08/15 Marvin AMPS~322 +3~313 +6~320 +9~326 PMPS~356

[Marvin]

Hi everyone,

Just wondering if anyone can shed some light on why Marv's levels have been so high lately? We were doing so well for a while there until the insulin got to the 28-30 day mark. Even with a new insulin, we still haven't been able to get back on track. Please help!

Thanks,
Carolyn

 

[Sienne and Gabby (GA)]

I think you are holding your doses too long. It looks like you are holding Marvin's doses for 5 days. If you're following the Tight Regulation Protocol, you'll want to evaluate the dose a bit sooner:

Increasing the dose:

• Hold the dose for 3 - 5 days (6 - 10 consecutive cycles) if nadirs are less than 200 before increasing the dose by 0.25 unit.
• After 3 days (6 consecutive cycles)... if nadirs are greater than 200, but less than 300 increase the dose by 0.25 unit.
• After 3 days (6 consecutive cycles)... if nadirs are greater than 300 increase the dose by 0.5 unit.

Unless the nadir is under 200, you hold the dose for 3 days. Since it looks like the nadirs are in the 200s, you would increase by 0.25u (not 0.5u) after 3 days/6 cycles.

It may be that your insulin was going bad. According to the manufacturer, Lantus should be discarded after 28 days. Most of us get longer use from a pen provided it is stored in the refrigerator, hasn't been shaken or frozen, and generally, is handled gently.