Lantus vs Humalog dosage Formula??

[TN_type1]

Does anyone know a formula for amount of Lantus needed for a basal dose vs how many units fast-acting you take per carb?  I have major swings.  Yesterday was told by a nurse that the Lantus I take is really low compared to amount of Humalog I take, but she never told me HOW much she thought I should be taking.



I take 1.5 u Humalog per carb for all meals (for last 3 weeks - has changed many times).  I'm supposed to take 11 u Lantus in am.  My morning BS is usually 300-500.  I think the Lantus is not lasting 24 hours.  If I try to split the dose, I'm wondering if I need to just take 5 and 6, or if I need to up the overall dose.



Any anecdotal info on how much Lantus you have to take daily?



I usually have lows or good BS at bedtime.  Then, BS goes up VERY HIGH every morning.



I'm 40, Type 1, diagnosed 1990, one Lantus shot per day, Humalog for meals, with sliding scale adjustment for high (which I have to use EVERY DAY).  Last A1C was 8.5, which was the best in about 3 years.  Blood sugars very bad, lows in 20-25 range, highs up to 500-600.  See nurse practitioner at endocrinologist's office.  She doesn't know how to help me, so is passing me off to a diabetes center.  I feel like I need to adjust my own insulin, because I'm not getting a lot of help.  Very discouraged.  And depressed.  BS not helping.  I'm thinking this is all up to me, because I'm not getting anywhere with "professional" help.  Any experience with amount Lantus vs amount Humalog??

[JDRF-Team-gg]

Hi TN!  None of us are medical professionals and therefore cannot recommend dosage corrections.  We can, however, share our type 1 experiences based on our own life experiences in dealing with type 1 diabetes.  My daughter is currently on the insulin pump and only goes on Lantus/Humalog when her pump is malfunctioning.  Thankfully (for us), this hasn't happened in so long that I cannot remember what the formula is to calculate the lantus.  I do remember that prior to going on the pump, her endocrinologist switched her lantus shot from AM to PM as her morning bg's were higher than they wanted them.  You should discuss this possibility with your endo along with your thoughts of splitting the dose, however I have never heard of this as an option.  I gather from your post that you are not getting much assistance from the nurse practitioner.  Can you appoint directly with the endocrinologist?  How about finding an endo that you are happy with?  Unless you have limited access to other endocrinologists, maybe it's time to find a new one.  You certainly, after 16 years of living with diabetes, should be able to make the necessary adjustments to bring your bg's within the range that you are looking for, but seeing that you are experiencing extreme lows & highs, I'm thinking that you need to re-evaluate your diabetes regime with a healthcare professional team(including a dietician).  I can totally understand your frustration with your situation, but every day is a new one and with the proper medical guidance and support, I know you can take the initiative and make those necessary changes to get you feeling better and taking control of your diabetes.  Have you considered insulin pump therapy?  You may want to check this option out.  My daughter has had hers for almost three years and absolutely loves it.  It's not for everyone, but it is an alternative to shots that generally produces much more even keeled bg results.  



There are many people out there, like us, who want to help you with this.  Good luck to you & please let us know how you make out!

[TN_type1]

Have been told by the Nurse P. that she does not want me to go on a pump.  I farm, raise and ride horses, etc., and she says that the pump would get damaged.



I have not seen an actual endo. in probably 3-4 years.  I don't know if I could see one at this office or not.  Unfortunately, these are the only endocrinologists close (non in my town), and I have no other options.

[PediatricChallenge]

My 6 year old son was diagnosed type 1 30 days ago (Oct 2). I understand it's really apples to oranges trying to compare a new pediatric Type 1 who may be Honeymooning with an lifelong adult, but anything may be helpful for you.



He's a big healthy boy, 57 pounds. Per UCLA Med Center we are currently dosing him 8 units of Lantus split to 5 units in the AM before school, then 3 units about 2 hours before bedtime), with a bedtime BG check. We also are giving 1 unit Humalog per carb unit. We found the thigh for him is the best place for the Lantus. Stomach absorption rate was too fast.



It's early in the game but this so far is working quite well for us. During the initial 15 days we administered first 12, then 10 Lantus all at night, as recommended. We found he was drifting into the 60 and sometimes 40s at times during the night. This split has really helped keep him in 70s for his morning BG. We are told the Lantus has a small peak at around 2 hours, so that's the reason for the 2 hours before bedtime with the BG check just before bed.

[JDRF Team SGG]

I am an adult female in my 40's who has been a type 1 diabetic since childhood. My dosage is identical to yours. I believe that your morning highs are because the Lantus is indeed petering out while you sleep. From what I have read about Lantus, it works BETWEEN 20-24 hours. In my case, too, it does not last a full 24 hours. I do split my dose and achieve excellent control this way.



Ask your doctor about doing this. Of course you cannot do it overnight because the previous day's Lantus is already at work, and so it has to be done one unit at a time over several days. The way that my doctor had me do it was to reduce the morning dose by one unit on the first day, and that night I added a unit. We waited several days to see how this would work as my body adjusted to the routing -- we need to see patterns and not just one-time results. Then a few days later, I reduced the morning by one more unit and added another unit. Waited a few more days, etc. When your morning sugars are running where you want them on a routine basis, your split is correct and you stop changing the dosage. For me, 8 units in the morning and 2-3 at night turned out to be the ideal. My identical twin needs to split her dosage more like half and half. Each person is different.

[TonyAlmeida]

> TN_type1

> Have been told by the Nurse P. that she does

> not want me to go on a pump. I farm, raise

> and ride horses, etc., and she says that the

> pump would get damaged.

>

> I have not seen an actual endo. in probably

> 3-4 years. I don't know if I could see one at

> this office or not. Unfortunately, these are

> the only endocrinologists close (non in my town)

> and I have no other options.



Damage the pump - pretty interesting ....  I'm not advocating anything but I'd say you need to see someone other than this Nurse Practitioner who doesn't (from what you have said) know much about insulin pumps.



I have friends who farm and I have been to horse shows where there are diabetic riders with pumps.  I've known roughnecks out in the oil fields with insulin pumps, firemen, policemen, construction workers, diesel truck mechanics and even a few high school cheerleaders.  Pumps are pretty tough, made out of the same safety high impact plastic as motorcycle helmets.



Nurse Practioners, it has been my exprience, are good basically for treating coughs and colds and the like.  Not to downplay their role - but not one of the ones I've ever had knew a whole lot about Diabetes, Insulin Pumps, or even how to count carbs.



Get in touch with a real endo - and soon.  If you do opt for a pump, you'll find a life that is lot more free and you'll have better control.



Good luck and good health!

[thomasakehoe]

Hello everyone, new to this forum. My name is Tom I'm 32 years old and have had diabetes (insulin dependent diabetes, type 1) for 24 years. I've been a pump user for almost 6 years now, but recently lost my health insurance and was forced to go back to injection because of costs for pump supplies. First off I hate it, not because needles hurt etc... actually using a pump it's more critical to make time for blood glucose monitoring. I just hate it because my control isn't anywhere near as good with sliding scale injections of Humalog for meals and a shot of Lantus at night to act as a basal rate. My first recommendation would be to get in to see a "diabetes specialist, endocrinologist. I've had some hyperglycemia in the mornings, but nothing as high as 500 and I feel crummy so I'm sure you must not be feeling your best. And secondly I wouldn't recommend the splitting of your Lantus dose just because of the long lasting time frame, even if Lantus only lasted for say 18 hours you'd be getting a bunch of overlap somewhere in your day or night. Instead I'd tell you (and I'm not a doctor) to take your Lantus at bedtime that way you'll be sure to have it at full strength in the AM and if it does start to fizzle out, it will be later after dinner or toward your next where you are more likely to catch your blood sugar on the rise and can correct it with Humalog. Just don't make any huge dosing changes I had to slowly adjust my Lantus dose up higher with the help of my physician until I got my AM readings where I like them. Basically just adding 1-2 units of Lantus at a time and remember anyone can have a high blood sugar ounce in a while due to diet, stress, infection so don't just add insulin look for a pattern where a high blood glucose reading is happening over and over before you try to change it. And insulin pumps are definately tough enough to be used on a farm. I'm an automotive technician and crawl on top of and underneath cars all day long. just use common sense and make sure the infusion set is protected and the pump itself is tucked away ina pocket or better yet one of the hard shell clip on cases and you'd have no problems. I cannot wait to get back on mine next week. Good luck.

[Brian2009]

im on lantus and humalog as well...

i take 35 units of lantus IN THE MORNING....

that way my sugar does not drop off at night per my doctors reccomendations basicly the lantus runs out in the 22-24th hour after taking it.

they also took me off the sliding scale today and have me doign this formula thing

i take my blood sugar level then subtract 100 and divide by 20 to get my humalog amount example

blood sugar 240 before meal.

240 - 100 = 140

140 / 20 = 7 units of lantus

this was just to start with doctor wants me to write down results for this insulin formula so he can review it and make any changes to the math this is just an alternitave to carb counting.

[Brian2009]

also he said to increas the lantus by 2 units until the am blood sugars are less than 140

example starting lantus dosage 25 units

day 1 am bs 260  increase lantus by 2 units
day 2 am bs 220 take same ammount
day 3 am bs 210 increas by 2 units
day 4 am bs 180 take same ammount
day 5 am bc 178 increase by 2 units
day 6 am bs 150 take same ammount
day 7 am bc 133 increase by 2 units
day 8 am bs 89 found correct lantus dosage @ 33 units

[lmw7]

I have had type 1 diabetes for 31 years. I have always used humalin insulin. Recently my doctor changed me to Lantus and Humalog. I hate it. My last A1c test on Humalin insulin was 6.7 and I do not want to change. I don't like this new age insulin. It's hard to change your whole life style after doing something for so long, something that works. I'm switching back. I dont have any advice for you, I just wanted to let you know that I completely understand your stress...

[aleciacs]

I have been type 1 for 26 yrs, and switched from regular and nph to humalog and lantus about 6 yrs ago. I am not the best person to follow doctors orders and never have normal bloodsugars. I take my lantus at night and when i first started taking it my dose was 35 and sliding scale with humalog whenever i ate. I dropped low middle of night and close to the max. end normal range. Now i take 5 units humalog when i eat a full meal and adjust it as needed , my lantus is 15-25 units depending on the bs level  and what i ate last before i took the lantus. My sugars were starting to fall into the almost normal range.
It jsut depends on the <