Husband's been type 2 a long time, and is about to start Lantus.

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hlp5040

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My husband, diagnosed T2 some 15 years ago, has just had his first hospital clinic referral (which materialised 12 months after the GP referral). He told me that he took with him a few random tests of the week before going (all around 10). He said the clinician was pleased with the consistency of them but that it could do with coming down a little - maybe about 10%. (I don't always believe he accurately tells me what was said). To do this he said they want him to use a very small dose of insulin.

After first diagnosis he he told me the advice was there was nothing he could do, it wasn't his fault, it was a progressive disease which would be controlled with an increasing pathway of medication. Doing my own research, I didn't believe him. I'm not sure how it came about but eventually he had an improvement to diet and, over time, lost 4st (he says 5!). He's about 15.5st now and says they're very happy with that as he is pretty muscular - very fit for his age (68).

On hearing he is to start Lantus (as soon as the GP prescribes it after getting the hosp letter), I am worried because I know just how inconsistent his eating can be. Sometimes he's sensible but other times he will not be, having 2-3 pints of cider in an evening, or go through a tub of ice-cream in 2-3 days, or other things. He said he's only been told to test for the first few weeks to see how his body reacts to the insulin (I think he said it is to start at 2 units nightly).

He hates me asking or commenting about it and acts like a petulant child. It's ok if he decides to initiate a discussion, which is rare. The trouble is, like many people I suspect, he can sit in a clinic and tell the most believable lies about his diet, then tells me the advice he was given based on what he said. I know it's true as I sat and listened to one such encounter some years ago. He told me last year (not thinking I'd know any beter) that the local diabetes nurse was really pleased with his HBA1C as it had come down to 70 - I made the mistake of saying how pleased I was it had come down, and hoped it would keep going down as it needed to be a bit under 50. He was livid, telling me THEY were pleased, so who was I to know better, and that whatever he did it was never good enough for me.

Lovely people, I am worried. I love him to bits and am scared he won't respect insulin and may end up with high/low spikes that could be dangerous.
Do you have any advice for me?
 
Welcome to the forum @hlp5040

It can be tricky to know how best to support a loved one eith managing their diabetes. And i certainly recognise the petulant child in my own attitude some times!

Diabetes always affects more than just the person with the diagnosis, and it’s perfectly natural for you to be concerned.

Lantus is a long-acting insulin analogue, with a profile that lasts approx 24 hours. So any dose he takes will provide a background of additional support for his pancreas rather than a surge of action for a particular meal.

The suggested starting doses are quite modest, so his clinic seem to be being cautious which is a good thing.

Hope it helps him 🙂
 
Oh, and just to add, that us folks with diabetes can be a bit prickly when people are wanting to help. Diabetes can be frustrating to live with. High or erratic BG levels have a direct negative impact on mood, and also come packaged with frustration and/or guilt that somehow it was our fault that we didn’t do better :(

This ‘etiquette card‘ has some tips on way to try to have more open and positive conversations around diabetes with someone you love.

Diabetes Etiquette card:
http://behavioraldiabetes.org/xwp/wp-content/uploads/2015/12/BDIAdultEtiquetteCard.pdf

Regarding HbA1c, while under 50 is a common target, it is interesting to note that in people without diabetes their HbA1c increases with age, so a personalised (higher) target may be more appropriate in older years.


and


In people without diabetes:
1676279828431.jpeg

So higher targets for PWD in older years are often appropriate. 🙂
 
I suppose it may be worrying that if he has erratic eating he may think that now he is taking insulin that diet doesn't matter but the long acting insulin will not deal with high carb meals or food and drink like the ice cream and cider so he will really need to monitor to keep things on track.
 
Plus!!! he'll need to test his BG for driving and absolutely tell the DVLA he now uses insulin and will only get a 3 year medical licence from immediately onwards. Us lot also lost our C1 (vehicles over 3500kgs) licence a few years ago, though you can keep it by making special arrangements. I should look the regulations up if I were you and get him the forms to complete - otherwise his licence becomes invalid BY LAW.
 
Thank you. He has told the DVLA and got a letter acknowledging this. He's about to turn 68 so licences have to be renewed regularly now anyway. Thanks for the tip about C1. I will make sure he notes that. Our current ancient motorhome is 3500, so not in that category fortunately.

What is continuing to concern me is what he's told me about the advice he was given. I am not sure whether I believe it or not. If he's being truthful, it seems strange advice. He says he is to:
  • Use 2 units Lantus at night for 2-3 days
  • After this, test BG in the morning
  • If it is not around the figure suggested, increase by 2 units for a further 2-3 nights and test again
  • Repeat until the reading is in range then he will know what dose is needed going forward.
  • Then he will only need to do occasional BG checks and he may be able to come off the gliclazides.
Why it concerns me is it takes NO account of diet (which in him can vary a lot from sensible to bingeing on ice cream and/or cider) and it seems odd to me to not be asked to keep at least a daily check on BG.

I am sure he privately is struggling psychologically with this, because in the 2 weeks between being told he was to start insulin and actually getting it, he demolished 4 tubs of ice-cream single handed. When I'd been working late one evening, I came in at 9pm and he was just finishing one bowl of it; I got myself a sandwich, having missed dinner, and he decided to get a further large bowl of ice-cream at the same time. I didn't say anything as I couldn't face the stroppiness it would have caused.

Can anyone tell me what kind of dosage level of Lantus might start to be dangerous if he has a day or two when he decides to eat a lot less? What symptoms might I notice if there is a problem? I have started to wake up every 1-2 hours with worry, checking he's sleeping peacefully and am having odd nightmares linked to it, such as dreaming I am getting an incoherent phonecall for help from him and cannot get home to check he's ok.
 
Lantus is a basal (slow release) insulin and is designed to cope with the body's background insulin needs rather than the food that he is eating. I don't know whether or not he is accurately reporting the conversation he had when he was put on it, but if his team thought he needed to adjust insulin to diet then they would probably also put him on a bolus (fast release) insulin for his meals, and they would definitely be wanting him to check blood glucose more often if they did do that.
 
Sounds like standard advice, lantus doesn’t cover food so what you eat isn’t relevant to the dose. It’s normal to start on a low dose and increase it slowly too. Only part that sounds missed is he will still have to test before driving as per the info he will have from the dvla
 
The only time I can see the Lantus dose adjustment causing an issue is if he eats lots of ice cream/pizza/pasta every night which may well give him high levels overnight meaning that he will increase his Lantus because his morning levels are high and then stops eating the high carb slow release foods for a few days. I imagine the levels he is aiming for may still be slightly above range, so I don't think there is too much to worry about, but as insulin dependent diabetics there is always a risk of hypo. I used to have at least one every day, although Libre 2 is helping me to reduce that a bit now. Hypos only very rarely render people unable to manage it themselves, but most people who are not familiar with them assume people end up unconscious.... which can happen but only in extreme circumstances. The Lantus is a slow release insulin, so it will drop his levels more slowly, if the dose is a bit too much, whereas mealtime insulin acts more quickly and cause levels to drop faster. I imagine if your husband's levels have been pretty high for a while, he will feel pretty grim when his levels come down into the normal range and well before they get dangerously low.

It may also be that he will stop wanting/needing to gorge on ice cream once the insulin starts working, because at the moment his body may be starving because it cannot utilize the glucose in his blood stream for energy so it is burning it's own fat and protein stores, due to insufficient insulin of his own. That may also make him tetchy/hangry, so your decision not to challenge him about the ice cream was probably wise.

Hopefully he will start to feel better when the insulin starts to kick in and then it will be easier to manage, but it does take time to get used to it all. Wishing you both well and I really hope he starts to feel better soon. Please ensure that hypo treatments are everywhere including next to the bed and in the car and in coat pockets for walks etc.
 
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