Lantus not working?

Well,after a good start Lantus doesn't seem to helping or am I being impatient? I'm currently on 12 units going to 14 tonight. Woke up to a 178 and haven't dropped below that all day. I'm taking 2500 mg of metformin in combination(I've taken that for years) The doctor asked me to discontinue my Glipizide for now.
Had a fairly light lunch followed by three sugar free candies. 2.5 hrs later,215. I was doing better than this on glipizide and metformin.

P.S Threw in a brisk walk as I always do walking the dogs for a mile.

Yes, you are being 12 units of Lantus is a very low dose for a type 2! Also if you are regularly hitting numbers like 215 2 hours after meals you may also need insulin for bolus. Insulin can be a wonderful tool so don't be discouraged. When you find the right dose(s) you will find it is very helpful.


Zoe is right, 12 to 14 units of Lantus is a low dose for a T2, Doctors almost always start T2's with a very conservative dose and then build from there.

With the insulin resistance that most T2 have larger amount are often required. There are no problems with taking more as long as you don't experience low blood glucose. Blood glucose levels are the only limiting factor with insulin.

I was in your shoes 2 years ago. With my doctors guidance I continued increasing my basal amounts until it became clear that basal insulin alone was not going to do it. Short acting bolus insulin was added at meals and I was finally able to get this monster under control. I have gone even further and use a pump now.

Another thing Zoe is right about is that insulin is a wonderful tool. Everyone's diabetes is different and there is no way to tell whether you will need bolus insulin or not. I just want you to know that I have found it to be the best treatment option and would not want to go back to the oral meds.

Thanks Stemwinder.
Formerly,I was using Byetta which aside from plugging me up ceased to function as designed. I also just lost a childhood friend to pancreatic cancer and wanted to lower my chances of contracting that awful disease.
My doctor is 68 now and winding down his career. The patient overload and godawful load of paperwork is getting to him.
I have to nudge him on my case as I seem to take the disease more seriously than him anymore.
Great guy,but I'm urging him to retire and enjoy sleeping in and not thinking about patients anymore.
I'm going on thirteen yrs with this crap,but have minimal negative effects especially the eyes which are doing pretty well.

I have taken Byetta also with the same results. I'm over 20 years with T2 and I have the best control I've ever had now.

It might be a good time to find a new doctor. Have you considered seeing an Endocrinologist. If you are just starting with insulin it might be best.

I'm actually working closely with my group's diabetes educator as well as him. It's just going to take time. I'm famous for expecting instant results. just going to have to avoid starch carbs and keep my exercise up.

I would agree with others, your Lantus is likely not even close to what you need. As a T2, I struggle with my fasting blood sugars and use about 50 units of basal a day. I found the books "Using Insulin" by Walsh and "Think Like a Pancreas" by Scheiner really helpful. According to these sources, a typical protocol is to start with a small dose (as your doctor has) and make 20% adjustments upwards until there is a noticeable change in your blood sugars. This establishes your physiological dose. From there, you make smaller adjustments, 5-10% up or down to gradually refine to the proper dose. You need to wait several days, or even a week from basal dose changes in order to fully observe the changes. Typically you will send in your blood sugar readings to your doctor or CDE and they will guide you through making these adjustments.

I have to be honest with you. If you have been on Glipizide for some time, you likely have little beta cell function left. If you really wish to get on top of things, it would be appropriate to ask your CDE and/or doctor about starting a rapid meal-time insulin to your treatment. A basal insulin is useless for dealing with the rise from meals and raising your basal to try to compensate for meals is a recipe for weight gain.

Thanks. I was 133 this morning with light pm eating with 14 units. Just finished off a cup of Cheerios w/three banana slices and a dab of 1% milk. I'll check in 2 hrs. Lunch should be under 180 after 2 hrs according to my guidelines.

Wht I'm finding too is that the sugar-free candies are adversely affecting my levels apparently. I'll start minimizing them in favor of a small apple w/peanut butter in the evening followed by yet another bike ride or walk.

Thanks for the book recommendations.

A reading of 133 mg/dl is actually pretty good. I have to tell you, I eat a lot less carbs. By my count, your breakfast was about 70% calories from carbs. I couldn't hope to eat that and maintain good blood sugar control. I'll typically have a cheese omelet and perhaps a side of sausage. And I agree with your experience on the candies, they often contain sugar alcohols which are carbs and in some cases are no better than regular candies.

Returned from a bike ride and am reading 138. I eat Kashi Original sometimes also. Lots of fiber and protein to slow down the absorption of carbs. It does contain sugar though. Haven't had a glass of juice in yrs.
One thing I need to mention is that I've never seen a A1C over 7.8%. My last was 6.8%. It's the morning highs and post meal peaks that I'm trying to moderate. I've also had two frozen shoulder operations that are tied to elevated glucose levels. You don't want that. Sucks bigtime.
Doc got back to me and said as others here that I'm still real low on the Lantus level.
I'm retired from a job as a truck driver. That job enabled me to eat fairly normally,but since retiring it's tough to mimic that level of activity.

Lantus can really help with highs that you have upon waking. These are called Dawn Phenomenon, although I call it Darn Phenomenon. Lantus really won't help with post meal peaks, for that a low carb diet and a rapid mealtime insulin are the best treatments.

Yeah,we'll see if I can knuckle down and behave. My father,uncle and grandmother had diabetes on both sides of the family. My sister is seriously overweight but thankfully hasn't got it...yet.