2/24 Mickey amps 328

[Peggy and Mickey (GA)]

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[Venita]

Yesterday's thread.

Hi folks. Peggy asked me to come take a look at Mickey's progress on the Levemir. It is an amazing schedule that y'all have set up for him and, Peggy, I would suggest you put the schedule you sent me into a google document and link to it from your signature line. It certainly helps to explain the complexity you are dealing with.

Sheila said:

I guess you should get through the time change and then look at numbers before deciding to go to .75u.

It is clear that Mickey needs a dose increase. I agree with waiting to get through the time change. But I don't think I would "look at the numbers" before deciding on a dose change. If I were holding the syringe, I would make the change on the 26th, his first full day on the 11am/11pm shot cycle. You don't work until 2pm that cycle, so you do have time to get +2 or +2.5 tests on the AM cycles, and maybe you can try to catch his nadir a couple times on his PM cycles. (I know, I know.)

Also, if I were holding the syringe, I would go higher than .75U. I know this is contrary to the advice in this Levemir 101 sticky, but the mid-cycle tests yesterday show him running in the 300s. This sticky on the Lantus forum advises a .5U increase in that situation.

After 3 consecutive days (6 cycles)... if nadirs are greater than 300 increase the dose by 0.5 unit.

I would raise to 1U. He's been pink or high yellows a long time (including when on PZI).

Just my

 

[tuckers mom]

Peggy, I think when you originally asked me about Levemir I had asked you if you were going to start at 1 unit. Mickey has been on insulin for a while and even though you have a crazy schedule, Mickey is used to getting more insulin, with ProZinc his dose was much higher. I have to agree with Venita, I'd go up to a full 1 Unit.

 

[Sheila & Beau GA & Jeddie GA]

Since the syringe is in Peggy's hand, not any of ours, she is the best one to make the decision. I have posted several times about raising the dose and I don't like one sentence of my various posts quoted as if I was taking a lackadaisical approach here. In my earlier post I said this:

Well, he is sitting in the 300s now - that's not good. Lets see if he come down at all on the "fat half unit". Since he was up to more than 3u on the other insulin, he may need a lot more lev. We just don't know how much and with the schedule changes (moving up shots) we don't want to rush the dose increases. But maybe you could increase by quarter units for the next couple of increases? Go to .75u next, then 1u after that. Are you comfortable with that? Normally, I would say to raise him on Saturday if he isn't coming down, but how does that fit with your working schedule and when you will be home to test him? And when is your next time moving him earlier?

And then the sentence Venita quoted came after Peggy answered my question about when the next time change was.

I would be all for a faster raise if he was on a set 12/12 schedule, but he isn't. His shots get moved forward, and then back, repeatedly. When shot schedules are changed, along with the dose it is impossible to sort out what is causing the BG change, and it makes it take longer to settle on a given dose (as each time change causes enough upset to need its own settle time) so I feel that either smaller dose increases should be used or a longer settle time.

Yes, he needs more insulin. I have said that. I do think that the numbers need to be looked again right before an increase that was planned days before. You look at them and see they are still where they were, so you go ahead and raise the dose - or you see that they are lower and you ask yourself if that effects your decision to raise the dose or not.

Raising the dose from .6u to 1u is a 66% increase. I just don't know that it is a good idea with all the schedule changes happening here. But Peggy it's your call.

 

[Vicky & Gandalf (GA) & Murrlin]

Schedule changes are a bear any way you try to finangle them. (hmm, "finangle" must not be a word, my spellcheck doesn't like it.) The less number of changes or the less those changes are at any rate, be they time or dose, the better, in my experience.

We might also look at increasing dose NOT during a time change actually. Most dose increases won't show up for another couple cycles anyway, so she should be able to then get some tests in on days she's off to see how the increase is working. Coupling dose changes with time changes could cause all sorts of confusion, as Sheila said, when trying to sort out what caused the resulting BGs.

The thing here is that Peggy is actually moving times earlier more than moving times back, so increasing by .5U at a time is not advised in that case. As long as Mickey is healthy with no infections and a good appetite, moving him through the lower doses should carry him through this period fine if you're all worried about ketones.

 

[tuckers mom]

Since the syringe is in Peggy's hand, not any of ours, she is the best one to make the decision. I have posted several times about raising the dose and I don't like one sentence of my various posts quoted as if I was taking a lackadaisical approach here. In my earlier post I said this:

Well, he is sitting in the 300s now - that's not good. Lets see if he come down at all on the "fat half unit". Since he was up to more than 3u on the other insulin, he may need a lot more lev. We just don't know how much and with the schedule changes (moving up shots) we don't want to rush the dose increases. But maybe you could increase by quarter units for the next couple of increases? Go to .75u next, then 1u after that. Are you comfortable with that? Normally, I would say to raise him on Saturday if he isn't coming down, but how does that fit with your working schedule and when you will be home to test him? And when is your next time moving him earlier?

And then the sentence Venita quoted came after Peggy answered my question about when the next time change was.

I would be all for a faster raise if he was on a set 12/12 schedule, but he isn't. His shots get moved forward, and then back, repeatedly. When shot schedules are changed, along with the dose it is impossible to sort out what is causing the BG change, and it makes it take longer to settle on a given dose (as each time change causes enough upset to need its own settle time) so I feel that either smaller dose increases should be used or a longer settle time.

Yes, he needs more insulin. I have said that. I do think that the numbers need to be looked again right before an increase that was planned days before. You look at them and see they are still where they were, so you go ahead and raise the dose - or you see that they are lower and you ask yourself if that effects your decision to raise the dose or not.

Raising the dose from .6u to 1u is a 66% increase. I just don't know that it is a good idea with all the schedule changes happening here. But Peggy it's your call.

Sheila, I hope you're not upset with me commenting on Peggy's threads and giving my thoughts on Mickey. I care very much for Peggy as she is the amazing woman who brought Lilly Grace to my family and even without that reason, she's just a wonderful person.

I've been watching Mickey on ProZinc for a long time and could not say anything because I've never used that insulin. I have only my own experiences to draw from, but for years with all of the FDs I've adopted, if they were long term FDs used to getting insulin I start the dose at 1U and this is why I've mentioned the dose increase, I didn't think he was getting enough Lev to begin with.

 

[Vicky & Gandalf (GA) & Murrlin]

Jennifer, I don't think there's any upset that you are helping out. It's very important to have other input for Mickey. It's clear, however, there is a difference of opinion on the method for raising dose for him. I think Peggy should be cautious and not jump to 1U just yet because of the time change factors she has to deal with. The less she changes the variables the better. He possibly could need as much or more than 1U but we need to see what he does on a lesser dose through some of these time changes to have a better picture on how he reacts to that factor before throwing another huge variable in the mix.