Know That When You Check Your Blood Sugar The Number Tells Us How Well Your Last Dose Of Insulin Worked
For example, meal rapid-acting insulin peaks in 1 to 2 hours and lasts 3 to 4 hours. Your blood sugar taken 2 hours after the meal tells us how well the peak of the insulin covered the peak of the blood sugar after you ate. Your blood sugar taken before the next meal tells us how well the insulin worked during the time your carbohydrate was breaking down.
What Are The Starting And Maximum Doses Of Lantus
There arent starting and maximum dosages of Lantus that apply to everyone.
The starting dose of Lantus that your doctor prescribes is based on whether or not you take insulin and how much you take. The dose may also depend on how much you weigh.
Your doctor will use your blood sugar levels and other tests to adjust your dosage of Lantus until they find what works best for you.
Theres no standard or maximum dosage of Lantus. Instead, your doctor will prescribe a dosage of Lantus thats based on your individual needs. You should not take more Lantus than your doctor prescribes.
For more information on dosages of Lantus, see the rest of this article. You can also talk with your doctor or pharmacist.
When To Stop Oral Hypoglycaemic Agents
Sometimes patients develop frequent daytime hypoglycaemia on combined treatment. When this happens, the sulfonylurea dosage should be reduced or ceased if necessary. Apart from this and in the absence of contraindications , there is no good evidence that oral hypoglycaemic drugs must be stopped at any stage and our policy is to continue them while glycaemic control remains satisfactory. Most diabetes specialists would support the continuation of metformin indefinitely, because it increases insulin sensitivity. Others advocate stopping the sulfonylurea after insulin treatment is established, an attitude based more on philosophy than real need. Some patients may wish to reduce the number of tablets they take especially when they are already on multiple medications for blood pressure and lipid control. There is nothing wrong with reducing one or more of the oral hypoglycaemic drugs once they are established on insulin therapy, as long as it is recognised that the dose of insulin needs to go up, by an average of 20-30 units per day for each withdrawn drug, to maintain the same degree of glycaemic control.
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Insulin Dosing: How High Can You Go
What is the highest dose of insulin that can be used in a patient whose diabetes remains uncontrolled on a regimen of insulin plus an oral antidiabetic agent?
MD
When it comes to using insulin to treat hyperglycemia, the skys the limit. Extremely high doses are occasionally required that is the reason U-500 insulin is available. A colleague once reported using 35,000 units of insulin a day in a patient with a genetic receptor defect. In patients with glucotoxicity, hyperglycemia, and down-regulation of the beta cells, very high doses of insulin are needed to reverse the clinical situation after this has been accomplished, the insulin dose can be gradually lowered to a maintenance level. Ironically, hyperglycemia may either stimulate the beta cells to correct the clinical problem or have a toxic effect on the beta cells and thus worsen the situation.
In patients with type 2 diabetes, marked obesity, and insulin resistance, total daily insulin doses of 200 to 300 units are often required. In this setting, management for most patients includes a total of 1.0 to 2.0 units of insulin per kilogram per day thus, in very obese patients, a larger total dose is required. In these patientsprovided they have no contraindicationmetformin therapy is continued by most clinicians to treat insulin resistance, improve glucose control, and minimize further weight gain.
Russell D. White, MD
Insulin Dosages On A Flexible Dose Therapy
If you are on a flexible insulin therapy , you will need to inject an appropriate dose to ensure your blood glucose levels dont go either too high or go too low.
When you start on insulin, your diabetes team should give you guidance on how much insulin to take. Insulin requirements will typically vary from meal to meal and can be influenced by a variety of factors see below for more information on these factors.
Blood glucose testing will play a useful role in helping you to judge how much insulin to take.
People on a flexible insulin therapy should test their blood regularly to help support dosing decisions and to help prevent hypoglycemia
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Will My Lantus Dose Be Adjusted If I Also Take Other Diabetes Drugs
Yes, its possible. Your Lantus dosage can be affected by many factors, including the type of diabetes you have and other medications you take.
If you have type 1 diabetes, your total daily insulin dose will include a long-acting insulin . Youll take this along with a fast-acting insulin at mealtimes. Humalog is an example of a mealtime insulin you may take with Lantus.
For this condition, your starting dose of Lantus is about one-third of your total daily insulin dose. Your doctor may adjust your dosage over time to help manage your blood sugar levels.
If you have type 2 diabetes, you may take diabetes medications other than insulin at first. If your blood sugar isnt well managed, your doctor may prescribe a long-acting insulin such as Lantus.
Taking Lantus with other diabetes medications can increase your risk of low blood sugar as a side effect. So your doctor may adjust your Lantus dosage to help reduce your risk of this side effect.
To learn more about how other medications may affect your Lantus dosage, talk with your doctor.
Basal Insulin Dose In Adults With Type 1 Diabetes Mellitus On Insulin Pumps In Real
Maciej T. Malecki
Abstract
1. Introduction
Continuous subcutaneous insulin infusion therapy by insulin pumps has become a widely used treatment in patients with type 1 diabetes mellitus . CSII is currently the most physiological method of insulin delivery available . This mode of insulin therapy includes two components: basal insulin infusion that mimics physiological hormone secretion during the night and between meals, and boluses of insulin substituting acute postprandial insulin secretion . The total BI dose is recommended to constitute 3050% of the total daily insulin dose in all age groups of individuals with T1DM . One algorithm that is commonly used in adults with T1DM specifically suggests programming of BI as a half of the DID . However, whether these recommendations are followed in real-life clinical practice and if %BI in adults with T1DM treated with CSII affects glycemic control have not been assessed so far. This is particularly intriguing in light of the clinical observations that keeping the %BI below 40% and encouraging the patient to bolus more frequently might lead to improved glycemic control with less weight gain .
2. Materials and Methods
3. Results
Patients with less than 30% of %BI were characterized with higher total insulin requirement per kg than those with 30%, 0.83IU versus 0.7IU/kg, respectively, . No correlation was found between %BI and BMI .
4. Discussion
5. Conclusion
Data Availability
Conflicts of Interest
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New Oral Drugs Or Insulin
Traditionally metformin plus a sulfonylurea has been the mainstay of oral treatment. Patients understandably often want to know whether they should try adding a third drug or begin insulin. The addition of acarbose can usually only decrease the HbA1c by 0.5% at best, so one would only consider its use if a slight improvement in control is needed. Repaglinide and sulfonylureas should not be used in combination, as they are both insulin secretagogues. The response to therapy with a thiazolidinedione can be more profound with improvements in HbA1c of 1-2%.The decision whether to start insulin or to add a thiazolidinedione would depend on factors such as patient acceptance, coexisting conditions and access to medicines. At this stage it matters less which drug or ‘pathway’ is used, but more that the patient’s glycaemic target is reached.
Sometimes it is necessary to let patients try triple oral drug therapy. If nothing else, it serves to convince them that insulin is indeed necessary. In this situation, it is important not to delay insulin therapy for more than a few months. A trial of triple therapy for two months should be sufficient to assess whether it is likely to be effective or not.
How Can I Deal With An Insulin Reaction
People who have diabetes should carry at least 15 grams of a fast-acting carbohydrate with them at all times in case of hypoglycemia or an insulin reaction. The following are examples of quick sources of energy that can relieve the symptoms of an insulin reaction:
- Non-diet soda: ½ to ¾ cup.
- Fruit juice: ½ cup.
- Fruit: 2 tablespoons of raisins.
- Candy: 5 Lifesavers.
- Glucose tablets: 3 tablets .
If you dont feel better 15 minutes after having a fast-acting carbohydrate, or if monitoring shows that your blood sugar level is still too low, have another 15 grams of a fast-acting carbohydrate.
Teach your friends, work colleagues, and family members how to treat hypoglycemia, because sometimes you may need their help. Also, keep a supply of glucagon on hand. Glucagon comes in a kit with a powder and a liquid that you must mix together and then inject. It will raise your blood sugar level. If you are unconscious, or you cant eat or drink, another person can give you a shot of glucagon. Talk to your doctor to learn when and how to use glucagon.
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Insulin Doses Need To Be Raised Or Lowered:
- Throughout life as you grow
- For different activities
- For foods that may affect your blood sugar differently
- When you are sick
The information on the following pages may be hard to learn. Learning to change insulin doses can take time. It is important to learn this because changing insulin doses at home when needed and between diabetes appointments will help to control your blood sugar.
It is better to prevent high blood sugars than to chase them with extra insulin at the time of the high. It is better to prevent low blood sugars than to chase them with extra quick-acting carbohydrate.
Your certified diabetes educator will teach you how to change your insulin doses to prevent high or low blood sugar. We will help you by phone or email for several months after you find out you have diabetes. After you learn to change insulin doses without our help, we are still here to help you when you need.
What Are The Typical Dosages Of Lantus
The information below describes dosages that are commonly used or recommended. But be sure to take the dosage your doctor prescribes for you. Your doctor will determine the best dosage to fit your needs.
The typical dosage of Lantus your doctor prescribes will depend on whether you have type 1 or type 2 diabetes. If you have questions about the normal dosage of Lantus for your condition, talk with your doctor.
Youll likely inject Lantus once per day. You can inject it at any time of day, but it should be done at the same time every day.
Dosage for type 1 diabetes
If you have type 1 diabetes, your starting dose of Lantus is about one-third of your total daily insulin dose. The rest of this daily insulin total is made up of a fast-acting insulin thats given at mealtimes.
Your doctor will use weight-based dosing to determine your total daily insulin dose. The usual dosage range for type 1 diabetes is 0.4 units to 1 unit of insulin per kilogram * of body weight.
For example, a doctor might prescribe 0.5 units per kg daily to a person weighing 66 kg . So their total daily insulin would be 33 units. Their Lantus dosage would be one-third of this total, meaning theyd take 11 units of Lantus daily. The remaining 22 units would be given as a fast-acting insulin with each meal.
For details about possible dosage adjustments with Lantus, see the Dosage adjustments section below.
* One kg is about 2.2 pounds.
Dosage for type 2 diabetes
* One kg is about 2.2 pounds.
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What Are The Typical Dosages Of Basaglar
Typically, your doctor will start you on a low dosage. Then theyll adjust it over time to reach the right amount for you. In the end, your doctor will prescribe the lowest dosage that effectively treats your condition.
The information below describes dosages that are commonly used or recommended. But be sure to take the dosage that your doctor prescribes for you. Your doctor will determine the best dosage to fit your needs.
Dosage for type 1 diabetes
If youre just starting Basaglar treatment for type 1 diabetes, your doctor will calculate your dosage for you. This will be based on your body weight. In most cases, your starting dose will be about one-third of your total daily insulin requirements. Youll likely use Basaglar along with a short-acting insulin. This will make up the rest of your total daily insulin dose. You should inject your dose of Basaglar once daily, at the same time each day.
According to the American Diabetes Association, your total daily insulin requirements will usually be from 0.4 units/kilogram to 1 unit/kg each day. So, for a person weighing 100 kg, or about 220 pounds , the daily dosage of insulin would likely be 40 units to 100 units per day. Since one-third of this would be long-acting insulin, such as Basaglar, their dosage of Basaglar may be 13 to 33 units once daily.
Below is a dosing chart with this information:
| Body weight | ||
| 100 kg | 40 units to 100 units | 13 units to 33 units |
Dosage for type 2 diabetes
Usual Adult Dose For Diabetes Type 1
Note: Regular human insulin is available in 2 concentrations: 100 units of insulin per mL and 500 units of insulin per mL Doses should be individualized based on patient’s metabolic needs, blood glucose monitoring results, and glycemic goals
- Total daily insulin requirements are generally between 0.5 to 1 unit/kg/day
Insulin U-100 :
- Insulin U-100 should generally be used in a regimen with an intermediate or long-acting insulin
- Humulin R: Dilute to a concentration of 0.1 to 1 unit/mL in an infusion system using polyvinyl chloride infusion bags this insulin is stable in normal saline
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Disposal Of Used Insulin Syringes
Used syringes, pen needles, cannulas and lancets must be disposed of in an Australian Standards-approved sharps container, which is puncture-proof and has a secure lid. These containers are usually yellow and are available through pharmacies, local municipal councils and state or territory diabetes organisations such as Diabetes Victoria.
Procedures to dispose of sharps containers vary from state to state.
For sharps disposal information and help, you can contact:
- state or territory diabetes organisations, such as Diabetes Victoria
- state Department of Health
Insulin needs to be stored correctly. This includes:
- Store unopened insulin on its side in a fridge.
- Keep the fridge temperature between 2 and 8 °C.
- Make sure that insulin does not freeze.
- Once opened, keep it at room temperature for not more than one month and then dispose of it safely.
- Avoid keeping insulin in direct sunlight.
Extreme temperatures can damage insulin so it doesn’t work properly. It must not be left where temperatures are over 30 °C. In summer your car can get this hot so don’t leave your insulin there.
There are various insulated insulin carry bags available for transporting insulin.
The Younger The Sooner The Better
The key to when to start insulin is to identify the appropriate glycated haemoglobin target for an individual patient. Despite the promulgation of various ‘guidelines’, there is no single HbA1c concentration which suits everyone. For example, the younger patients already on maximal oral therapy and as much lifestyle modification as they can manage, would benefit greatly in the long term from early introduction of insulin, even if their HbA1c is only minimally elevated . The important point here is the early introduction of insulin, as the lifetime risk of complications for young patients is great. On the other hand, older patients who are not symptomatic and have no microvascular complications such as retinopathy, can be allowed to remain in ‘secondary failure’ at an HbA1c of 8-9%. In these patients, prognosis is governed mainly by macrovascular disease, which is not greatly influenced by glycaemic control.
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Would My Doctor Recommend Splitting My Lantus Doses
Maybe. Your doctor may recommend splitting your Lantus dose if your blood sugar levels start to increase shortly before your next dose is due.
Dosing twice a day with Lantus is not a dosage thats approved by the FDA. However, your doctor may recommend it off-label.
If you have additional questions about your Lantus dose, including off-label dosing, talk with your doctor or pharmacist.
How Is Levemir Used
Levemir comes as a liquid solution. Your healthcare professional will show you how to give yourself injections under your skin. Youll use either a FlexTouch pen or a syringe and vial.
To give yourself injections using Levemir FlexTouch pens, youll use pen needles. With Levemir vials, youll need insulin syringes . You should always use a new pen needle or syringe for each dose.
Note: Levemir doesnt include needles or syringes. These are sold or dispensed separately. Ask your pharmacist for details.
You can inject Levemir under the skin of your belly, thigh, or upper arm. Its best to choose a different injection site each time. Using the same injection site over and over can make your skin irritated, hardened, or lumpy. You should also avoid injecting insulin into areas of skin that are already damaged or thickened. Doing so can cause changes in your blood sugar level.
Detailed instructions on how to use Levemir vials or FlexTouch pens are available in the drugs labeling. If you have questions about how to inject Levemir, talk with your doctor or pharmacist.
For information on Levemir expiration, storage, and disposal, see this article.
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