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Old 05-14-2012, 21:32   #1
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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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Old 05-14-2012, 21:54   #2
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Also my husband has been injecting it into my arm and it stings! Not really the needle, but afterwards. Anyone experience this?

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Old 05-15-2012, 02:01   #3
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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

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Old 05-15-2012, 03:47   #4
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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.

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Old 05-15-2012, 04:32   #5
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Quote:
Originally Posted by jojeti
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.

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Old 05-15-2012, 04:37   #6
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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.

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Old 05-15-2012, 05:13   #7
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Thanks for all the advice & info.!!! I will try to follow it and report back!!!

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Old 05-15-2012, 05:59   #8
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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.

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Old 05-15-2012, 15:00   #9
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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!

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Old 05-15-2012, 15:01   #10
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Quote:
Originally Posted by policebox View Post
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.
I'll definitely look into getting that book. I don't have anything but one dose of basal insulin at this point. No idea if that will change or not. But would like to know more about insulin.

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