Lantus dosages?

[stackingcups]

Those of you who do, or have in the past taken Lantus what dosage did you land on?

So far it seems to have made my sugars a bit more stable (less worrying highs) though I don't know if part of that is getting into a testing routine too. But for my waking readings it doesn't seem to have taken things down that much. I'm in the 10's usually now, I started on 10 units and am now up to 14 and don't feel like I've seen a difference in the readings after the adjustments.

The DN said there was no upper limit on dosage, but I think I expected to get to the right dose quite quickly. Probably my own naivety just thinking if I do the right things everything will sort out immediately.

 

[rebrascora]

It takes time to find the correct dose and they start you off on something a lot less than they expect you will need so that your levels come down slowly and they can see how you are responding to the insulin and they reduce the risk of you experiencing nasty hypos.
Doses can be very individual. I started off on 6 units of basal insulin and I am now up to about 30units (currently 22units on a morning and 7-8 on an evening) but I am using Levemir, not Lantus, which is similar but not exactly the same. It has taken me a couple of years to build up to this level as my own pancreas has slowly ceased production. I may need more or less in the future. Our bodies change and they need whatever they need. There was a lady on my DAFNE course who had been Type 1 for 50 years and she only needed 2 units of Lantus and she was suffering really bad hypos almost every night and then her levels were going up to mid teens during the day. Hard to imagine 2 units could do that to you. Thankfully she is now on an insulin pump which can be adjusted to give her tiny amounts of insulin as and when she needs it.
We are all different, but it sounds like you are probably ready for another increase in basal dose. Do you have quick acting (bolus) insulin as well?

 

[stackingcups]

No bolus at the moment, waiting for a telephone call with a DSN to perhaps discuss that, I'm too complicated for my GP surgery I think.

Going up by 2 units every 3/4 days at the moment. Thanks for explaining why its slow and steady rather than rushing into it!

 

[Inka]

What time of day do you take your Lantus @stackingcups ? It does take a while to get up to the correct dose for you. It’s best to increase insulin cautiously in order to avoid hypos. I usually leave a change for around 3 days so I can be sure of what I’m seeing.

 

[stackingcups]

I'm taking it around 8pm. Mostly because I take my tablets around the same time so it was easy on the brain routine wise.

 

[Inka]

Ah, ok - I was wondering if you were taking it in the morning and it was running out overnight, but clearly not. My guess is you need a little more Lantus, but, as I said above, it’s best to increase it slowly and cautiously.

I see you’re also going to discuss a fast/bolus insulin too, so if that’s going to introduced soon that it would be sensible not to rush to increase the Lantus anyway.

 

[stackingcups]

I'm assuming it'll be discussed anyway. I think the DSN will take over the direction of my treatment. They hospital told the GP to start me off on Lantus instead of metformin. Thankful for that, I don't think my body would have coped with metformin.

 

[Inka]

That sounds like good news @stackingcups The hospital and DSN will have a lot more experience.

 

[rebrascora]

Most GP surgeries are reasonably capable of overseeing Type 2s assuming they are fairly straight forward (although many here on the forum might dispute that) but have very little understanding of Type1, which is essentially what your 3c makes you, plus the inconvenient extras like Creon which make you 3cs extra special (read complicated) Things will be much better when the diabetes clinic takes over your treatment and you start on a bolus insulin as well. At the moment, that Lantus is having to cover everything which means it is difficult to get the dose right without risking overnight lows. It is all a complicated balancing act but you will gradually have all the right tools and start to gain the experience to master the dark art. Gradually it will start to make sense and levels will become more stable and in range.

 

[TheClockworkDodo]

I was started on 16 units of Lantus when I was diagnosed, and woke up very hypo every night for the first week (I was getting up and eating jam sandwiches in the middle of the night!) until my next appointment with the diabetes team, who put my dose down to 6 units! I ended up needing 4 units in the winter and 8 in the summer, and spent all autumn hypo-ing and all spring fighting high readings (so glad I'm now on a different basal!).

Even if you're on a basal that suits you though, it does take a while to get things right.

One thought - are you testing in the middle of the night at all, or do you have a Libre so you can see what your blood sugar is doing through the night? Because sometimes high waking readings can be caused by your body releasing glucose to get your blood sugar up again after a hypo in the night, in which case the worst thing you can do is keep increasing your basal.

High waking readings can also be caused by dawn phenomenon, when your body releases glucose as soon as you wake up, to prepare you for the day - in which case again, increasing basal is not really the answer, you'd need some fast-acting insulin to counter this. I hope the DSN will be able to sort some out for you - they are usually very helpful and knowledgeable so will be the best person to talk to about this.

 

[stackingcups]

Gosh so much to learn. I haven't tested in the night. To be honest it only occurred to me last night to take my testing kit upstairs so I can test when I wake rather than when I make it downstairs.

Overall it sounds like I just need to be more patient.

 

[eggyg]

My DSN changed my basal to Levemir, I was on Humulin I at first which isn’t really suitable for Type 1/3c. The Levemir was a game changer, it’s a twice a day basal, I take mine when I rise and retire, others have it at set times. I think when you start on the bolus too things will change but as @rebrascora says it can be difficult ( and very frustrating) for us special folks. I’m afraid it’s a time thing, I’m still learning, 7 years after starting on insulin and only 3 on Levemir. It really will get better, not always perfect, but diabetes isn’t an easy thing for any type to deal with. Just keep popping on here and we’ll do our best to reassure and guide you. Elaine. 🙂

 

[helli]

I’m still learning, 7 years after starting on insulin

I think I am still learning after more than 15 years. But agree with you that it gets easier.
As for perfection, I am not convinced it is possible. We are doing the job of a major organ whilst doing what everyone else does just to live.

 

[stackingcups]

I'm still convinced they're going to undiagnose me with 3c and declare I'm type 2. Think so much hasn't sunk in yet.

 

[mikeyB]

Can you tell us why you were diagnosed with 3c? Because if you are, there is no danger of you being differently assigned to T2. The current guidelines state that 3c should always be treated with insulin.

 

[stackingcups]

Because I've had so many bouts of pancreatitis this past 2 years, and I think the fact by bloods didn't change slowly either. There was no sign of anything in my bloods at a pre surgery appointment and then there was 2 months later. So pancreas damage is assumed by the hospital but no-one has checked. I think when I actually get to speak to the DSN I'll feel more reassured.