Pls reply asap. Very urgent question about taking Lantus before dialysis.

[jo]

My mom usually splits the Lantus in the mornings and nights. She takes 7 units in the morning and 8 units at night. On dialysis days, she doesn't take any insulin as her blood sugars drop instantly if she did. Currently, she is admitted at the hospital and is being treated with antibiotics for blood infection which I think is caused from the Urinary Tract Infection as the urine culture and the blood culture ended up being the same bug. One of the doctors prefers that she takes Lantus once a day rather than taking it twice. So today (no dialysis day), she was given 15 units of Lantus in the morning and nothing at night. Tomorrow is her dialysis day and I am wondering if she should take 20 units of Lantus  before dialysis or skip it completely and take it after dialysis? If so, how much? Normally, on the dialysis days, she skips her morning 7 units of Lantus and just takes the 8 units after dialysis at night. With this change of Lantus dosage now, what are your recommendations/suggestions? Faster response is helpful as she has dialysis in the morning. Thanks.

[Charlie B53]

Lantus is a slow-acting insulin, the effect lasts for 24 hours.  Spliting the dosage into two injections achieves the same effect of taking it all in one shot.  The only real drawback is having a second needle stick.

I take all my Lantus just before bedtime.

Adjusting the dosage is essential.  You do not want too much, nor too little.  Ideally taking you blood sugar before bed, and again first thing again in the morning,  WITHOUT eating from say three hours before bed and until after taking that morning sugar reading.  You want those two readings to be close to the same.  If the morning reading is higher then you may need a couple more units.  If the morning reading is lower then you may be taking a couple units too much.

Verify this with your Dr's and see that he agrees before making any changes to your dose.

If you lose or gain more than 10 pounds your body requirement for insulin can change.  Be aware as weight change from diet can have a large effect on medications.

I have lost a LOT of weight.  My insulin resistance is now gone.  I have had to make major cuts in my fast-acting and am still making adjustments to my Lantus.  Where I was taking 60 units of Lantus I am now down to 30 and still not balanced yet.  I am having low sugars in the mornings which is proof I am still taking too much Lantus.  I expect that I will be cutting at least another 10 units off before my sugars even out again.

NEVER change your dose more than a couple of units.  And always confirm your numbers with your Dr.

[jo]

Lantus is a slow-acting insulin, the effect lasts for 24 hours.  Spliting the dosage into two injections achieves the same effect of taking it all in one shot.  The only real drawback is having a second needle stick.

I take all my Lantus just before bedtime.

Adjusting the dosage is essential.  You do not want too much, nor too little.  Ideally taking you blood sugar before bed, and again first thing again in the morning,  WITHOUT eating from say three hours before bed and until after taking that morning sugar reading.  You want those two readings to be close to the same.  If the morning reading is higher then you may need a couple more units.  If the morning reading is lower then you may be taking a couple units too much.

Verify this with your Dr's and see that he agrees before making any changes to your dose.

If you lose or gain more than 10 pounds your body requirement for insulin can change.  Be aware as weight change from diet can have a large effect on medications.

I have lost a LOT of weight.  My insulin resistance is now gone.  I have had to make major cuts in my fast-acting and am still making adjustments to my Lantus.  Where I was taking 60 units of Lantus I am now down to 30 and still not balanced yet.  I am having low sugars in the mornings which is proof I am still taking too much Lantus.  I expect that I will be cutting at least another 10 units off before my sugars even out again.

NEVER change your dose more than a couple of units.  And always confirm your numbers with your Dr.

Thanks. Also my question is should she take any insulin before dialysis? Even if her blood sugar shows above 300 before dialysis, it will drop way down to 120 within 30 mins of starting dialysis.

[Alex C.]

Jo, there are most likely no doctors here, and your question is one which MUST be answered by a doctor. My suggestion to you is this:

1: turn off the computer

2: get up and go to the phone.

3: CALL THE DOCTOR

any questions?

[PaulBC]

3: CALL THE DOCTOR

I second this advice, though I think I have seen one or two doctors here, perhaps it's worth emphasizing call your doctor.

[jo]

Jo, there are most likely no doctors here, and your question is one which MUST be answered by a doctor. My suggestion to you is this:

1: turn off the computer

2: get up and go to the phone.

3: CALL THE DOCTOR

any questions?

My mom is admitted at the hospital and is being treated for a blood infection. I started posting my question here as the only response I received from the doctors is "I DON'T KNOW". I don't want them to experiment with my mom but rather tell me a definitive answer.

[Michael Murphy]

Personally I think I would talk to the nurse at dialysis tell him or her your concerns,  if they know your mother is trying a new amount of insulin they can watch her for signs of either high sugar or low sugar and at least in the dialysis center I use they will test and treat a diabetic patient if they get a tad wonky.

[PrimeTimer]

My husband has diabetes and says that when a diabetic has infection/fever, blood sugar levels can end up being all over the map as your body reacts to the infection/fever. As for Lantus, he said that is mostly used at bedtime (I think CharlieB53 had a good post on this). Lantus helps to counter the "dawn effect", which is when a person's blood sugar level kind of just naturally starts to rise in the early morning hours. He also said that insulin shouldn't get "washed out" by dialysis because the insulin is injected subcutaneously between skin and muscle. Someone here (sorry I forgot who) mentioned that your mom should see a "Diabetes Educator". My husband agrees. They are specially trained nurses that work with Endocrinologists and they can figure out how much and when your mom should take her insulin and Lantus. Sorry you and your mom are going thru a rough time right now, these darned diseases (kidney/diabetes) are terrible! But keep fighting and learning all you can and definitely talk with an Endocrinologist and Diabetes Educator. They should be a big help.

Here's a link about the "dawn effect"

www.mayoclinic.org/.../diabetes/.../dawn-effect/FAQ-20057937

(if my link doesn't work, just google "the dawn effect", sorry).

Just hilighting some things here for you in case you want to make a list: Endocrinologist   Diabetes Educator    the dawn effect    Gastroparesis


Sorry, wanted to add that you might want to ask an Endocrinologist about testing your mom for Gastroparesis (delayed stomach emptying). That can mess with blood sugar levels too. Makes the levels go up and then suddenly down. Good luck.

www.mayoclinic.org/diseases-conditions/gastroparesis/                               

[Charlie B53]

Prime Timer raises a very important fact that I missed.  Diabetics with any additional/new illness or infections WILL have elevated sugars until the new condition is controlled or cured.  It is the bodies natural response to aide fighting off this new invader.  Her being in the hospital right now is best as they will keep a much closer monitor on her condition.  They will be closely watching her sugars and constantly adjusting her insulin until she becomes more balanced.  Once the infection is gone then final adjustment of her Lantus may be needed.

[Alex C.]

My mom is admitted at the hospital and is being treated for a blood infection. I started posting my question here as the only response I received from the doctors is "I DON'T KNOW". I don't want them to experiment with my mom but rather tell me a definitive answer.

Well, Jo, the way to get answers to serious medical questions like your (ones where some idiotic response could kill somebody) is to get it from a professional, and not just somebody on an online forum who has "xx" number of posts to their account. When the doctor told you "I don't know", your response should be, "Then refer me to somebody who CAN answer the question". He is required by law to do so.

Asking for medical advice from anonymous online posters is foolish and dangerous.

[Charlie B53]

Lantus is a slow-acting insulin, the effect lasts for 24 hours.  Spliting the dosage into two injections achieves the same effect of taking it all in one shot.  The only real drawback is having a second needle stick.

I take all my Lantus just before bedtime.

Adjusting the dosage is essential.  You do not want too much, nor too little.  Ideally taking you blood sugar before bed, and again first thing again in the morning,  WITHOUT eating from say three hours before bed and until after taking that morning sugar reading.  You want those two readings to be close to the same.  If the morning reading is higher then you may need a couple more units.  If the morning reading is lower then you may be taking a couple units too much.

Verify this with your Dr's and see that he agrees before making any changes to your dose.

If you lose or gain more than 10 pounds your body requirement for insulin can change.  Be aware as weight change from diet can have a large effect on medications.

I have lost a LOT of weight.  My insulin resistance is now gone.  I have had to make major cuts in my fast-acting and am still making adjustments to my Lantus.  Where I was taking 60 units of Lantus I am now down to 30 and still not balanced yet.  I am having low sugars in the mornings which is proof I am still taking too much Lantus.  I expect that I will be cutting at least another 10 units off before my sugars even out again.

NEVER change your dose more than a couple of units.  And always confirm your numbers with your Dr.

Reviewing the thread it is obvious that most everyone has been very clear to CALL the Doctor.

If your Doctor is unwilling or unable to answer your questions it may be past time to start looking for a different Doctor that will take the time to find answers.

Keep posting to let us know how she is doing.

We care,  many of us on dialysis are also diabetic, so we really do understand what she is going through.

Take Care,

Charlie B

[jo]

Personally I think I would talk to the nurse at dialysis tell him or her your concerns,  if they know your mother is trying a new amount of insulin they can watch her for signs of either high sugar or low sugar and at least in the dialysis center I use they will test and treat a diabetic patient if they get a tad wonky.

We would be so grateful if we had a dialysis center like yours. Unfortunately, they don't really care about the patients here and we have no other choice. Hopefully we will move to a different clinic soon. Let's see.

[jo]

My husband has diabetes and says that when a diabetic has infection/fever, blood sugar levels can end up being all over the map as your body reacts to the infection/fever. As for Lantus, he said that is mostly used at bedtime (I think CharlieB53 had a good post on this). Lantus helps to counter the "dawn effect", which is when a person's blood sugar level kind of just naturally starts to rise in the early morning hours. He also said that insulin shouldn't get "washed out" by dialysis because the insulin is injected subcutaneously between skin and muscle. Someone here (sorry I forgot who) mentioned that your mom should see a "Diabetes Educator". My husband agrees. They are specially trained nurses that work with Endocrinologists and they can figure out how much and when your mom should take her insulin and Lantus. Sorry you and your mom are going thru a rough time right now, these darned diseases (kidney/diabetes) are terrible! But keep fighting and learning all you can and definitely talk with an Endocrinologist and Diabetes Educator. They should be a big help.

Here's a link about the "dawn effect"

www.mayoclinic.org/.../diabetes/.../dawn-effect/FAQ-20057937

(if my link doesn't work, just google "the dawn effect", sorry).

Just hilighting some things here for you in case you want to make a list: Endocrinologist   Diabetes Educator    the dawn effect    Gastroparesis


Sorry, wanted to add that you might want to ask an Endocrinologist about testing your mom for Gastroparesis (delayed stomach emptying). That can mess with blood sugar levels too. Makes the levels go up and then suddenly down. Good luck.

www.mayoclinic.org/diseases-conditions/gastroparesis/                               

Thank you so much for the info.

[jo]

Thanks to all for your responses. By the way, they found she got an MSSA bacteria infection (Staph infection) which entered her bloodstream and not a urinary tract infection. She is on antibiotics right now and we came back home yesterday after a 6 day stay at the hospital. Her oxygen is low without her using the oxygen tank. Without using the oxygen tank, her oxygen level is around 84-85. Doctors said it's usual for oxygen to be low after an infection and asked her to take deep breaths and walk a little bit everyday. Could anything be done to bring her oxygen levels up? They were not able to find the source of the infection though. Anyone had this infection before?

Regarding my question about Lantus, the attending physician changed the insulin to be given at bedtime (20 units) and they also gave us a sliding scale for the long acting insulin along with the discharge instructions. We will start with that and see how her blood sugar gets controlled. I pray for everyone with kidney disease and I really hope there are more advanced treatments in the upcoming years. Thanks again.