Lantus insulin

[Terry Cordery]

Hello to all. I lived in France, in the Dordogne. Well not quite in the river but in the department of the Dordogne. I have been diabetic for 12 years now. ( I am 63). Up until a couple of years ago all was well controlled. I was using Gliclazide and Avandamet. My HbA1C was about 6.5 Then I was taken off Avandamet and told that the drug was no longer available. I tried a multitude of different drugs but none of them were any where near as effective as Avandamet. My hbA1C climbed to 8.4. Now the doctor has started me on slow acting insuin. Its brand name here is Lantus. I am taking 38 units at night. I test my blood in the morning The Level is often around 180mg/dcl or about 10mmol. This is way too high. I am eating very little, drinking very little alcohol and feeling pretty miserable. I am trying so hard but nothing seems to work. What can I do?

Another problem is that diabetic care is not joined up here in the same way that it is in the UK. Five years ago when I lived in North Yorks, I had an annual diabetic review, if I had any worried I could phone the practice and speak to the nurse in charge of the diabetic unit, I had regular foot and eye checks with retinal photographs. They are almost unheard of here. I have to visit the doctor and ask for all of the checks that would automatically be scheduled in UK.

Has anyone any suggestions or comments on taking Lantus insulin. Is 38 units a lot?

 

[Northerner]

Hi Terry, I've been using lantus since diagnosis (although I did stop using it for the past couple of weeks, but that's a long story!). It's impossible to say what a 'lot' of lantus is, as we are all different and one person's needs may look high or low against another's. Type 2s tend to need more than Type 1s, due to insulin resistance, but this isn't always the case. Are you in contact with your doctor or nurse so that you can get advice on how to adjust your dose if it seems to be insufficient to bring down your levels? I've had to do quite a lot of adjusting of my dose over the years, going from 20 units, down to 10, then 1, then none! With me, the amount varies a lot according to my activity levels. Some people need a hundred units or more, so you can see that there is quite a range!

It's worked very well for me, once I got the doses correct for my needs, so I hope that the same is true of you once you find the correct level 🙂

p.s. Another question - do you test immediately on rising? A lot of people find their levels climb quickly in the morning as your liver gives you a 'boost' of glucose to start the day (known as Dawn Phenomenon). It's a good idea to have a little something to eat to switch off this boost.

 

[Robster65]

Hi Terry.

Lantus is one of the most commonly prescribed insulins for T1s or T2s. I've been on it for many years.

38 units isn't a huge dose for a resistant T2. I would imagine you'll need to raise the dose gradually but youd need to test before meals to see how high or low you're going.

If at any point, you're dipping to near hypo levels, say 4mmol/l, you wouldn't be able to raise the lantus any higher without hypoing at that time.

You may find you need a 'bolus' insulin (short acting eg. humalog, novorapid) at meal times to reduce your post meal spikes as well as the long acting 'basal'.

Only your doctor can advise you on this but you can certainly present him with some options you'd prefer.🙂

Rob

 

[Pumper_Sue]

Hello Terry,
sorry to hear you have problems.
Give HelenM a shout, Helen lives in France as well so I'm sure she will be able to help you out. 🙂

Have you actually been back to the Drs and said I am not coping with just Lantus I need more help?

 

[Kwaka1]

Hi Terry,
I would explore the possibility of a Basal/Bolus regime, which mimicks the bodies natural insulin production and usage. The Basal insulin (Lantus) in theory should last 24hrs, and should really be administered at roughly the same time every day, and I'm led to believe that Lantus takes care of what your liver gets up to. Bolus (Novorapid for example) is a rapid action Insulin which deals with your food intake, and can be taken at any time of day with food. Its purpose is to open up the cells to accept glucose produced by carbohydrates, thus giving the body its energy and preventing the glucose from building up in the blood.
The downside of this regime is multiple daily injections, or MDI for short. But you do get used to it, and it has its benefits inasmuch as you can, in theory, eat a more varied diet (still healthy, of course). 🙂

 

[trophywench]

You say your FBG is 10 - but what's your bedtime reading?

And assuming it does rise overnight, when does the rise in BG start? When your feet hit the floor or earlier?

Ideally, the difference between the two should be no more than 1.7 (up or down) If it is greater than 2.0 rise, then you need more overnight.

Sorry, but each of us has to experiment with insulin dosing ourselves as we are all quite different in this respect - and with Lantus it takes up to 3 days to settle down after any change. Tedious but necessary. Take any changes very slowly and very gradually. You will 'get there' quicker by going slower with this.

 

[DeusXM]

It sounds to me like your problem isn't a lack of insulin, but insulin resistance. Avandamet is used to reduce insulin resistance - your doc shouldn't simply swap it for Lantus as you'll be resistant to it, hence the numbers you're seeing.

Avandamet is combo drug that contains Metformin, a standard frontline T2 medication. Is there any reason why your doc can't just substitute your Avandamet for Metformin?

 

[HelenM]

Hi Terry,
You should have the same care as in the UK.
This ALD doc for t2
http://www.has-sante.fr/portail/jcms/c_419389/ald-n8-diabete-de-type-2
says that the each year you should have:
4 visits to the GP or diabetologue (I actually only see mine every 6 months now but if I had problems would see her more often)

4x HbA1c
1 x opthamologist
1x dentist
1x lipids (cholesterol test)
1x renal tests
1x electrocardiagraph.
At your checks with the doc you should have your feet checked (it actually suggests that you think of showing your feet to your doc at least once a year!

I almost never see my GP, so in that respect I'm a bit odd. When I see my diabetologue she directs my treatment. She writes prescriptions for lab tests; tells me when it's time to see people such as the cardiologist/ angiologist who I see every 2 years. She nagged me to see a gynae (all French women see a gynae every year!)
Having said that the onus is on you to make the appointments and you can of course choose who you go to. Retinal checks are yearly appointments so I just get on and make the appointment for the right time. As we only have one opthamologist in town I have to make those ones 6 months in advance.
I understand most T2s are looked after by their GPs but it is always possible to ask for a referral to a diabetologue. Indeed you can make an appointment to see one without a referral but you won't get the same reimbursement.
My own doc sees more T2s than T1s. My hospital also runs 4 day courses for people with T2.