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Question about Lantus
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Liladieni posted:
Does anyone know if there is a maximum dosage of Lantus that a person can take? I started out at 10 units, adding a unit every day my insulin was over 110 in the am, up to 50 units. I reached 50 units and was still running am sugars over 200 so I called the Dr. to find out what to dol.

Now, he's saying keep increasing until i reach a dose that brings my am blood sugar under 140...which I have not reached yet. At 53 units, I am still running about 200 in the mornings.

It just concerns me that I have reached a high enough dosage that requires 2 injections to administer. Not that I mind the injections, thats no problem....I am just unsure about a dose that high. Anyone know of any information regarding a maximum dosage of Lantus? I haven't been able to find anything about it.
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flutetooter responded:
I reread all your post over the years concerning you meds and the switch to insulin. Nowhere did I see anything about your current weight, exercise program, and limiting the grams of carbs you eat per meal. This is the biggest part of controling diabetes. The meds just clean up the excess sugar as much as possible, but don't really help change the disease for the better. The doctor may add different types of insulin at your meals, then there is dialysis, amputations, etc. Let us know what you are doing in your lifstyle to help.
If at first you don't succeed, try, try again!
 
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nutrijoy responded:
There is no "official" maximum dosage (obviously, because the manufacturer wants patients to use as much of their product as possible). However, anytime the dose exceeds 50 units per 24 hour day, it is a warning flag that something is terribly amiss in your overall control regimen. What is out of whack is one or more of the following:
1. Your diet is completely out of kilter for you to even hope for reasonable diabetes control
2. Your activity level is woefully inadequate; even if you have disabilities, physical activity of some sort is still a must
3. You most likely have insulin resistance and/or inflammation. Reducing abdominal or visceral fat is often the most effective means of reducing either or both and is best accomplished via dietary intake (the type and portions of food consumed as well as how it is cooked) and exercise
4. Lantus is a basal insulin and is used to help maintain a more even blood glucose level throughout the day. In only rare cases is a basal insulin used to actually lower BG levels. A bolus (quick acting) meal time insulin is an essential complement to lower your post prandial (after meal) blood sugar levels. Bolus insulins are often used in conjunction with basal insulins.

Flutetooter is 100% on target. If you are relying SOLELY on your doctor or health care provider to control your diabetes, then you are still in pre-school (or perhaps even cradle/toddler level) in terms of learning how to control your blood sugar levels. All diabetics need to become their own primary care provider when it comes to controlling the disease. A 30-minutes visit to the doctor can't possibly provide sufficient guidance for good long term control. YOU are the one that has to live with the disease 24/7. That simply means that you have to learn how various foods and activity levels affects you personally (each of us is different). You also have to learn how your insulin dosages affect you. Then you must balance all three factors (food, activity, medication/insulin) to achieve reasonably good blood glucose control.

How close are you to properly balancing your food intake/activity levels/insulin? My own guess is "not very" because if your fasting BG levels are in the 200 range, then your post prandial levels must be in the suicidal (my interpretation) range. If you want some helpful, targeted advice, you will have to expand on the areas that Flute mentioned.
 
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Liladieni replied to flutetooter's response:
As far as excercise goes, all I was doing was walking...but now I have added a stationary bike to that and I'm working on increasing the time I ride it every day. I am hoping it will help me lose some weight...I am overweight by about 80 pounds but have lost 5 so far. As far as counting carbs, I was doing it before, but honestly was often lax about it....now I keep a stricter count, limiting the amount at each meal.

Really don't know what caused my sugars to suddenly start running high. My diet and excercise levels were still the same, I wasn't overly stressed, and wasn't sick. I was doing ok on the glipizide, running between 100 and 140 or so in the mornings, then it jumped to the 300s, and then 400s...and staying high all day.After a trip to the ER because it was so high, my doctor started the Lantus. This was 2 days before Thanksgiving. Now I just have to find the right dose to bring the am sugars down to the 100 - 110 range he has set for me. So far, I'm still running around 200 first thing in the morning.
 
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flutetooter replied to Liladieni's response:
Yes, Liladieni, do do have to find the right dose to bring morning sugars down from the 400's to the 100-110 range--- The right dose of food/sugars/carbs!!!

I am 74 years old, still BARELY in the pre-diabetes range (without meds so far), exercise daily, am 138 lbs. for 5'5" and exercise mildly daily - like 1 mi. walk plus some weight and core strength. Yet my body can only tolerate 15-20 grams of total carbs at a time in a meal without going up higher than I like. I eat 3 meals and 3 snack a day, no more than 1200 calories total for the day, and less than 100 grams of carbs a day. I eat about 9 ounces of protein a day (3 ounces is the size of a deck of cards) and good fats like nuts and avocado. My doctor agrees with this plan, but we both would like to get my A1c down below 6. Probably I will need some meds. This isn't easy, but for you it will prevent many horrible complications.
If at first you don't succeed, try, try again!
 
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auriga1 responded:
Liladieni, Flute is totally right. What you eat and how much you exercise makes a big difference in how much Lantus you should take.

Also, there are many medications which can lower or higher your blood glucose levels. There are lists on the internet on which meds will cause your BS to go higher.

You need to ask your doctor how many carbs you are allowed per meal. If you can't get an answer, ask for a referral to a dietician. You may find that you can eat very few carbs per meal.

I had to drastically cut carbs even with the use of insulin. Actually, I was in the same boat as you with my a.m. fastings 250 and over. That's when they started the insulin. I use two insulins, the Lantus and the meal-time rapid-acting insulin, Humalog. Humalog prevents your BS from rising when you eat carbs.

My Lantus started at 15 units. That did not work. My doctor increased it every day by 2 units. This went on for about two weeks. Each increase bought it down a little bit. I finally wound up taking 40 units each morning. The doctor finally decided to do 4 unit increase until my BS got to where it should be.

You need to keep moving every single day. Any activity will help your body utilize any excess glucose running around in your blood stream.

I have a job where I am active four hours per day five days a week. Really moving. I was able to lower my Lantus dosage and not even use the Humalog during the day except for my evening meal. The activity I do negates the use of my meal-time insulin.

Try and get a referral to a dietician. Before this job, I was eating between 20-30 carbs a day. My dietician recommended 35-45, but I had to use more insulin. Didn't want to do that.

There really is no max dosage. If you need a huge amount of insulin, there is also available the U-500 unit dosage. It is rare, but some people have extreme insulin resistance. If they use 300 or more units of insulin, the doctor would recommend switching to the U-500 insulin. It is not a dosage, but rather a concentration of insulin. U-100 has 100 units of insulin per milliliter and the U-500 has 500 units of insulin per milliliter

Try and cut back on carbs. See if you can exercise more. Dr. Dansinger has recommended 1 1/2 hours per day, seven days a week. This helps your body to utilize glucose, especially your skeletal muscles. When you walk, take with you some hand weights. Increasing muscle strength helps with your blood sugars. When you really start to lose the weight, your body will require less insulin. It is best to get things under control as soon as you can.

Try and not to stress about it. If your doctor said you can increase the insulin on your own, go ahead.
 
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nutrijoy replied to Liladieni's response:
Lila, your exercise regimen sounds like a good beginning but may need to be refined and/or intensified based on how exercise affects your BG levels (test frequently in the beginning until you develop a track record). Your fasting BG of 200 is much too high and needs to be brought down below 100 to avoid future complications. An essential part of achieving good BG control is to maintain a detailed, ongoing written log. This must include your blood glucose test results, descriptions and amounts of all foods eaten, exercise/activity logs, weight and BMI measurements, and any other pertinent info that has an effect on your BG levels, both up or down. The written record can subsequently be referred to and analyzed by you as well as your healthcare professionals for subsequent tweaking and gradual improvement since so much of diabetes treatment involves some degree of trial and error.

Elevated blood glucose levels over a prolonged period of time will cause significant damage to your internal organs. This is due to a process known as glycation whereby glucose molecules in the blood stream bond or stick to the cells of your precious body proteins and fats. After a cell has been glycated, it is rendered virtually useless, unable to perform its intended function in the body. For example, your finger-prick blood tests are actually measuring the approximate percentage of glycated red blood cells in your system. Sixty to ninety days later, the damaged/glycated RBCs will die off and are replaced with a new crop. Unfortunately, thiis applies only to RBCs. Glycated cells in your precious internal organs (such as the kidneys, eyes/retinas, heart, nerves and blood vessels) are NOT so readily replaced and the damage can not only be cumulative but is usually permanent. There are often no physical symptoms accompanying the glycation process. In other words, you won't "feel" anything but the damage will occur nonetheless. By the time that symptoms do eventually manifest themselves, it is often too late to prevent serious complications. That's why it is so essential for diabetics to "normalize" their blood glucose levels as much and as soon as possible.

What are "normal" blood sugars? My own personal target is in the range between 65mg/dL and 85mg/dL. Dr. Richard K. Bernstein defines normal as 83mg/dL (you can read portions of his book online for free ). The Blood Sugar 101 website states that normal blood glucose is in the range of 70 to 92mg/dL. Life Extension, of which I am a member, views normal as 85mg/dL and under. LE has studies that show glycation begins at levels above 85mg/dL and can be read at this link:
http://www.lef.org/Health-Wellness/LECMS/PrintVersionMagic.aspx?CmsID=117794

My own personal stats? My average fasting blood glucose levels are well below 100. Even more important, my average pre-meal BG levels are also below 100 (warning: if a diabetic starts off with elevated BG levels before a meal, it's only going to get a lot worse after eating). My A1c tests have been below 5.0 (it was 4.9 seven months ago and measured 4.8 last month). I can go into detail on how I accomplished these results but this particular post is already too long and will post back if time permits.
 
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Liladieni replied to auriga1's response:
Today I was under 200 for the first time...still 196, but it felt good to drop below the 200 mark. Last night I had 55 units. Today, I cut back a bit more on carbs and increased my time on the bike...I'm increasing a little slowly because I know me....and I know that if I get too sore, I'll quit. Hopefully I'll be a little lower still in the morning.

As far as a max dosage....I think that worry comes from taking it at bedtime, and thinking I could drop too low during the night. 've read more about Lantus by now though, and have a better understanding of how it works...not so worried anymore. I still feel like such a baby as far as controlling my diabetes goes because it was so easy to control for so long...2 years or so...and now it's suddenly gotten much harder for some reason. I feel like I'm starting all over again trying to understand it.
 
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Liladieni replied to nutrijoy's response:
Those are some great stats, you should be proud!

I already do have some complications from my diabetes..I have some mild neuropathy in my feet and legs, and I am in stage 3 renal failure. (That was blamed on taking metformin and nsaids for arthritis, so I no longer take either one). Sounds weird to say I have complications after how easy it was to keep controlled before as I mentioned in my response to auriga1, but I think most of that damage was done before diagnosis. My am sugars when I was "controlled" were about 100 to 125...a tad high, but not really out of range like they are now. I really don't know why it is so out of control now because my lifestyle had not changed...but rather than worry about why, I'm just going to work on getting control again.

I'm also keeping written records..sugars, carb intake, excercise records. Excercise I am increasing a little every other day or so...if I get too sore, I'll get too discouraged, so I'm trying to avoid that.

I think too, that only testing once in the am is not testing enough, even though thats what my doc said to do. I am also testing after meals and anytime that I feel like my sugar is changing too much....I just have to balance how much testing I do with how many strips I can get through indigent care...it's all I have right now. If I find a pattern of too high sugars at other times than morning fasting developing, I'll bring it up to the doc.
 
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auriga1 replied to Liladieni's response:
Liladieni, everyone feels like something or other as far as controlling their diabetes. Many times, it's trial and error. There are days when you absolutely want to eat something you know you shouldn't. We've all gone through that.

You've got a great idea about taking it slow. The first time I put in an exercise tape, which by the way, was walking slow, then fast, lifting knees, I was out of breath. Embarrassing, even though I was alone. LOL. I used to exercise all the time every single day. Then I was laid off of work and angry. Bored. You would think I would get back into the groove.

Even though the literature for Lantus says it is a bedtime insulin, I take mine every morning. It really shouldn't make a difference either way because it has no discernible peaks or valleys. I don't know why, but my doctor prefers I take it in the morning. If it would make you feel more at ease, ask your doc about it.

Little baby steps are the way to go. Pat yourself on the back that you have a good attitude and are listening to some good advice. I applaud you.

Taking insulin is new for you. We all had to start somewhere. Ease up on yourself. Know that things are going to get better.
 
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Liladieni responded:
Just another update...I am now at 100 units of Lantus at bedtime, and sliding scale Novolog during the day for mealtime highs. Without the Novolog, my 2 hour sugars run about 180 to 250. With it, I can usually stay under 150. My a1C jumped from 6.9 to 10.8, so thats no good...got to get that back down. I've also had 3 ER visits for sugars over 500, two of them within the same 24 hour period. Still haven't identified a reason for such a drastic change in such a short time, but getting it back in comtrol is what matters, so that is what I am focusing on.


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