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increasing insulin dose

18K views 62 replies 15 participants last post by  mbuster 
#1 ·
hi
im not sure where to post these questions

do the morning fasting numbers ever go down to
a better or normal number?
and

do i need my RN or NP's permission to increase my
insulin above the prescribed amount in order to
maybe get better morning fasting levels?
do people just increase it then tell their dr/nurse?
especially if it did improve their numbers?
i use lantus
:)
 
#2 ·
You posted in the perfect place!

When we begin control, or start a new med, fasting numbers are usually the last to go down. If I remember correctly, it's still pretty much Early Days for you.

Change may not be necessary right now. Please share your numbers with us, and we may be able to help more.

Permission is not required before a dose change -- BUT -- it's best to get advice before you change, especially in the Early Days.

You may also want to ask if there's a diabetes clinic near you. A diabetes clinic (or educator) should be able to help you to learn how to figure out your own doses.

Many communities provide such services for free, but you'll probably need to ask for them.

Please keep us posted!
 
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#9 ·
i went to the local one here and they highly disagreed with
the lchf and warned me against the low carb intake
and my clinic i have now can do everything the diabetes
clinic can do (except for food advice) in addition to
the prescribing needed. so i felt that it's unecessary
to duplicate services.
the only problem i'm having with this so far is that they still
push me to go back but i don't really want to spend the
tme arguing food choices and i explained this but
they don't seem to understand
and it seems that they blame me for the uncontrolled
numbers because i wont go to the dietician again
but i just ignore them when they try to push me to go
i know what i'm trying and the work i do to try the lower the numbers
i wont take all the blame
 
#7 ·
#8 ·
As an addendum here: You will eventually be your best advocate as to your medications. You'll know what best suits your needs and share that information with your care giver. After all...they're your only gateway to prescription medication. Unless Lantus is an over-the-counter medication in Canada.

The way it works here is you're prescribed a certain daily amount. More than likely you get your Lantus in either a vial or pens. Let's use a pack of pens as an example. In a pack of pens you get 1500 units. If you're prescribed, let's say, 30 units per day...that's 1500 divided by 30...or enough Lantus for 50 days, at which time your pharmacy is authorized to refill your 50-day prescription. They will not fill it before the 50 days...and therein lies your "bump" problem.

By that I mean...if you decide to bump up your injections from 30 units to 35 units to see how much it will drop your FBG...you're going to run out of Lantus before the 50 days are up. If you do decided to do that...and find out that's helping...you'll have to get together with your care giver to cover the additional units. 1500 divided by 35 units a day is about 43 days. If your titration goes higher than that...less days, obviously.

As to how much higher your FBG is compared to the rest of the day; using your FBG as your benchmark for low blood sugars could be a bit dodgy. Let's say your FBG is usually 110 mg/dL (6.1 mmol/l). You would like it to be in the 80s...let's say 85 mg/dL (4.7 mmol/l). Let's say that you usually eat breakfast early and eat a late lunch. You take a BG test before lunch and your BG is 80 mg/dL (4.4 mmol/l). In mg/dL, that's 30 points lower than your FBG. Were you to titrate your FBG down to 85 mg/dL...then theoretically your BG could be 30 points lower just before lunch as well...or 55 mg/dL (3.0 mmol/l).

So, in deciding on what FBG number you're willing to live with...you may want to consider that. Lantus, being an 18 to 24 hour basal insulin, has no idea what time of the day it is.
 
#20 ·
Wow, this is all new to me. I have been injecting Lantus from a pen with the longer needles for over 5 years. I did spend time with a diabetic nurse when I was first diagnosed, but I was not yet using insulin. When my doctor prescribed Lantus he showed me how to inject it but did not talk about other sites besides stomach area. So that is all I have used for all these years.

I worked my way up to injecting 126u every night. I had to inject 80 and then wind the pen up another 46u and depress again. I got real good at it, but sometimes it would burn life fire. When that happened, I would get a bruise that would surface in a day or so. I rotated sights every day working back and force across my midsection.

With LCHF eating I have been able to back off my injections to now 70u, which is so much easier....and I hope to back off more, as I learn to eat better and as my body gets better from eating properly....

Thanks for the information....
 
#21 ·
I just started Lantus recently and was advised to start with 2 units once per day. Reading the Lantus website, their recommendation is 10 units, not factoring in my weight. Dr. Bernstein's recommendation is to divide the doses in two. His experience and opinion is that to get a full 24 hours coverage requires an overdose of insulin. If split, you get better results with less insulin and less risk of hypos. My short experience so far doing two 5 unit injections indicates this is sound advice.
 
#23 ·
Hopefully just temporary Pat, and I must give credit where credit is due. MCS advised me to get it and advised exactly what I read on the Lantus and Bernstein sites.
 
#24 ·
MB....I too take Lantus... I have been on Lantus for sometime. I take metformin and inject lantus before bed. I have never split the dosage. I doctor started me out on 25u way back and told me to increase in 3-4u increments letting 4days pass before increasing again. He said keep doing this until my morning BS is around 100. Since it is slow acting, I do not believe it causes a big risk of low BS unless you jump up to fast. I think you recall I had increased my injections up to 126u, I slushed when I walked....and still my BS were not around 100....Now that I am on the LCHF eating, I have dropped my injections down to 70u.

Based on what I am hearing I may change my dosages to two injections...cannot hurt and my help me get off of some more....!
 
#25 ·
When I was taking lantus, it really didn't make a difference. I tried it both ways and went back to giving my lantus in the evenings. Sometimes I divided into two injections at night because I found absorption to be better in smaller doses.

now with the insulin pump I use just rapid acting (humalog) in that. It covers both the basal and bolus insulins. I do like using the humalog for basal.
 
#31 · (Edited)
One still needs insulin, and if one's body doesn't make enough to overcome insulin resistance, one would need to supplement with injected insulin.

Some need only basal insulin to set things right. Some need fast-acting to cover carbs at meals.

Every diabetic's body functions differently, so there is no one-way to treat diabetes. Some have success through diet only, some need help from metformin, and some need help from insulin. It is very much a YMMV
 
#33 ·
very tempted to just increase the insulin on
my own -- with careful testing of course

the dr's don't have to live with no limbs, no eyesight,
or other complications
we do/may

I'm not necessarily freaking about high fasting numbers
its the fact that high numbers are doing damage the
longer they continue
 
#34 ·
I think it's reasonable to figure out your own insulin needs. Every person is different and doctor's start out "one size fits all". Increase in small units every 3 days until fasting are where you want them, or if you run low later, you might need to pull back on the basal. Sometimes we have to live with higher fastings no matter what because the liver has a mind of it's own. I would recommend eating early and taking your fast acting as soon as you can upon rising, because my liver keeps dumping til I eat and give insulin.
 
#41 ·
i went to the original prescriber(of lantus) walkin dr
about another condition
and i mentioned the fasting numbers being so high
and he increased the lantus to 10 to 20
from 2 to 5
i told him i went up to 9 on my own and he was ok with that
and he explained this time how to do the increases(as opposed
to last time with no instructions given)
and said to try to take as much metformin as i can
(within the 2000mg)
and to take some at night is ok (due to bathroom side effects)
(as opposed to twice daily as it was prescribed)
and to eat chicken/fish and veggies
plus a 1200 calorie diet
no grain or processed foods
( i like everything he said but the 1200 calorie diet)
so i'm hoping its all good from now in-- we'll see
:)
 
#42 ·
I'm so glad someone FINALLY gave you instructions on using the insulin. Now you can have more confidence in making any other adjustments you may need.

I'd ignore the suggestion of a 1200 calorie diet if it was me, and keep on eating LCHF. Metformin can help, of course, but your diet is much more important as part of your diabetes management. Sounds like the doc is "into" low-fat, no red meat, kind of eating. That's not necessary, just reducing carbs and increasing fats will do a much better job.
 
#43 ·
i forgot to say that the dr's suggestion of the
1200 cal. diet was in response to a
question i asked
he said that using insulin can cause weight gain so
i asked if there was anything i could do
to stop it besides my daily walk and diet
modifications
it was then that he suggested the 1200 cal. diet
but he did say it would be hard too (1200 cals.)

i won't be doing that tho
dieting has never got me anywhere but more
fat lol
;)
 
#44 ·
Insulin results in weight gain if you give too much, and then eat to "cover" the resulting lows.

If you follow the "rule of small numbers" insulin does not result in weight gain.

I'm not sure how dieting makes you fatter .... could you explain that one?
 
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#46 ·
firstly 1200 cals. is going to feel like a diet to someone heavy
like me
and dieting has made me more fat because everytime
i dieted and then stopped the lost weight came back on
and usually a little more
so you end up fatter by dieting
i have dieted off 100's of pounds
and am still fat
i guess because a diet is only temporary
and i think because our bodies are designed
to hold fat for a future famine so it thinks
its starving (if i understand that right)
just my experience tho
idk maybe a person is supposed to live on the 1200 cals.
alway

what does the rule of small numbers mean?
 
#45 ·
The typical low-fat, calorie restricted diet does cause some people to gain weight. It has to do with the body going into starvation-mode and not letting go of any fat, and, in fact, storing fat if it can.

This has been a decades long battle for many - especially women where hormones play a role in weight gain. Seems it doesn't affect men nearly as much.

However, most can be successful in losing unwanted weight with LCHF, as long as the carbs are very low and the fats are very high.
 
#48 ·
The law of small numbers is a concept that Dr Richard Bernstein covers in his book Diabetes Solution. Here's a link to the chapter in the book that covers it in detail The Laws of Small Numbers - Diabetes Solution - Dr. Bernstein's Diabetes Solution. A Complete Guide to Achieving Normal Blood Sugars. Official Web Site

Put simply, if you eat a lot of carbs, you need a lot of insulin/medication. If you make an error in the dose, there's a lot of scope for disaster. Keep the numbers small, and a mistake is no big deal.
 
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