Should I adjust my Lantus (insulin glargine) dose from 64 units given a fasting blood sugar of 236?

Lantus (Insulin Glargine) Dose Adjustment for Persistent Hyperglycemia

You should increase your Lantus dose from 64 units to 70 units based on your consistently elevated fasting blood sugar readings. 1

Analysis of Current Blood Sugar Pattern

Your fasting blood sugar readings show persistent hyperglycemia despite your current 64-unit Lantus dose:

• 8/9: 218 mg/dL at 5:15am
• 8/10: 340 mg/dL at 6:40am
• 8/11: 248 mg/dL at 5:45am
• 8/12: 171 mg/dL at 5:15am
• Current: 236 mg/dL at 5:20am

This pattern indicates inadequate basal insulin coverage with your current dose.

Recommended Dose Adjustment

According to current diabetes management guidelines, when fasting blood glucose remains consistently above target despite basal insulin therapy, a dose increase is warranted 1:

1. Initial adjustment: Increase your Lantus dose by 6 units (approximately 10% of your current dose)
2. Monitoring: Check fasting blood glucose daily for the next 3 days
3. Further adjustments: If fasting glucose remains above target after 3 days without hypoglycemia, increase by another 2-4 units every 3 days until reaching target

Titration Algorithm

The American Diabetes Association recommends the following evidence-based titration algorithm 1:

• Starting point: Current dose (64 units)
• Adjustment: Increase by 2 units every 3 days until reaching fasting glucose target
• Target: Individualized fasting glucose goal (typically 80-130 mg/dL)
• Safety check: If hypoglycemia occurs, reduce dose by 10-20% (6-12 units)

Important Safety Considerations

1. Hypoglycemia risk: Monitor for symptoms like shakiness, sweating, confusion, or readings below 70 mg/dL. If hypoglycemia occurs, reduce your dose by 10-20% 2

2. Timing consistency: Continue taking Lantus at the same time each day to maintain consistent insulin action 3

3. Injection technique: Rotate injection sites within the same region to reduce the risk of lipodystrophy 3

4. Overbasalization warning signs: Watch for:

   • High bedtime-to-morning glucose differential
   • Frequent hypoglycemia
   • High glucose variability 2

5. Consider prandial coverage: If fasting glucose improves but post-meal readings remain high, discuss adding mealtime insulin with your healthcare provider 1

When to Contact Your Healthcare Provider

• If you experience hypoglycemia (blood sugar <70 mg/dL) • If blood sugar remains >250 mg/dL for more than 2 days after dose adjustment • If you develop symptoms of diabetic ketoacidosis (nausea, vomiting, abdominal pain, fruity breath)

Remember that insulin adjustments should ideally be done under medical supervision with appropriate glucose monitoring 3. Contact your healthcare provider to discuss this dose adjustment and establish a follow-up plan.