Lantis/Novalog Question

Hi All,
First off, these questions are on my mother behalf, She was Diagnosed T2 Diabetic some 20 years ago and, up until the last 1 or 2 years she was managing it very well with, "Standard Insulin" I believe maybe Novolin? Then All off a sudden, a couple years ago, we found her on the floor in insulin shock with numbers down in the 20's, In the following year or so these incidents became more and more frequent, We finally found her the Right "Endo" and it took a few until we found one that seemed to want to take some time with her and explain things to Her/Us to get to the bottom of the problem, and he decided to put her on a Lantis/Novalog regimen, and that has seemed to end the bouts of insulin shock she was having...Thank God! Ok, so here is where were at now....It has been almost a year since she started on the Lantis, but her numbers are still all over the place, there just not as Low or as High as they used to be but still not where they should be, and this is Very likely due to some BAD habits/routine she got herself into during the time that she was crashing all the time.
For example, she started having a Sugar Snack before bed because, she felt safer with High sugar at night then to go too low, and not wake up! She also varies, her meal times and sometimes skips meals altogether, which, as you can imagine has created somewhat of a challenge for her Endo to get her numbers to level out....Which brings me to my questions.
1st - Lantis is used as a "baseline" insulin, and the Novalog is ONLY used to level off the "Spikes" caused by mealtimes. So that being said, if she skips a meal because in her words "I'm just not hungry" then should she also skip the novalog, or can she still take it if she has checked her numbers and they are High?
2nd - If she skips meals, what kind of effect will this have on the rest of the numbers for the day/night, Will the Lantis just keep her even till the next meal?
Thanks in advance,
Mike

[Anita Ramsetty, MD]

Hi,
Thanks for writing in on behalf of your mother.

ON your questions:
1)Ideally your mother should have a scale for the Novolog which takes into account her blood sugar before she eats AND what she is about to eat. Carbohydrate counting is used to determine how much insulin should be taken with a meal. If this proves to be a bit much in terms of calculations etc, then she should have two separate written Novolog scale--one for correction only i.e when her sugars are high, and another for pre-meal sugars when she is also abut to eat. Sometimes Lantus needs to be split into two doses as the effect doesn't last 24 hours for some people.

2)If she skips meals, her Lantus should keep her relatively even until her next dosing period, IF the dose is right. Lantus should basically keep sugars under control when there is no eating involved(your basal needs). When food comes into play, you need mealtime insulin.

Please do encourage your mom to try and develop a more regular pattern of eating and activity as this makes it MUCH simpler in terms of her insulin regimen, and will decrease her chances of high-low excursions.

Take care.