still has his usual banana, cereal and toast before Lantus then bed. Should I cut down on the supper to see if its the food or not enough Lantus :?:
     
  7. sugar2

    sugar2 · Well-Known Member

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    Hi Stoney,

    Does he inject and novorapid for the snack?

    Personally, I would get him to skip the snack for a day of two, and do some regular testing, and see what the pattern is...if he is , say 7mmoln/L at 8pm, 6.8 ate 10 pm, 7.2 at midnight, but at 4 am he has shot up, then you know that it is not the snack, and then could be not enough lantus, or the dawn effect. Alas, only way to find out is trial and error.

    Is it jus the lantus he finds really painfull?

    If he is newly diagnosed, then he may well be on lower doses that a child his age and size, that had been diagnosed at , say, age 5, as his body may be producing a little insulin for itself?

    I just tried Nigels calculation for me...and I take about 2 units more than my weight would suggest I should. It is a great place to start, but I would guess most peole have to tweak the initial level a bit.
     
  8. iHs

    iHs · Well-Known Member

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    Hi

    One way to ease the sting from Lantus is to inject into the side of the bottom and inject slowly not quickly. Another way is to numb the area off using frozen peas, iceblock, emla cream, ametop gel, xylocaine spray (these can be got using eBay).

    If you now have a half unit pen you could increase the Lantus up by half unit to see if that alters the breakfast bg or reduce the food at supper by 10g carb. The best way though is to do what Sugar2 has suggested and go by that first. Loads of things are all trial and error using MDI and getting bg levels to behave.

    Why is your dsn so keen for James to use Lantus instead of Levemir? Levemir is so much better really even though it usually needs to be injected twice a day. Humalin is also a good alternative.
     
  9. stoney

    stoney Parent · Well-Known Member

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    Thanks All

    SophiaW - Lantus was the suggestion of the DSN but will ask about Levemir at our next clinic

    Janabelle - It is just the Lantus that stings

    ZACNEMMA - Just gone on MDI's so a pump may be for the future

    sugar2 - No he does not inject Novorapid for his supper, just for breakfast, dinner and tea. The DSN said not to do this at the moment but may need to later. He just has 15 units Lantus before bed. It is the Lantus he finds VERY VERY painful and will ask about other alternatives at our next clinic. He is not newly diagnosed he has been diabetic now for 10 years and coeliac for 5 but he is new to MDI's only had 2 injections daily prior to this new regime. Will try your suggestion and will keep you posted.

    iHs - I actually did the side of his bottom last night and he said it was a lot better. So let's hope I can get it right for him again. If not will try your suggestions with peas etc. Also have a half unit pen but apparently not the right one, so this will be asked for on his next script.
    I don't know why DSN said Lantus but I think all her new MDI's are on Lantus (WHY!) Maybe, I did say when we were going on this regime that I did not like the fact that James had to inject so much in a day (possibly it was me then!). Does Humalin need to be done twice a day?
     
  10. iHs

    iHs · Well-Known Member

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    I've never used Humalin but Copepod does I think. I think it releases a bit more evenly but is injected twice instead of just once. Lantus probably would not sting so much if smaller doses were injected twice a day but this is for you to talk about with your new dsn.
     
  11. vasilij.seniut

    vasilij.seniut · Member

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    never heard about that.if my weight is 100 kg which is more than 200 lb,do i need 50+ units?but i use only 38-42(summer-winter).
     
  12. noblehead

    noblehead Type 1 · Guru
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    Yes that would be the total daily insulin for that weight, but as I say this wasn't a precise science and only a rough guide, I think most clinics start there patients on lower doses and then adjust accordingly depending on bg control.

    Nigel
     
  13. noblehead

    noblehead Type 1 · Guru
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    Of course not, if 38-42 units are keeping you within range why would you want to increase it? As I said to stoney, its was only ever a very rough guide and may not be used in diabetes clinics now.

    Nigel
     
  14. LaughingHyena

    LaughingHyena · Well-Known Member

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    I find I have to inject the Lantus really slowly, I'll insert the needle then do a few clicks, wait a couple of seconds then finish the dose. I was trying to do it quickly to get the stinging over with but this seems to work better.

    Also I roll the pen around a bit before injecting, not quite shaking but making sure everything is mixed up.

    I had a lot of stinging when I started this 5 months ago but it's only sometimes now. Not sure if that is an improvement in technique of just me getting used to it.
     
  15. janabelle

    janabelle · Well-Known Member

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    Hi Laughinghyena
    I posted earlier about the reason Lantus causes stingling. It's to do with it's acidity, and If you're being affected I doubt technique will affect that. I wonder why anyone bothers with Lantus when there's so many negatives associated, roll on it's demise. :lol:
    Jus
     
  16. Glyn1390

    Glyn1390 · Member

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    I am really newly disgnosed, usually taking 8 units x 3 with meals (dependant on carb count) then 12 lantus at night - I have not adjusted the lantus - left it at 12. Every morning I am at 13 - 14 mmols. What does a unit relate to - could I go to 14-16 and see a drop of 2 to 3mmols in the morning?
     
  17. iHs

    iHs · Well-Known Member

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    Hello Glyn

    Do you do a bg test before you inject the Lantus, if so, is it more or less the same mmol result when you do it?

    Has your doctor or dsn given you any guidance on adjusting your bolus insulin to keep your bg levels at desirable targets?

    Your bg level in the morning is a tiny bit higher than the desirable target of 5-7mmol but before you start altering the Lantus dose upwards, it's better to first get your evening meal bolus dose correct so that when you go to bed, yr bg levels will nearly always be the same. Once you've got that right, it's then easier to re calculate the Lantus dose.
     
  18. Glyn1390

    Glyn1390 · Member

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    I always test before all injections. My BS's at bed have been between 8 and 13. I have had good contact with my dsn with my lantus being adjusted upwards for the last 3 weeks from 8 to 10 to 12. I changed my dose last night to 14 and have gone low all day. Will take some advice on Monday me thinks!
     
  19. iHs

    iHs · Well-Known Member

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    Hi

    Talk to your dsn soon about calculating your bolus insulin dose using an insulin to carb ratio so that instead of your bed bg levels being between 8 and 13, they are about 7 to 9. Lantus doesn't work all that well when people start adjusting its dose upwards or downwards in order to correct a higher/lower bed bg level. It all starts to go a bit hit and miss so try to get your evening meal bolus accurate for the carb you eat so that when you go to bed, your bg level is more or less the same each night.
     
  20. epicure_2002

    epicure_2002 Type 2 · Member

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    i occasionally have a stinging feeling when i don't change the needle ( i used to do 3-4 injections with the same needle) . now i change every 2 jabs. ( i'm on 44 units of lantus ) so i jab 22 units in the right thigh and 22 in the left. with the novo needles from novonorsk i feel absolutely nothing most of the time!!
     
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