04/13 Joey AMPS 459 +6 320...dose increase Q

[Brytny&Joey]

Hey all We've got Joey on a relaxed Lantus regime & he's been testing within the 3-400's for the last while on 0.5u. Just wanted to check that we should increase his dose to 1u. He was on 1u but went low so we dropped to the 0.5u. Should we maybe do more of a curve before deciding to go up? Could do that tomorrow, but if not necessary we may as well bump him up.

Thanks!

 

[Sienne and Gabby (GA)]

For me to be comfortable making a recommendation about a dose increase, I would like to see a few more mid-cycle tests. The rationale is that if Joey is dropping into low numbers during the cycle, what you may be seeing at shot times are bounces back up. Gabby has been known to have her AMPS in the 400s, drop to the 40s mid-cycle, and then bounce back to the 400s at PMPS. If I hadn't been testing, I wouldn't have known to decrease the dose and would have assumed a dose increase was needed. It helps to always remember that Lantus dosing, whether you're using the Tight Regulation Protocol or the Start Low Go Slow approach, is based on the nadir and not pre-shot numbers.

With Lantus, when you decrease the dose, in most cases you want to decrease by 0.25u. It's looking like the reduction didn't hold because you reduced by 0.5u.

 

[Libby and Lucy]

I would do a curve first, preferably by getting some spot checks tomorrow during the day and then a couple more in the evening.

While Joey is probably not dropping very far, there is a possibility that he is - see 4/6, when he went lower than usual and then bounced up high after that? It is possible that some of those other red AMPS numbers were also the result of some lower numbers overnight. Getting spot checks over a couple of different cycles will help us see if we think that is happening, or if he is just staying high. Does that make sense?

 

[Brytny&Joey]

Yes that makes sense, thanks! I will have some mid cycle tests done tomorrow to see how he is doing. Damien (the boyfriend) had been urging to increase back up to 1u, and I wanted to ask here first. I can tell him he was wrong this time, haha! For now, anyway.

OK thanks again.