Lantus, how do you rate amount for injection?

Armourer
By Armourer Latest Reply 2012-03-21 14:51:13 -0500
Started 2012-03-19 00:31:26 -0500

Yesterday my father-in-law and I had a bit of a heated discussion on how one should calculate amount of units for injection. He does calculations the same for Lantus as he does for his Novalog, base plus sliding scale. I do this too, but I have carb count to boot, but I use this method for short term insulin, in my case Humalog. For Lantus, I have a set amount I inject of 55 units in the morning and 55 at bedtime. For seven years the Doc has told me how much to inject, never do I do calculations as on does for short term insulin.

So what do you do if you take Lantus?


14 replies

kdroberts
kdroberts 2012-03-20 21:11:37 -0500 Report

There is no point in a sliding scale (as in base + sliding scale) for any insulin really, but especially not lantus. Like John said, Lantus is meant as a background insulin to keep your blood sugar steady, it's not really meant to actually lower blood sugar. In a perfect world, if you take Lantus when your blood sugar is 250 and you don't eat anything for 24 hours your blood sugar will still be 250 and will be 250 at any time in that 24 hour period. Now, it's not a perfect world so you give a +/- 30 point fudge factor so if you don't eat anything, as long as your blood sugar is within 30 points of where it started then your dose is considered fine. So in the case of the real world, especially if you split a daily dose, you need to have the same dose consistently and not mass with it.

I'm a fan of thinking like a pancreas (stealing from the book title) in general rather than sliding scales when it comes to rapid acting (bolus) insulin like novolog, humalog and apidra. Once you have your background (basal) insulin sorted, which you can't do if you change it every day, you have an insulin to carb ratio and a correction factor. The correction factor is kind of like your sliding scale in that it's reactive rather than proactive and you are giving yourself extra insulin because your blood sugar is higher than your target or less insulin if your blood sugar is lower than your target. However, the insulin to carb ratio replaces the static base amount and makes you proactive by hopefully stopping your blood sugar getting too high. Without a consistent basal insulin you can't even start to figure out the insulin to carb ratio or correction factor since you don't know which insulin is doing what. At best you are just guessing and hoping things turn out OK. At worst you are taking too much of both basal and bolus insulin and could in some low blood sugar trouble.

It sounds like you are on the right track, maybe a couple of tweaks here and there but basically doing the right thing. Your father in law sounds like he has either been given bad advice or completely misunderstood what his doctor said.

Armourer
Armourer 2012-03-21 14:42:19 -0500 Report

I told my father-in-law about all that has be said here and his reply is that his doc knows what he does and hasn't corrected him. That he is only doing what his doc said. We are all wrong, and he doesn't care if it is wrong, it works for him and he won't change.

Caroltoo
Caroltoo 2012-03-21 14:51:13 -0500 Report

How discouraging for you when you obviously care what happens to him. Guess your choices are limited at this point: drop it or drop a note to his doctor just letting him know what is happening. He won't talk to you, of course, because of HIPPA, but he would put the note in the chart and hopefully read it.

Of course, he would probably also share it with your father-in-law who would probably be angry at your "meddling". Caring makes this a tough choice; it's hard to walk away and say: ok, whatever happens, happens.

Jan8
Jan8 2012-03-20 14:15:27 -0500 Report

My endo keeps telling me the same thing even if my BG is off. "Keep taking the same amount". But,you bet your sweet bippy that if it gets too high I have my own sliding scale

John Crowley
John CrowleyCA 2012-03-20 12:59:53 -0500 Report

I can't imagine trying to manage blood sugars and make any sense of your numbers if you were adjusting your Lantus dose every day. It would play havoc with your numbers.

As you know, Lantus is a basal insulin that is kind of like the background. If you're messing with the background everyday, there's no way you could really zero in on any issues with your carb counting and meal-time insulin.

That's my two cents.

Set apart
Set apart 2012-03-20 05:59:36 -0500 Report

I am on Lantus take 9u am and 9u pm, may be decreasing since doc wants to eliminate midnight lows, If I do we are looking at going to 16u in a 24 hr period. We are now in a 2 wk monitoring session, woke up at 59 night before, fasting BG this morning 60. As for novolog am on a sliding scale.

nanaellen
nanaellen 2012-03-20 01:08:31 -0500 Report

When I started on the Lantus I was on 50 units @ bedtime per Dr.'s orders, it wasn't until my FBS got UNDER 100 that my Dr. told me to lower it to 40 units, but since my daily #'s have gotten into the high 200's I've had to put it back to 46 units. Lantus is definitely not the same as Novalog or Humalog and should not be treated the same! Lantus is a timed released insulin! I too am with you on this one!! Ellen :)

melissarose
melissarose 2012-03-19 22:43:16 -0500 Report

I'm on Lantus, I base mine on necessity. I stick with 35 in the am usually. If my am BG is high for many days, I increase by 10. If my am BG is low I decrease by 10. Not much need for adjustment usually. Especially if I'm eating right and excersize regularly.

Harlen
Harlen 2012-03-19 20:40:23 -0500 Report

When I was on it
It was set to cove my needs till the AM and that didnt go up or down in the time I was on it after we got it to what my need where .
Best wishes
Harlen

Type1Lou
Type1Lou 2012-03-19 08:48:17 -0500 Report

When I was on MDI of Lantus and Novolog (before going on the pump last August) my Lantus dose was an amount set by my doctor and did not vary daily.
Prior to starting the pump, I was on 14u of Lantus each morning. I dosed the basal Novolog on a sliding scale based on the amount of carbs I was eating and my carb to insulin ratio. I'm with you on this one and would suggest that your father-in-law further discuss this with his doctor.

Armourer
Armourer 2012-03-19 11:13:14 -0500 Report

Thanks Type1Lou, he was so sure that he was right and I was wrong, it is silly but his way is not correct as far as I've been educated. However from my experience with military docs (which he has being retired military) some were great and others should have their license taken away.