Re: About a week on insulin - To Walt, please read!

[Guest guest]

Walt wrote:

I am trying to get my blood sugars down. In the morning I average about 110.

Two hours

after meals even with lantis it is about 210. I am trying different schedules.

My main

injection is 10 units before I go to bed. Then I have trying 3 units before

breakfast and

dinner. This has helped getting it doing to 180.

I wish my endo knew more about pancreatitis I have had to educate him on my

illness. I

can not wait until I get back with my primary care doc. She will be able handle

thing better.

Dear Walt,

Lantus (glargine) is a basal insulin that is designed to give you coverage for

24 hours. It

should only be taken once a day, or some people take a split dose every 12

hours. It

should not be taken any more frequently than that. People that are on Lantus,

(I am one

of them), also inject a fast acting insulin like Humalog or Novalog for their

meals. Once

you have injected Lantus, it takes about 5 hours before the insulin begins to

work, so it's

not designed to be used prior to meals for meal coverage. For meal coverage,

you should

be taking a fast acting insulin such as Humalog or Novolog, which begin working

and peak

within approximately 1 1/2 hours. These insulins are designed to work with a

person's

digestion schedule.

The way you are taking your Lantus is totally incorrect. I cannot believe that

an

Endocrinologist would only give you a basal insulin and not one to take with

your meals,

since the Lantus is not designed to be used for meal coverage! Is this doctor

familiar with

Lantus dosing schedules? Did this doctor tell you to take Lantus with your

meals??? I ask

this because Lantus is a new insulin and many doctor's aren't that educated with

how it

works. It is NOT designed to be taken for blood glucose control with meals.

Additionally,

any adjustments in Lantus dosages should only be done once every three days.

Since it is

an insulin that stays in the system for 24 hours and there is a 5 hour lag time

after each

injection, adjustments to dosing take a full 3 days to take effect.

You need to contact your PCP, and talk to her about getting another fast acting

insulin for

meal coverage, or call the Endo back and tell him that you have spoken to a

patient that

has been on Lantus (under the guidance of an excellent Endocrinologist and a

Certified

Diabetes Nurse Educator), who has told you that Lantus cannot be used for meal

coverage,

and that there are fast-acting insulins designed precisely for this purpose.

The way you

are taking it now is totally incorrect, and if you have any doubts about this, I

will post a

Lantus information and dosing website in my next post.

For example, I take Lantus on a split schedule, a dose of 10 units at 8:30 pm

and then

another dose of 5 units at 8:30 am., making my full 24 hour dosage 15 units per

day. I

only started taking it in a split dose after a two month's trial taking it once

a day. I found

that it wasn't providing coverage after the 22nd-23rd hour, so the split dose

system was

initiated. When you do this, you do have to have a 12 hour period between each

dose.

Then at mealtime, I take Humalog fast-acting insulin. The amount of Humalog

that I take

with each meal depends upon how many carbohydrates are in that meal. I take 1

unit for

every 5 carbs. Most of my meals contain approximately 40-60 carbs, so I take

8-12 units

of Humalog at mealtime. I have dual digestion, which meals that my protein

doesn't

digest until about 3 hours after I eat, so I have to split my meal dosage to

compensate for

this. I inject a portion of the Humalog immediately prior to eating, and then I

inject the

remaining portion of Humalog 1-1/2 hour after I eat. This dosing schedule was

set up by

an authority on insulin and is designed for my digestive system, according to my

weight

and other factors, so don't try to apply it to yourself. I was only trying to

explain how an

insulin schedule is set up for most people taking Lantus. They take Lantus as

their basal

insulin once a day, and then take their fast acting insulin with meals. Some

people use a

sliding scale regimen, while others, like me, adjust the amount of fast-acting

insulin they

take according to what their carb content is at each meal. I do not follow the

ADA

pyramid diet with exchanges, as I find the carb allowance in that diet to be too

high for me

to maintain adequate control. I follow a moderate carb regimen, with

approximately 110

-120 carbs per day.

My aim is to keep my blood glucose within a range of 80-110. After meals my

range can

go up to 140, at the very most. I test often (8-10) times a day, and inject

Humalog up to

8-10 times each day, also. I do whatever is necessary to keep my BG's within my

personal

range of 80-110. It takes a lot of testing and understanding your body's

reaction to

insulin before you can do this kind of precise control monitoring, and everyone

is

different.

I do think you should call your doctor and get some help with this before the

22nd. Once

you get the hang of it, you should be able to maintain the kind of control that

will lower

those high after meal BG's, and once the suitable Lantus dose is established,

you can

maintain a stable BG all day long. Meanwhile, if you have any other questions,

please

don't hesitate to ask.

With love, hope and prayers,

Heidi

Heidi H. Griffeth

South Carolina

SC & SE Regional Rep.

PAI

Note: All advice and comments are personal opinion only, and should not be

substituted for professional medical consultation.