6/22 Ernest AMPS 384

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LJ and Ernest

LJ and Ernest

Member Since 2011
Hi All,

Ernest is on 2U lantus twice daily and has been on insulin for less than a month, although he was diagnosed in April. We brought him down into the 200s with food, but on Memorial Day he went Ketoacidosis and since then, even with 2u twice a day has hovered around 300 at the AMPS and PMPS. Yesterday AMP he was at 483 which was the highest I had seen since he was in ICU. I tested him at +6 and he was at 323 bg. Then he dropped to 164 at the PMPS. I did not give him his shot last night, but took 3 more samples, all in the same range (I use relion, and I think I read somewhere that it has =/-20 BG accuracy). This morning, he is at 384, which seems reasonable considering he had no shot last night.

So the question is, what happened yesterday? Is this the Lantus Shed? Mainly I want to know if I need to change what I am doing. I will be testing him again in an hour for his +6.
 
Welcome LJ! I am not able to give dosing advice. There will be someone who can come along soon. I did, however, want to welcome you and let you know that we are glad you are here. Someone will be along soon to help you out.
 
Thanks Melissa. It's not urgent, he seems to be back to his normal high numbers, although he is not extremely hungry today.

Relatedly, I just learned that if you don't get enough blood on the strip, the Relion will throw a "Hi' which apparently means over the maximum reading of 600 bg. Small panic attack! but I retested and he is at 393. Not great, but not over 600 either.
 
Really? I use a contour and it gives an "E 2" error message when I don't get enough blood.

One thing you need to try and do is get some +2 and +4 numbers. I work during the day so I can't do it then, but I do try and get a test before bed at night. I also do a full curve each weekend one day. Since Lantus dosing is based on nadir (lowest point of the cycle) and not on preshot numbers, it is better to have that information. Tarragon, my cat, usually has his nadir at +6, sometimes +8, so I know that I need to be aware if he is low at +2 because he will just go lower in the next 4-6 hours.
 
I thought of one more thing. If you want dosing advice or need help, it is best to put that in your title. You can go back and put "6/22 Earnest AMPS 384 Dosing advice". This will flag our more experienced members to look at your post!

Again, welcome to Lantus Land!
 
hi there
welcome to Lantus Land

couple of questions, have you read the starred stickies here?
what food is Ernest eating? what is his feeding schedule?
any history of ketones?
I would also like to add, I would encourage you to grab a bit more spotchecks on him thru the cycles, we are a data happy forum and the more data the better, and easier it is to offer input on dose.
cycles can vary, number wise, so every little bit helps.
what is your schedule like? work, school?
 
welcome to Lantus Land!

I agree with Ronnie. If you can get some mid-cycle spot checks that will help a lot. Then you will know if the 100s yesterday were a fluke, or if maybe he is hitting those numbers other times and you just haven't caught them. So far, so good though.

Just a note, with Ernest's history of DKA, you want to be careful about letting him sit in high numbers for too long. The more often you can get spot checks, the more often you'll be able to adjust his insulin dose if needed. That will help get him to better regulation faster. In the meantime, have you been testing his urine for ketones?
 
Welcome to Lantus Land!!

You've gotten some good info as well as several questions that once you answer will help fill in some of the gaps about Ernest. It sounds like a UTI threw him into DKA back in May. I hope you are routinely testing for ketones.

Please continue to get some mid-cycle checks. As others have noted, Lantus dosing is based on the lowest point of the cycle. I'd also point out that given Ernest's history of DKA, there are other alternatives to skipping a shot. If you have a question about whether it's safe to shoot or what the best alternative is, please post and we'll be happy to help you figure out what to do.

Please read through the starred, sticky notes at the top of the Board. I hope you will continue to post here. In addition to the sticky notes, this post will help you to maximize your experience here.
 
i can't add any more to the excellent advice you've already received, but wanted to stop by to welcome you to the group!

hope to see you posting often...
 
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