First, a celebration. I've had Pirate Luke for a year now and he's now officially moved into Foster Fail territory and we're transferring ownership to me! Yay!
Secondly, a question. I've had his vial of Lantus since March and we've been able to consistently reduce his dose and keep him in decent numbers.
Until recently.
Now it doesn't really even make a dent in his blood sugar. I have tried raising the dose a few times to little avail. So I think I need a new vial.
When changing vials from one which has lost potency, do you go back to the last good dose when the insulin seemed potent or what? Don't want to overdose the fella but I do want him back on
Congratulations that you have decided to make him yours permanently!
It’s very hard to answer your question because you haven’t been following any dosing method we have here. If you are doing SLGS, you would hold every dose for one full week, unless he drops below 90, and then determine if he needs an increase or not. If he drops below 90 at any time, you reduce the dose by 0.25u.
At no time should you do dose increases or decreases by less than 0.25u unless he’s high and flat all the time above 300. The reason he’s making no progress is because the dose changes are too minimal. Again, when you increase or decrease, it should be by 0.25u. Even with PZ, that’s the way we would correctly dose.
You’ve been changing the dose in tiny increments way too often. And while I understand you have data but don’t always enter it, it’s vital for us to see if you want us to answer a dose question.
With Lantus, we don’t dose primarily on the preshot which is what you’ve been doing lately. It’s not like PZ. We dose primarily on the nadir. Lantus dose increases take a minimum of six cycles to settle in to where we could tell which dose might be best for him but, again, under SLGS, you hold the dose a week.
To answer your question, normally, we would give the dose he was on before his BG headed up but there isn’t enough data there for me to tell if that was a good dose or not. But, when I look at what he was doing on 1u, I can tell he needed more insulin and the increase would have been to 1.25u bid. That’s where I would suggest you start.
I’d also like to suggest you follow SLGS
exactly as it is written and it’s really critical you
always get a preshot test. Too many times, I’ve seen members fail to get one because the BG was high at night only to test at +1 or +2 and kitty was at 20 and showing hypo symptoms. Not only can this result in death but a Lantus hypo can go on for several cycles due to the depot.
