My brother with, who has type 1 diabetes, is traveling east from Hong Kong to Los Angeles for an extended stay. He takes 10 units of Lantus at night and NovoLog, eight units for breakfast, four for lunch and 12 for dinner. His flight is 14 hours from 12:35 a.m. to 2:35 p.m. in Japan time, which places his arrival with a 16 hour difference from Japan to Los Angeles time zones, at 9:35 p.m. in Los Angeles? How would you, generally, adjust his insulin (especially the glargine). His doctor couldn’t tell him what to do.

This has been made a little easier with the Lantus. First, the Lantus should be taken at the same time every 24 hours. That means he will take his Lantus at usual time, Hong Kong, and use NovoLog with meals. He will have to make a decision if the content of the food, especially the carbohydrates, is similar to what he takes at other meals and adjust accordingly. When he approaches the U.S., he can wait to take the Lantus roughly 24 hours later. If he finds he cannot take Lantus right at 24 hours later, he can gradually phase into schedule by taking 18 to 22 hours later and successively earlier till he is on target with his dosing.

JTL