Hypos on Lantus

Help. My mother, who is 86, is a T2. Her regime, set by the Endo,is 40 units Lantus at breakfast and supper and 10 of Novorapid at lunch. Recently she has had a number of lows, in the 3.0 to 4.7 range and where she dropped to 2.2 and spent a number of hours in the ED. I think the lows may have something to do with the fact that I’ve moved in and taken over the shopping and cooking and that she can no longer get to Walmart to stock up on cookies etc. So basically she’s getting a healthier, lower carb diet. Could this change have affected her pancreas so they’re correcting he sugars naturally? I must say though that she is obese and weighs in excess of 120 kg. Any advice, pleas. We seeing the GP next week but need a referral to the Endo from him.

One of the weaknesses of a fixed dose insulin schedule is that it doesn’t take into account things like a diet change. Even without a diet change, life can throw plenty of items at you that should be accompanied by changes in insulin dosing. Getting sick, having a bad night’s sleep, or even some extra stress can require different insulin needs.

I think you make a good observation. Your mother’s current doctor-specified regimen is now mismatched to her new, lower-carb food intake. If it were me, I would try to restore some of your mother’s old food habits until you can make some corresponding insulin dose changes after seeing an endocrinologist.

You might check out the low-carb eating information at Diabetes UK. This type of information may help your mother’s endocrinologist to better understand the type of diet you prefer for your mom.

At this point, I think your mom would be safer reverting to some of her old food habits and avoid any more hypos, especially one where she need to visit the ED. Food changes need to be accompanied by insulin dose changes. I agree with your sentiment that your mom would do better reducing her carbs, but it will need to be coordinated with insulin dosing changes.

Unfortunately, you may run into some pushback from the medical professionals over this. Good luck! Are you a type 1 or type 2 diabetic, if you don’t mind me asking?

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I am T1, so no c pep etc, and mum does have trouble distinguishing that I’m different from her so I’m far more strict about my dosages and carb counting etc. In spite of the title I’m now living back in Canada, moved back from a UK last September, and boy do I miss the NHS, especially the but where I didn’t pay for my insulin, only through my taxes!

I’ve been following the career of Dr. Eric Westman. Here’s a short bio taken from Duke Health, a hospital that he is affiliated with.

I am an associate professor of medicine, the director of the Duke Lifestyle Medicine Clinic, and medical director of the Duke Center for Smoking Cessation. I am board certified in internal medicine and obesity medicine, and I have a masters degree in clinical research. My clinical research and clinical care relate to lifestyle treatments for obesity, diabetes, and tobacco dependence, and I have over 90 peer-reviewed publications. I am currently the president of the American Society of Bariatric Physicians, and a fellow of the Obesity Society and the Society of General Internal Medicine. I am co-editor of the medical textbook, Obesity: Evaluation and Treatment Essentials, and co-author of The New Atkins for a New You, and Cholesterol Clarity.

Dr. Westman has more recently helped start a new medical business model based on carb limits for type 2 diabetics. There are three or four clinics in North Carolina and Virginia. He is also utilizing remote technologies like Skype. The clinics are know as HealClinics.

I don’t know what’s possible with an 86 year old patient but Dr. Westman’s success in taking most people off of all medications (type 2) in a short time frame might be a promising path to pursue. I have no personal experience taking care of a geriatric type 2, but I’m 65 and starting to appreciate some of the challenges that lie ahead. I would expect most medical advice is going to be very conservative.

I wish you the best!

Here’s a link to one of his videos that explains how he treats his patients.

Seems that your mothers lantus and/or novorapid doses are now too high considering that her diet is lower in carbs.

Has she / you been taught how to reduce insulin doses? Safest approach would be to reduce the insulin doses. Lantus is a basal insulin, it is meant to hold blood sugar stable when one doesn’t eat. Typically lantus is only dosed once a day. So the twice daily dosing alerts me that the endo is trying to make the lantus act to cover food.

It is not meant to cover meals, though it seems that her endo is requiring it to cover food (breakfast and supper). He has then given her a short acting insulin (extra dose of 10 units novorapid) to cover her lunch. Dosing of short acting insulin should ideally be matched to how much carbs and protein a person eats. Then the appropriate dose of insulin is dosed based on the meal.

Do you get to test her blood sugar (fasting, pre and post eating, bedtime)? These results should also guide you on how much insulin is required.

Virtahealth group are also doing great work in getting people off insulin / lowering meds by having them adopt low carb ways of eating.

Thanks for all the help. What we have done is reduce the Lantus to thirty units twice a day, in the a.m, and before bed. This seems to have stabilized her sugars. I take her sugar at lunch and Whatever it is I dose her with the Novorapid to cover the carbs she’s eaten. It’s usually a sandwich, low calorie bread, and vegetable juice. However I just found out that she has forgotten to take her Victoza for nearly three months as she thought it was mine! It is obvious to me that her memory is increasingly failing so not only will I be keeping a closer eye on her illbe getting a glucagon prescription just in case.

IF you are lowering her carbs you NEED to lower her medicine. That’s a fact. Hypos can cause someone’s heart to stop. Not something you want to take a chance with with someone’s who’s 82 yo. Good I’m glad it’s working out well. My nanny (I’m from Scotland) had dementia and Alzheimer’s. It was tough. I hope for the best for you and her.

Many people need to split doses of Lantus am and pm because it doesn’t cover 24 hours. My guess is that may be why. Nancy50

Diabetics need insulin. T1 for sure and some T2s.

But make no mistake DIET is the biggest part of the puzzle.

Learn about carbs or you will have BIG problems.