I’m wondering whether my Lantus dose is high enough. I am type1, 27 yrs old, female, and 170 lbs. I take 25 units of Lantus at night. How do I know if this is enough? My A1c is 6.0 but I feel like I’m battling highs and lows all day long. Up and down is still up and down even if it is between 80 and 200! It’s exhausting and I’m thinking maybe my Lantus dosing might hold the key here. Any thoughts? What are you guys taking? Thanks a bunch!!
In order to find out if your dose is right, there is not a lot of point in comparing to others, because we are all different. There are two ways to know if your basal is right for you. One is by basal testing. John Walsh in Using Insulin explains basal testing in detail, but basically it involves fasting for blocks of time and seeing if your blood sugar stays lose to steady. A correct basal dose should ensure that you can go without eating and not go up or down significantly. Another less scientific way to do it is by looking at your numbers (this is how I do it). Your basal influences your fasting blood sugar, your bedtime blood sugar and the times before meals. Up to about 2 hours after meals (longer if they are high carb/high fat) your blood sugar is affected by your food and bolus doses. So if you look at the times I mention above and see a lot of highs, chances are your basal is not enough. If you have frequent lows say during the night or when you are due for a meal, then your Lantus is too high. But if most of the highs you are experiencing are after your meals then you need to alter your I:C ratios to take a larger bolus insulin instead.
If, as you seem to suspect, you aren’t taking enough, then try increasing it by one unit at a time and sitting with that for about 3 days to see the effect on your blood sugars. If they are still high, then try another unit.
Ditto- that is what I did…
1- Focused on my Bedtime to AM 1st
2- I wanted to get up with a 100 BG
3- But biggest problem using Lantus? It peaked on me and got too many Hypo’s, even reducing it considerably and then if too little? No Hypo’s over nite, but High Mornings
4- So I would just take the lower Dose of Lantus and Set my alarm for 3-4 hrs, test and if I was too high? I would take a CB ( Correction Bolus ) of NLog and 3 hrs later when I got up was fine.
5- Then when Levimire came out I tried that and No More Over Nite hypo’s and nice AM Bg’s now on the ave of 5 out of 7 mornings a week… other times? Too low ( 70’s )
6- and Important for me to go to bed with Good BG’s ( 90-120) and if above that? I have to take A CB for that as well and if Way too High At Bedtime? (a) Take a CB (b) Set the Alarm for 3 hrs and test again and be ready to take another CB…
It’s just the price one pays for “not following the program” going back to either Dinner or Eating Some High Carb Snack, etc… too late or Not taking the Right Bolus for it…
It’s a Constant Balancing Game… and it doesn’t give you an Inch of play either…
You may find getting on a Insulin Pump is a better option, if you can get one
Split the 25 units in 2 am and pm you will do better. Get a book called :" using insulin" does give a procedure to set your basal and bolus insulins.
I find myself not answering if your Lantus dose is high enough, but if it’s low enough.
If you are not over-correcting after meals, I am concerned with the lows that may be produced by the peak of Lantus and the highs in blood glucose when it has finished working, maybe 16-18 hours after dosing.
In your case those high BG would be coming thru the afternoon and evening. And if its then that the highs are coming, you need split dose.
You will find if you skip a different meal each day for 3 days you can test yourself pretty much around the clock, writing it down and filling in the blanks for every hour.
What split of the total dose depends on you. Some people take 2/3 to 70% in the morning and 1/3 to 30% at night.
I take 4/5 at 7 am, and 1/5 at bedtime. Depends on your metabolism. I believe in determining what the LEAST is that will get you through the night without a low and give that at bedtime.
Then give the rest in the morning when you’re wide awake and can test to see where you are.
Remember, It takes 3 days to settle out. Be ready with glucose tabs. Recognize that your daytime dose will be active til 1 am or so. Recognize that your bedtime dose may peak about then. Recognize that your bedtime dose will be active through the morning.
All day should have it within 30 mg/dl of itself. I’ll sure agree that between 80 and 200 would drive me bats.
I remember a physician telling me that my blood glucoses couldn’t be due to Lantus peaking and not active for a full 24 hours. He had a bunch of quiet people in his practice. Think in terms of its action maybe being for 16 hours and look at your blood glucoses to see if maybe that’s what’s happening. Best wishes tweaking.
And remember your A1c is an average. your highs and lows are cancelling each other out. You don’t want to live like that.
Great answers here. I want to reiterate that the 3 day rule is a good one. I find that I can tell the effect of a change in L dose by the 2nd day but if I want to be sure of it, I should wait 3 days before making another change.
If you are battling lows and highs every day, then I would suggest doing some basal testing. Like Zoe & Anthony mentioned, John Walsh’s Using Insulin goes into some detail how to do it. Here is an article by Gary Scheiner that also describes it some.
Both John Walsh & Gary Scheiner suggest using 8 hour shifts with the overnight being the most important. I do my testing for 24 hours – if you are trying to figure out how long your Lantus is lasting, then doing 8 hour shifts really won’t cut it. You don’t want to go up or down by more than 30 points – if you start at 100, you should not drop below 70 or go above 130. John Walsh actually says not to go up by more than 15 and Gary Scheiner says 30.
Lantus was very unstable for me but in fairness, I used it before I learned how to do basal testing. I was taking more than I should have in order to get it to last the full 24 hours – the more you take, the longer it lasts. I would take it at night and wake up in the 40s but if I cut back, then I was high later in the day. I would split the dose before I would add more because you are only going to create bigger rollercoasters by adding more.
You could do a basal testing as the others are mentioning. I skip two meals and I test more frequently and I don’t do exercise. If my numbers creep up and up then I increase lantus by one unit. I test this again in a few days and if I still creep up I increase lantus my one unit once again. If I get low during the test I cut back one unit of lantus. It works pretty well for me. I take about 15-18 units of lantus depending on my activity level and stress level and even if I’m pms’ing. I adjust my lantus up and down all the time but only by one unit at a time to avoid scary lows or highs. Good luck!
ok, it’s July 12. Keep us posted!
I wouldnt take more. It sounds like you are managing very well to get A1c to be a 6…I think you may want to adjust your eating. I found that if I eat more protein or a piece of fruit in between meals I dont get low as much.
Thanks everybody!! It means a lot to me that so many people had such detailed advice. I’m going to start the basal testing and get the book about using insulin. Looks like I’ve got some work to do but I’m a mad scientist, so it shouldn’t be a problem. Thanks again and I’ll keep you posted
By the way everyone, I got the book (which is AWESOME) and I did the basal testing method and have been recording all my readings and boluses (boli?). So far, I’ve added one unit of Lantus to my night time dosage and I’ve been careful not to over-correct highs and lows. This book Using Insulin: Everything You Need For Success With Insulin is amazing! I also ordered Think Like a Pancreas by Gary Scheiner. I’m excited to figure this all out and start to feel better. Good luck everyone!