We do not dose Lantus based on the PS. We dose it on the nadir (the lowest BG) primarily with some consideration to the PS. We also don’t increase a dose unless we know how low the current dose is taking him and we don’t know that because we don’t have enough data (tests). I suspect Bubba is bouncing from a low BG but without the data, it’s not certain.
My suggestion is to try the
tight regulation protocol (TR) but you will need to test more both cycles if you wish to do this. Before you decide, please go the
Lantus/Levemir/Biosimilars forum and read the Stickys at the top including the one on TR.
As Kyle explained, SLGS is less aggressive and has you holding doses longer than TR. It also has a higher reduction point (90 vs 50 human meter or 90 vs 68 pet meter). That means if he’s in higher BGs and you are doing SLGS, you are going to hold the dose where you might be able to increase it under TR every six cycles. Because we count cycles in TR, if you skip a shot, the cycle count starts over again. For example, if you were doing TR, you had 8 cycles at 1u and then you skipped a shot so the cycle count starts over. We also hold doses longer under TR if you are seeing BGs in the “blue range”. Either method, you need to go back to 1u bid for now.
I also encourage you to read the info post in the Lantus forum I linked above which deals with posting guidelines and then start posting there every day. You’ll get more eyes that deal specifically with depot insulins so there will be more people to help you. But, there are very specific posting rules so please read that and then post accordingly. And they are data driven there so you have to test more.