If he was on Novolin since July, I would use the 70% of his current dose on Novolin which was 2.00 so the lantus starting dose comes to 1.4u so you could start him anywhere between 1.25 and 1.5u. Do you have any other numbers prior to the ones on the SS do you think he's been running that high all along?
Normally we hold the initial dose for 5-7 cycles but since he's transitioning from another insulin, Per the TR protocol, i would leave him at this current dose for no more than six cycles. If his nadirs are above 300, I'd increase him to 1.75u. The midcycle tests are important so we know his approximate nadirs. A curve (every two hours) would be great if he will let you but even spot checks at PS, +3, +6, 10 give us a good idea of his numbers.
Lantus is a depot insulin so it works differently from Novolin which is a short term insulin. It's in, then it's out and you dose on the PS. With lantus, and levemir, we dose primarily on the nadir with some consideration given to PS. The L insulins like consistency in dose and time. So, as much as you can, it's best to shoot the same dose every 12 hours unless his dose needs to be adjusted because his BG is too high or too low.
You say he had infection...is it resolved? What kind of infection and was he on antibiotics? Is he eating well and drinking? Has he ever been treated for high ketones or diabetic ketoacidosis? Do you test his ketone levels? If you don't, you should.
Ketones can develop from not enough insulin + infection + not enough food/water.
To check ketones, buy Ketostix at the pharmacy, dip in his fresh urine, and compare to chart on bottle exactly 15 seconds after dipping in urine.
