lantus dosages

I have heard that the max is 100 units at a time.....but I have also given over 100 units to a few very large patients.

My grandpa is 400lbs and 6 foot 3.... he takes 100 units twice daily along with his humalog 100 units three times a day with meals..

I've had pt on amounts that are around 75 units.

I dont remember the exact dose, but it did exceed 135u lantus on a pt in the hospital I had. He was a large man and this new dosing schedule was the first time for years that his DM II was under control (mostly)

I just got an order on a patient who now takes 82 units Lantus daily, plus sliding scale Humalog. The doc says titrate the Lantus dose upward by 2-4 units Q 5 days until FBG is 80-160. I am worried we will hit the 'overdose' amount and have a hypoglycemic crash. (This is a home health patient, not in hospital.)

I had a patient that took 175 units qHS. Pharmacy sent it up in a 3ml syringe that we attached a subq needle to. If their blood sugars are still high, it's not too much.

I appreciate your reply. I have started titrating the dose upward, as the doc prescribed. The patient is able to identify signs of low blood sugar, so I think we will be OK.

I recently had a pt who was on 100 units bid while in the hospital. His home dose was 120 units bid!

The typical dosing of total daily insulin for an obese pt is 0.6 units/kg/day, so for a 300 lb pt, I'd think they'd start @ about 40 lantus then about 15 or so aspart with meals. That said, that's a base estimate which is titrated up from there as needed, so wow, this person must have really out of control diabetes!

One thing I've also seen is for bigger people is a divided dose of lantus, say 1/2 at night, 1/2 with lunch or something, which the endocrinologist said was because although lantus was theoretically giving a basal dose over 24 hours, it can be metabolized differently and effectively only cover for say, 20 hrs, so dividing the dose ensures more constant coverage.

Anyhow, the highest I've seen is 80 U, and the lady could've definitely probably gone up from there b/c her sugars were still 200+. It'd be interesting to see in your case how the dose had been titrated, ie, where did they start and how did they get here? At a certain pt too, I'd start to suspect there's more going on in this case than just 'pt needs more insulin'.

I have a lady in the NH that is getting 65 units every night....but she lays in bed and eats ALL.NIGHT.LONG, so its nothing for her 6am BS to be in the 200-300 range and her 1130am BS to be 300-500. I asked the dr. to adjust her ssc. I am thinking of asking again. Maybe she needs to be on ss#3...idk, but nothing is really working for her right now...except laying off the amount of food she eats.

I mean...when you have to dust potato chip crumbs off of her at 8am...you kinda got a problem.

ShannonRN2010 [congratulations!]:

I think compulsive eating is a lot of my patient's problem, just like your night-eater. When he comes home, the first thing he does is grab a handful of nuts or slices some fruit and gobbles it. Now, when these 2 occurances happened, he had had a good breakfast and his BG was in the 200s. So I don't think he was really hungry. He does struggle with depression, ADD, and dyslexia and has a lot of other 'issues'. Someone told him (he says) that it's OK to snack on these things. I pointed out that he only needs a between-meal snack if his BG is low or normal:rolleyes:. He looked like he had never heard that before!

Sigh. It's an uphill battle with this one, but I will give it my best shot. Finally got a referral to an endocrinologist and a diabetic nutritionist. The most important referral he has, though, is one for a psychologist. And that's the one he keeps putting off!

I have routinely seen 100units QHS, some with a morning/lunch dose as well. Byetta is also becoming increasingly popular for our patients who still have elevated FGB with lantus and sliding scales.