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Should Fast Acting Insulin Be Given Along With Long Acting Lantus Insulin?

Posted on Tue, 2 Feb 2016

Question: Gave my mom long acting lantus insulin around 9:00 pm. Her blood sugar has since increase and its 12:10 pm. Should I give her fast acting insulin as well? I'm afraid that it will bottom out by doing so.

Answered by Dr. Praveen Jeyapathy (19 minutes later)

Brief Answer:
Please don't.

Detailed Answer:
Hello there. Thanks for writing to HCM.

May I ask you if you have just started lantus last night? How many units did you give? What was her glucose level at 9 and what is it now? What is her normal meal time insulin dose and is it rapid acting or short acting insulin that she uses for meal time?

I will be able to advise rightly if I have these info.

Regards.

Above answer was peer-reviewed by : Dr. Prasad

Follow up: Dr. Praveen Jeyapathy (21 minutes later)

She began taking lantus about a week ago. Normal dose of fast acting is 8units. Her night time lantus dose is 24 units. Blood sugar at 9:00 was 412. Checked one hour later it was 433. One hour later 488. Last reading about 10 minutes ago was 421.

Answered by Dr. Praveen Jeyapathy (22 minutes later)

Brief Answer:
As mentioned below

Detailed Answer:
Thanks for the reply. Noted the contents.

I suggest 8 units of fasting acting insulin now. Please check the glucose levels at 6 am tomorrow. Don't worry. She will not have hypoglycemia.

The next thing to do is check her pre dinner and post dinner tomorrow and if the pre dinner value is more than 140-180, add around 3 units of short acting dose at night. If its 180-220, add 6 units to the night short acting dose. Please remind her that dinner has to be the lightest meal of the day.

I will also suggest to take 28 units of lantus tomorrow night and continue to check fasting glucose levels. You can follow the 3-0-3 rule. Check the fasting glucose every second day and increase the night dose by 3 unit increments every second day until the fasting glucose comes below 130 mg/dl.

It would be ideal if you can discuss my views about tomorrows insulin management with her treating doctor and start it accordingly.

Please feel free to contact if any doubts arise.
Warm regards.

Above answer was peer-reviewed by : Dr. Prasad

Follow up: Dr. Praveen Jeyapathy (37 minutes later)

Ok i gave her the fast acting insulin and will check again at 6am. I will share this with her doctor. She recently had a stroke so we worry when her blood sugar rises and falls. She is no longer independent. Thank you.

Answered by Dr. Praveen Jeyapathy (1 minute later)

Brief Answer:
Yes. I understand your concern.

Detailed Answer:
Good that you gave it right away. Please continue to monitor as advised. It would be good to have a word with the treating physician. Since you told me that she had a stroke recently we need to maintain her fasting glucose levels between 100-130 and post meal/random not more than 180. We need to take care that she does not have a hypoglycemic episode and to ensure that her meal timings and compostion are of utmost importance. Please ensure you give her a light mid meal snack. Hope it works out well for her. Wishing her good health. Stay calm. It will settle down. Don't worry.

Warm regards
Dr XXXXXXX

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Above answer was peer-reviewed by : Dr. Sonia Raina