Reduce Your Lantus Dose Immediately
Your overnight blood glucose readings of 101 mg/dL and 72 mg/dL on Lantus 40 units indicate you are experiencing nocturnal hypoglycemia and require an immediate dose reduction of 10–20% (reduce to 32–36 units). 1
Why This Dose Reduction Is Critical
Any blood glucose reading below 70 mg/dL constitutes hypoglycemia and mandates immediate insulin dose adjustment—your reading of 72 mg/dL is at the threshold and signals impending danger. 1
78% of hospitalized patients on basal insulin experience nocturnal hypoglycemia (midnight–6 AM), yet 75% receive no dose adjustment before the next administration—this is a dangerous management gap you must avoid. 1
A fasting glucose below 100 mg/dL predicts next-day hypoglycemia, and your reading of 101 mg/dL combined with 72 mg/dL overnight confirms your basal insulin dose is excessive. 1
Recurrent hypoglycemia shifts glycemic thresholds lower, making future episodes harder to detect and increasing your risk of severe hypoglycemia with loss of consciousness. 1
Immediate Action Steps
Tonight's Dose Adjustment
Reduce your Lantus from 40 units to 32–36 units (a 10–20% reduction) starting with your next scheduled dose. 1
If you experience any glucose reading below 70 mg/dL, treat immediately with 15 grams of fast-acting carbohydrate (4 glucose tablets, 4 oz juice, or 1 tablespoon honey), recheck in 15 minutes, and repeat if needed. 1
Monitoring Requirements
Check your fasting blood glucose every morning during this adjustment period to guide further dose changes. 2
Set an alarm to check your blood glucose at 2–3 AM for the next 3–5 nights to ensure you are not experiencing undetected nocturnal hypoglycemia. 1
Record all glucose values to identify patterns and guide your healthcare provider's recommendations. 2
Ongoing Titration Protocol
If Fasting Glucose Remains 80–130 mg/dL
Maintain your current reduced dose (32–36 units) and continue daily fasting glucose monitoring. 2
Reassess after 3 days to ensure stability without hypoglycemia. 2
If Fasting Glucose Rises Above 140 mg/dL
- Increase your Lantus dose by 2 units every 3 days until fasting glucose consistently falls within 80–130 mg/dL. 2
If Any Hypoglycemia Recurs
- Reduce the dose by an additional 10–20% immediately and contact your healthcare provider. 1
Critical Safety Warnings
Never ignore a glucose reading below 70 mg/dL—a single unexplained episode warrants immediate dose reduction and provider notification. 1
Do not wait for multiple hypoglycemic episodes before adjusting your dose; each episode increases your risk of severe hypoglycemia and impairs your ability to detect future episodes. 1
Scrupulous avoidance of hypoglycemia for 2–3 weeks can reverse hypoglycemia unawareness if present, restoring your ability to recognize warning symptoms. 1
Always carry a source of fast-acting carbohydrate (glucose tablets, juice box) with you at all times. 2
When to Contact Your Healthcare Provider Urgently
Any glucose reading below 54 mg/dL (clinically significant hypoglycemia requiring urgent evaluation). 1
Recurrent hypoglycemia despite dose reduction (more than one episode below 70 mg/dL in a week). 1
Inability to detect hypoglycemia symptoms (hypoglycemia unawareness). 1
Fasting glucose persistently above 180 mg/dL after dose reduction, indicating need for careful re-titration. 2
Common Pitfalls to Avoid
Do not continue your current 40-unit dose hoping the hypoglycemia will resolve on its own—it will not, and you risk severe hypoglycemia with seizures or loss of consciousness. 1
Do not reduce your dose by only 1–2 units—a 10–20% reduction (4–8 units) is required to meaningfully reduce hypoglycemia risk. 1
Do not skip your basal insulin entirely in response to hypoglycemia, as this will cause rebound hyperglycemia; instead, reduce the dose appropriately. 1
Do not rely solely on correction insulin without adjusting your scheduled basal dose—the problem is your basal insulin, not your correction doses. 1