Re: Normalizing Lantus Insulin Dosages

June 4, 2004

I have a question for the members of this discussion group. Are most members cut

loose to determine their own diabetes treatments, or are many members under the

expert care of a full corps of diabetes related clinicians? I had clinical

assistance working my way through all of my treatment options and diet

issues.---ROLF

[alldiabeticinternational] Normalizing Lantus Insulin Dosages

GREETINGS --

The following is a description of the Insulin Normalization process

that I went through when I first started using Lantus. This presumes

that the normalization will be done using a bedtime injection

strategy. If you have any questions after reviewing the information

please post it here or send an Email to me.

wambo1941

Insulin Normalization

DOSAGE CALCULATION -

Your principal goal here, as a first step, should be to establish the

smallest possible dosage of Lantus that works for you, to determine

how long a shot of Lantus works in your body, and to determine an

injection schedule that best serves your needs. In the case of the

dosage size your efforts may be complicated initially by two factors;

the unknown effect of any meds you are taking on your body's

resistance to the insulin and any possible elevated early morning

(fasting) blood sugars. The non-diabetes meds should be treated

as " givens " and you should not expect the Lantus to address any early

morning highs if they exist. What is needed here is to minimize any

unanticipated fluctuations in your blood sugars.

It took me about one week when I first started for my body to get

used to the change (from Humulin N to Lantus), but that may not be a

factor in your case. Also, I have found that I realize my best BS

control when my Lantus makes up 50-55% of my total daily insulin

dosage. This allows me to skip or delay meals and still keep my BS

relatively level. That is why I went through the fasting exercise

when I normalized my Lantus dosage. I have also found out that even

one unit of Lantus can make quite a difference so I purchased some

3/10 cc BD syringes w/ half-unit increments marked on them.

It is important to minimize the variables in the Lantus normalization

process and thus the fasting exercise. I also suggest that you

suspend your exercising regimen during the testing periods and do the

test on a day you are not working.

The following steps are involved in the normalization process:

1. Measure your blood sugar at least three hours after completing

supper (so the effect of the food and any rapid acting (bolus)

insulin are minimized)(It takes that long for the food and bolus

insulin to work their way through your system) and inject your Lantus

dosage.

2. When you arise in the AM (at your normal time) measure your blood

sugar and take whatever non-diabetes meds you normally take and plan

on not eating until late afternoon or early evening. Drink water but

no other liquids during the test.

3. Continue to measure/record your blood sugars hourly for the

duration of the test -- that will last nine hours if successful. If

your blood sugars drop below 60 mg/dL or rise more then 30 points

above the first AM reading at any point discontinue the test, eat

some food, and proceed with your normal day. If your test is

successful then you have established your basal dosage. If it is

unsuccessful you should allow your body to adapt for a couple of days

(using the same dosages of insulin) before trying again with a higher

or lower dosage.

4. If the first test is unsuccessful (and it probably will be) you

want to try and " bracket " what will ultimately be the correct dosage

so you can do some fine tweaking. If your initial dosage is too small

you should increase the Lantus dosage by 2-3 units (depending on how

rapidly your blood sugars increase) and proceed to the second test

following the same procedures as the first test. If your initial

dosage was too large you should decrease the Lantus dosage by 2-3

units and proceed to the second test following the same procedures as

the first test.

5. Once you have established a good bracket (i.e., the trend

established during the testing process is reversed by the latest

test) you should conduct one last test to confirm that the dosage is

correct following the same procedures as the first test.

6. Once you have established the correct dosage you should then

determine the period that Lantus remains active/effective in your

body. This portion of the test does not require fasting. The test

involves taking your blood sugars on an hourly basis starting 17

hours after your Lantus shot - which is likely to be about mid-

afternoon if you inject the Lantus before going to bed. If Lantus is

not effective for the full 24 hours in your body your suppertime

blood sugars are like to be higher then they should be (assuming that

your bolus insulin is properly dosed). If this is the case you have

some options. You can increase your supper bolus dosage to cover the

elevated blood sugars (but be careful of hypoglycemic events), you

can try splitting your Lantus dosage (50% at bedtime and 50% 12 hours

later), and/or you can try changing the time of your Lantus shot to a

time that works better for your body.

7. Once you have conducted the other tests you might want to look at

the advantages/disadvantages of various injection schedules. I tried

three different injection schedules during the last few months

(night, morning, and split). I now inject at midnight which I

selected for convenience as much as anything. I have a target BS of

100 mg/dL at bedtime and the same numbers when I awake in the AM -

and this happens for me, on average six times a week. I found that

the Lantus shot lasts for 24 hours in my case so I am lucky. I

noticed slightly better control with a split dosage, but I had

trouble remembering to take the AM ½ of the dosage (my alarm clock

only worked as a reminder when I was around to hear it) so I gave up.

I can think of only two other reasons to split your doses of Lantus;

if the effective life of the Lantus in your body is less than 24

hours or the dosage is large so the Law of Small Numbers (per Dr.

Bernstein's Diabetes Solution) kicks in.

8. There are some other idiosyncrasies of Lantus that I experienced

that you might need to learn if you haven't already discovered them.

These are things you learn from use and are not in the directions

that accompany the vial of insulin. First, Lantus should be

refrigerated between shots because it is temperature sensitive.

Otherwise it will lose its potency over time. Second, you will need

to be careful about Lantus losing its potency after 28 days that will

result in the upward " creeping " of your blood sugars. I end up

trashing a vial that is still 1/3 full for this reason. Third, once

you establish a schedule for your Lantus injections you should keep

it religiously. Otherwise you will start getting unpredictable

results with your blood sugars. Fourth, over time, assuming your

body's sensitivity to insulin changes, you may need to tweak your

dosage (upward if you gain weight or lower if you lose weight).

In conclusion the whole process of normalizing your Lantus insulin

involves a lot of scut work (another term for trial and error

testing), but the results are worth the effort.

wambo1941

June 5, 2004

Sounds like you have a good doctor , I love mine... have to kinda feel

sorry for the poor guy, he has me as a patient...lol.. I take a very active

stance in my health care, I am not one of those that the doctor can run in

check my ears, hand me a prescription and run back out again... with me, if

you are going to treat something, you have to know what you are treating,

and be ready to sit down and explain what you are treating, why you are

using a particular method to treat it, and know if there is a alternative

treatment available.. When I got diagnosed, the Doctor first wanted to just

treat the symptoms without testing to find out what was going on, told him

" No " we weren't going to do that, he would schedule testing and find out

what was going on, then we would treat with a purpose...once the results

were back, he took two hours to sit down with me, and go over all my

questions, I in turn did a lot of research on the web, and then attended

classes with a Diabetes Educator... I go in every once an a while with a

list of questions about what is going on with me...I keep him up to date

with my list of medications, how they are working or not working, and I can

call and be in his office within 30 minutes of calling, not having to wait

two weeks for a appointment..

So far I have been blessed, that I haven't had to take insulin, I hate

needles and dread the thought of ever having to give myself shots, but if

the needles for that are like the lancets that I use for testing, I can deal

with it I think, my baby brother has to give himself daily shots for his

MS..

Carmen

----- Original Message -----

> I have assitance. I do not think I could do it all by

> myself. I can call my doctor anytime and she will

> call me back. I even fax in my BG weekly sometimes

> when things are good crazy. Take care

>

> Bartlett, TN

June 5, 2004