Adjusting Doses

Hi all:

About a month ago I started having some rising numbers and so figured my insulin needs as a LADA were increasing. The highs were more at bedtime, morning and before meals than post-prandial so I started adjusting my basal. I also upped my I:C ratios a tad. I started at 10 units of Lantus at bedtime and decided to split the dose as I was seeing highs at bedtime (before I took the dose). Then I started raising the morning and night split doses up by a unit a day. It was still high at 13 total so I went to 14 and then started getting lows before meals so I took it back down to 12, it was ok for a day or two then high again so I have gone back to 14 and now am back having lows.

I didn't do basal testing because I figured I could tell from the in between time numbers (and didn't particularly want to So maybe I should do that. I'm also wondering though if I didn't wait long enough at each level. Does it take a couple days for basal dose to level out? Do I need to tolerate highs (or lows) for a day or two to see if this happens? The fact that I am doing the same process again makes me think that. Or maybe I am just seeing the LADA spurts of insulin that I have heard some other people talk about and it's just going to stay unpredictable for a bit. Any thoughts? Thanks!


I can give you my perspective on the Pump and previously on a long acting. Any basal dosage change you make may take 24 to 72 hours to level out. The other factors are exercise, exercise intensity, BM %, and other drugs.

If I make a change in my basal on the pump I will not see the complete adjustment results until about 3 hours. One challenge with making adjustments to Lantus is that the action does have a long action profile and when it overlaps, as background insulin it will impact the I:C ration and the action of the next dose of lantus. The manufacture suggest that you make only 1u per day to hit the fasting target for you BG. There are two slight peaks and one low level of action with Lantus. The action ramps up to peak at 6 hours and slightly again at 20 hours. I would guess that you may want to look at that 6 hour mark to see if he lows align with that.

Do you know for sure you are still producing insulin? If you are, there may be some over dosing of insulin going on after larger meals or during activities.

My son’s Docs say three days to adjust and use corrections if needed. He isn’t a LADA but they thought he was a 2 in the beginning and now they say he is a 1 but he seems still both. He gets frustrated waiting but it seems to help if he dosesn’t change things too quickly.

Thanks, guys. Yes, I did see lows today and yesterday roughly 6 hours after my AM Lantus. I had to re-read twice what you said about “overdoses of insulin after larger meals” to understand you meant that my body might be putting out more insulin to cope, and so the dose I’m taking is excessive. This morning I went out for breakfast and it was larger than usual; I took my usual morning bolus and ended up low. My insulin production in May was .70, but as a LADA I understand it can ebb and flow so that might be what I’m seeing. Do other LADAs have experience of up and down within a few days? I don’t do intense exercise; only walking. I’ll follow your advice, Katsz and let the Basal changes sit for a couple days. With my bolus I usually re-evaluate the I:C ratio only every 2-3 weeks (a page of numbers).

Changes in doses should be done for 3-4 days to get a better picture of the effect. Likewise, make changes after you have a good idea of a real pattern.

You might also consider changing to Levemir. For many (I’m one), Levemir is more level. I had afternoon lows with Lantus when it peaked, even though it’s not supposed to have peaks. Made it hard to assess basal needs when Lantus wasn’t as stable as claimed.

Thanks, Gerri. I’ll try being more patient while adjusting doses and if I still have problems I’ll look to changing to Levemir.

Very tempting to raise doses a smidge when you see numbers getting higher.

For testing basal, you only need to skip one meal. Usually lunch is the best to try. It’s not a total fast.

Oh, missing one meal I can probably live with…lol. Sounds like I have some good info on how to proceed. I always appreciate the benefit of other people’s experience and knowledge.

Yep, it’s not a 24-hour fast. Skip lunch one day & then a couple days or so later don’t eat dinner to get a good idea how Lantus is working at different times.