lantus dosages

LouisVRN, RN · Jan 9, 2011

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.

CharmedJ7 · Jan 9, 2011

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.

I don't necessarily think sliding scale adjustment (I presume ssc = sliding scale coverage?) is the answer here, although it may be part of it. Is this lady getting prandial insulin as well? SSI is really such a small part of diabetes management, it's reactionary and not physiological hence the results can be somewhat unpredictable - there's a lot of literature out on it in the past 10 years or so, interesting stuff. Anyhow, SSI is at best a stop-gap or bandage measure, she needs more thorough intervention. Is she TI or TII? Too, I believe there are some tx that are effective with at least some compulsive eaters/compulsive ppl in general, I want to say select antidepressants off the top of my head but I'd have to double-check that. I'd look into a psych consult + potentially raising her lantus and/or splitting the dose.

Also wanted to say, forget who wrote it, but for the pt that grabs snacks even when his BS is high, that's not necessarily surprising, ie, hunger is not as simple as you get hungry when BS is low and full when it's high. Of course, it's contributory, but there's a lot of other regulation from nerve pathways (vagus nerve stim from stomach when stretched for ex) and neurotransmitters, hormones (ghrelin, leptin, GLP-1 etc + insulin itself) , and many other psychological and environmental factors (see: studies on plate size or unending soup bowls on food consumption, external vs. internal hunger signals, etc). Hunger is a complex issue, it's one of the reasons diabetes mgmt is so hard. When I was sitting in on diabetes education sessions for people with persistent uncontrolled diabetes, there was always long discussions among the participants about feeling constantly hungry. This is why I :heartbeat endocrinologists, they're the best at putting all the pieces together.

Katie5 · Jan 9, 2011

We had a pt recently that was receiving 135 units of Lantus qHS. Is there a maximum amount of Lantus that anyone knows of? The pt was obese (@ 300lb), was still running high BGs (200's) and stated that his DM II is always out of control. Any thoughts, ideas, etc.? This person just got my brain to running and in spite of all the info on here I haven't come across a max dose for Lantus.

Can the patient also be encouraged to lose weight as an added intervention?

I'm of the notion that medicine no matter how good and well controlled, would still have some side effects.

rkitty198, BSN, RN · Jan 9, 2011

That seems like a lot! I had a pt recieving 80 units of regular insulin each meal- she was 300lbs. I even called her pharmacy to make sure she was correct on the dosage and I called our pharmacy to make sure that was safe.

I have never given 100units of anything. I too would have given it a second thought

rita359 · Jan 9, 2011

Can't speak to highest dose of lantus but fyi, don't remember the type insulin but they make a 500u/cc insulin so out there somewhere there a number of patients who require a LOT of insulin.

blondy2061h, MSN, RN · Jan 9, 2011

Can't speak to highest dose of lantus but fyi, don't remember the type insulin but they make a 500u/cc insulin so out there somewhere there a number of patients who require a LOT of insulin.

Regular insulin is available in that concentration.