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New to Lantus

12K views 25 replies 10 participants last post by  ln3158 
#1 ·
Hi,

I am new to taking Lantus. I take it once at night along with metformin ER 1000mg twice daily.

Normally prior to starting Lantus my numbers always rise right before I wake up (no matter how low it might be prior) and like to be around 130 or 140 when I wake up. She switched me to Lantus and said it would help with the morning highs (plus I requested it).

So far I've taken it for 3 days. The doctor started to have me begin by turning the dial to 10 (don't know what the number stands for as of yet), but changed her mind (due to my husbands concerns) and told me to start at 5 and go up 2 at a time from there.

First night I was at 157 before bed (ate too many carbs close to bedtime.. I think I was nervous about lows), turned the dial to 5 on the pen. In the morning, I was 119.
Next night I messed up and ate birthday cake and ice cream right before bed (again likely due to being nervous about lows) and was at 185. Turned dial to 6 on the pen. In the morning I was 140. Last night I was at 125 before bed and turned the dial to 7. Got nervous and ate two peanut butter crackers. Woke up at 3am and it was 94. Was worried it would go lower and ate one more peanut butter cracker and it was 115 when I woke up.

So my questions are the following:

Do you adjust your lantus dose based on what your sugar levels are near bedtime (that is when I am supposed to take it), or do you just give the same dose every night regardless?

Do you wake up if you go low in the night?

How do you settle on the daily dose?

How do you keep from being nervous about going low? (wouldn't be so bad except it will likely happen when I'm asleep which is freaky)

I think if I had not eaten the two crackers last night I might have dipped down near a low. The additional cracker at around 4am was definitely overkill. Tonight I think I'll try 6 again and try not to chicken out and eat anything extra. Will also try to be a good little carb girl and quit being a chicken.

Any advice would be appreciated :)
 
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#3 ·
Lantus is a long acting basal insulin think like an extended release pill. It is not taken according to what your BS is at the time or carb intake. That would be a short acting insulin such as Humalog or Novalog which are bolus insulins.

When you dial your pen to say 10 that is how many units you are taking.

Someone will come along to explain exactly how it works. I personally took 30u a day split into 2 injections of 15u at 7am and 7pm. I found that one injection a day didn't cover me.

It may help to give your injections in your stomach area pinching up the skin. Cold insulin can also cause stinging. Once you have done it for awhile the discomfort may subside. I was at 8 injections a day when I switched over to a pump. I am T1.

Sorry I can't be much more help. Someone will come along soon that can explain it all better :)
 
#4 ·
I don't adjust my Lantus according to my bedtime numbers but rather by my fasting numbers. I adjusted up until my morning fasting numbers were less than 100. I have gone low occassionally at night but it has always woke me up with either "looping type" dreams or night sweats. If I am below 90 when I go to bed, I usually eat a snack high in fat. I have more problems with lows at night if I eat a carby snack before bedtime. BTW, I didn't know you could give Lantus in the arm, I was told either stomach or thigh. I do stomach.
 
#11 ·
My endo said arm was one of the options. I prefer it because for some reason I feel like my stomach is a more vulnerable area LOL Guess I am an armadillo. Plus with it being in my arm, it is easier to look away when my husband does it. I used to be terrified of needles and even now I can't look. So far I am also too chicken to do the shots to myself since it requires looking.
 
#5 ·
jojeti said:
I don't adjust my Lantus according to my bedtime numbers but rather by my fasting numbers. I adjusted up until my morning fasting numbers were less than 100. I have gone low occassionally at night but it has always woke me up with either "looping type" dreams or night sweats. If I am below 90 when I go to bed, I usually eat a snack high in fat. I have more problems with lows at night if I eat a carby snack before bedtime. BTW, I didn't know you could give Lantus in the arm, I was told either stomach or thigh. I do stomach.
I was told any of the four locations: arm, stomach, thigh, or upper buttock. Have used all but the buttocks with only occasional issues. Worst is an occasional pain from stomach injections when I catch a hair follicle, usually lasts less than a minute. Other than that it's itching.

Sent from my iPhone
 
#6 ·
Since Lantus is a basal insulin, trying to find the right dosage is tricky. Food is what is messing you up. Try not to eat any carbs for four hours before you take it. You should target being at about 100 before your dose. Then adjust the next night based upon your morning fasting number. If you are nervous set an alarm for half way thru the night and check bg. Adjust bg if too low (glucose tablets work best). If you don't know how much to take to raise bg 20 points do some testing by taking a known quantity and then testing 30 minutes after. By eliminating food, you counter the metabolisms glucagon contribution with the basal insulin. Once you know what the amount is - you take the same amount every night.
 
#8 ·
A rule of thumb for your daily insulin needs is to take your weight in pounds and divide it by 4. I'm about 185 lbs, so 185/4 = 46.3, so my daily insulin need is about 47 units. The next rule of thumb is to take your daily insulin need and divide it equally between basal and bolus insulin. Thus, for me 47/2 = 23.5. So, with rounding I take 25 units of Lantus every evening and then save the other 22 units for bolus, fast-acting insulin before meals.

A Lantus pen is filled with 3mL of insulin glargine at a strength of 100 units/mL. So each notch on the dial represents 1 unit or .01 mL of Lantus.

As everyone else has mentioned, you can't base how much basal insulin you need upon your blood glucose before you go to bed. The amount of basal insulin you take should remain fairly stable over time, only needing to be changed as your weight changes or if your diabetes progresses. The general advice is to start with say in your case 5 units per night, then add 1 unit each night until your fasting blood sugar is under 100 mg/dL. Believe me, adding 1 unit of Lantus is unlikely to make a difference of you being 110 mg/dL one night and 45 mg/dL (a hypo) the next.

I would recommend you get the book "Using Insulin" by John Walsh. It's an excellent reference on the different types of insulins and how to properly use them.
 
#9 ·
Well by the time I saw everyone's messages I had already eaten dinner and my sugar level was like 140 at bedtime. Grrrrr I thought I ate less carbs than that. Anyway, I took 6 units at 10pm and woke up at 2am thinking I was going to throw up. At that point it was 109. I took two antacids and prayed I wouldn't really throw up and eventually went back to sleep.

I was 122 at 5:20am this morning (I'm guessing the sugar in the antacids messed it up a bit?) Then it rose to 140 by 7am. Not sure why. Then I ate an egg mcmuffin with 1 side of the muffin and now I'm sitting at 190. I really have got to cut the carbs down better! Normally I don't usually eat more than 5 in the morning. I'm pretty sure that egg muffin was probably closer to 15g even with just one bun.

I didn't think switching from Janumet to Metformin ER would cause me to feel ill again with it having the same mg of Met in both, but I think it is as I still feel slightly nauseous this morning, have abdominal cramping, and keep having to run to the bathroom.

Also, I've really got to find some sugar free antacids! I've only seen them online and not in the stores.

I'll try again tonight and let ya'll know how it goes. I plan to take 7 units this time and will try to eat early enough (is difficult because I don't get home until 7pm at the earliest).

I hate how dumb I still am about the amount of carbs in foods and also about how many carbs I should be eating! Ugh.

Not sure why, but I keep waking up in the night. Perhaps it is because I am still nervous?

Thanks for everyone's advice!
 
#12 ·
After one experience, I don't ever think I'd want to try an insulin injection in my arm again. Wishing to give myself more options to rotate my injection sites, I decided to try my left bicep. The needle hurt during insertion, the insulin burned during delivery, and a small amount of blood/insulin came out of the injection site when I removed the needle. That was even with using a BD Ultra-Fine Nano 4mm 32G pen needle, the smallest needle on the market.

My abdomen and the back of my thighs are the places I use. I use two different sizes of needles: I have the aforementioned BD pen needles and I have Novofine 3mm 30G pen needles. I actually prefer to use the longer and smaller gauge needles in my abdomen and the shorter and larger gauge needles in my thighs.

In my experience, injections given by other people always hurt more than injections I give myself. Most times (and I’m not exaggerating) there is no sensation of pain or discomfort whatsoever during an insulin injection nor is the blood/insulin leakage from the injection site. A proper subcutaneous injection is delivered just under the skin into a layer of fatty tissue; it does not penetrate deep enough to interact with pain-sensing nerves or blood.

I’d encourage you to try an injection on yourself. Most people would agree, the first time is the most difficult to do, not from a procedural perspective but from an emotional perspective. Once you do it and realize it’s survivable, the phobia goes away.

Look at it this way, you already know what the pain of someone else giving you an injection feels like. Do you like it? No. Did you survive it? Yes. Was it the worst pain you ever or will ever experience in your life? Not likely. Have you suffered through worse pain in the past and overcome it? Absolutely.

You already have the experience and the ability to overcome this phobia, all that remains is to make the attempt. As I said, it’s very likely to hurt much less (if at all) once you begin giving your own injections. It also gives you a sense of empowerment in taking control of your body and diabetes.

One practical tip is to prepare your mind to feel that tiny “pinch” and then as you insert the needle, do not rush it, but also do not hesitate. My worst injection experience so far came when I first began giving myself injections. As I inserted the needle I felt a twinge of pain. Rather than just following through, which would have resulted in no more pain, I jerked and pulled the needle out at an angle. In the end, it was my fear and my hesitancy which caused that unpleasant experience. I can’t imagine an injection going much worse than that and ever since then, my injections go smoothly and nearly always without discomfort.
 
#14 ·
I know your fear quite well. Ive had seizures and fainting spells from injections and blooddraws in the past. I still experience the fear from time to time, but I've only been doing this for 7 months. I still think there's something weird about intentionally sticking sharp metal into my skin. Lol

The first time I tried injecting I was still recovering from severe DKA. The nurses worked really well with me and gave me lots of advice and encouragement. But when it came to actually doing it...well, no matter how long I looked at it, that needle wasnt going in on its own.

It was funny now that I think about. I must have spent 5 minutes trying to get up the courage. Moving my hand up and down getting close but not quite. I was squeezing so hard that I left a bruise on my stomach from the nerves. I failed on that one and just had the nurse inject my arm.

The next meal I had a different nurse who made some suggestions. Do the first one in my thigh because its less sensitive and a larger area. He also said to think of it as playing darts. Just one simple quick movement. I actually did it! I had been in my hospital room for week by then getting injections several times a day but that was the first I did on my own!

After that one injection the mental barrier was broken and for the most part it gets easier everyday. Just those occasional times where the fear comes back, but those are becoming fewer and fewer.

I know you can do this. It will get easier once you get the first one out of the way and break that mental barrier.

Sent from my iPhone
 
#15 ·
I was subjected to some serious peer pressure when it was my first time.

Wait a minute, what is the topic again? Oh yeah, insulin injections. For a moment there I forgot which forum I was replying to.

Anyway, I had no experience with injections, never saw anyone give themselves an injection before, never held a hypodermic needle or syringe before. Well, I'll take that back, I think I once mixed some epoxy that came in syringes, but I digress...

I went to the student health clinic to talk to one of the nurses there who told me when my insulin came in that she would show me what to do. She grabbed a couple needles and syringes and a bottle of saline. She rolled up the bottom of her shirt, pinched together some skin on her stomach, inserted the needle, and pushed in the plunger.

All the while I was holding my setup with what had to be a dumbfounded look of astonishment on my face. She then asked me, did I want to give it a try? For a moment I stammered something about not being ready and I felt the next words out of my mouth were going to be "I'll try it later."

Then the magnitude of the situation hit me harder than one of Chuck Norris' fists. This nurse, this amazing and wonderful nurse, whom I barely knew, was willing to get a needle and inject herself with saline, because her heart was big enough to want to help me get well rather than eventually die from my lack of insulin.

I don't remember exactly what I ultimately ended up saying. It was something along the lines that I would have to be a pretty big **** to let someone stab themselves in the stomach to help me and then not have the **** to do it myself. And as they say, the rest is history.
 
#17 ·
So far I am taking 8 units now and my morning sugar was 114. Am planning to up the dose again tonight. It's looking like 10 may end up being the number, but is still too early to tell. I definitely slept better last night than I have in ages.
 
#18 ·
Put your mind at ease. Lantus is a very slow acting insulin. I went from 0-40units with in 2 weeks time and had the same fears as you, but my liver was very capable of keeping up with demand for glucose.

Thats another problem I found with Lantus, hunger. You have to be cautious with the amount you use, too much and you liver kicks in to make up the difference and your hunger level increases. To little and its ineffective.
 
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#20 ·
Thanks for the tip about hunger. I'll keep an eye out as I do not want my weight to creep up.

Prior to diagnosis I was dealing with extreme hunger (didn't know it was the diabetes talking) while trying to keep my weight in a good range. I kept wondering why a lot of people weren't as hungry as I was. I felt hungry non stop all day.

Ever since I got put on met however, I have to remind myself to eat and even then I really don't feel like eating a whole lot. Hopefully since I am still on met it will help, but it is a definite worry of mine about gaining. I ballooned up real big in my mid 20's and I do not ever want to go back to feeling that awful.

Yeah I don't know why I was so nervous about going low on Lantus. I mean yeah it is possible, but so far I have yet to go lower than 94 on it.

I think the main thing I will have to watch is going too long without eating. Sometimes I get trapped in a meeting at work or we go to a family get together and the food is very delayed to get on the table.

One time even on just Met I had my first false low because I forgot to eat breakfast and they didn't serve lunch until 3. By then I was shaky and feeling really weird. Was around 100 I think. So I really was fine, but didn't feel fine since I probably hadn't been at that range in ages.
 
#19 ·
MCS said:
Put your mind at ease. Lantus is a very slow acting insulin. I went from 0-40units with in 2 weeks time and had the same fears as you, but my liver was very capable of keeping up with demand for glucose.

Thats another problem I found with Lantus, hunger. You have to be cautious with the amount you use, too much and you liver kicks in to make up the difference and your hunger level increases. To little and its ineffective.
Well that explains quite a bit. I was wondering why things went the way they did for me.

Thanks!

Sent from my iPhone
 
#21 ·
A confidence building exercise I did when first Dxed was to fast before I ate dinner. My lowest readings are always before dinner, most people, D and non D alike have their lowest reading before dinner. Has to do with your 24hr hormonal curve. When I got home from work around 5:00pm I would test, I was hungry and stomach was really talking to me, but I would wait and test with every increasing hunger pain around 15-30 minutes to see how low I would go before my Liver would compensate for the lack of food. The lowest I would go was 65 and then my liver would bump me back to the mid 80's and the hunger would mysteriously go away. I did this for several days, it really boosts your confidence that you will not go to low. If you do go to low, there is food readily available to bring you back up. I used this information to my benefit, now when I come home I immediately eat a cheese stick so my liver doesn't kick in and I stay as low as possible before I eat dinner. A 30pt rise from 70 is a whole lot different than a 30pt rise from 80-90.
 
#23 ·
Man, people were not kidding about the hunger thing on Lantus. I haven't felt this hungry since before I was diagnosed! I literally have to physically move away from the food to keep from wanting the shovel down tons of carbs!

It's either that, or the Janumet was curbing my appetite a lot and now that I am only taking met, it is back to normal?

So far I am taking 12 units before bed and as long as I don't fall off the carb wagon my morning readings are around 90-100 and 2 hour after meal readings tend to be around 110-130 depending on what I eat.

However, if I so much as stick a toe off the carb wagon my sugars are zooming up to the 200's easy which wasn't the case on Janumet. I'm still taking metformin but I guess that doesn't help the meal numbers much does it? I do notice that the numbers gradually come down but it takes longer than 2 hours to do so unless I get moving.

Is that typical? Or does that mean I should increase my Lantus a teeny bit more? Or do I just have to be a carb angel?
 
#24 ·
annsrum said:
Man, people were not kidding about the hunger thing on Lantus. I haven't felt this hungry since before I was diagnosed! I literally have to physically move away from the food to keep from wanting the shovel down tons of carbs!

It's either that, or the Janumet was curbing my appetite a lot and now that I am only taking met, it is back to normal?

So far I am taking 12 units before bed and as long as I don't fall off the carb wagon my morning readings are around 90-100 and 2 hour after meal readings tend to be around 110-130 depending on what I eat.

However, if I so much as stick a toe off the carb wagon my sugars are zooming up to the 200's easy which wasn't the case on Janumet. I'm still taking metformin but I guess that doesn't help the meal numbers much does it? I do notice that the numbers gradually come down but it takes longer than 2 hours to do so unless I get moving.

Is that typical? Or does that mean I should increase my Lantus a teeny bit more? Or do I just have to be a carb angel?
From my experience (and thanks to MCS for this nugget of info), if you are hungry while taking Lantus you might be taking too much. That's why you feel like you have to force yourself to stop eating. That was what worked for me. Once I began cutting down the dosage, even just a unit or two, made a big difference in appetite since I didn't have to eat to make up for the extra insulin.

Again, that was my experience

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#26 · (Edited)
I have been prescribed a great combination of insulins. Lantus and Humulog. I take one dose of Lantus in the morning and if my blood sugar is over 120 I take Humulog. Lantus last 24 hours so it covers you the whole day. These 2 combinations of insulins have brought my blood sugars to normal range. I eat small portions at each meal, low carbohydrates and drink 2 glasses of water at each meal. I do not have any cravings and only consume sugar free foods. I also
have 3 protein snacks per day that are sugar free.
 
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