6/29 Ernest AMPS 196 -- dose advice?

[LJ and Ernest]

Hi All,

If you take a look at my spreadsheet you will see we had a low number last week at PMPS (160) and I decided to skip a dose. Ernest had a series of very bad days after that (although no ketones), so I am not ever skipping again unless it is way way low.

He was originally prescribed 2u lantus twice a day and because his numbers have been consistently high, and in some cases dangerously high, I have been giving him fat doses, probably around 2.25-2.5 -- my syringes only measure in 1u increments.

I've read through the stickies and I see that ~10-25% is recommended in cases of PS 150-200, but because we are so close to 200 and with Ernest's history, I am thinking just slightly less than 2u this morning.

Does that sound reasonable?

I'm going to test again in a few minutes -- last test was 30 minutes ago -- and plan to shoot in the next 1/2 hour.

Thanks

 

[PeterDevonMocha]

Hi guys .. I don't think I have ever stopped into Ernest's condo before, so welcome from us! I don't really know what to say about dosing advice, but others will be along soon to help out I'm sure .. have a great day guys!

 

[Sienne and Gabby (GA)]

With regard to the skipped shot, I suspect that the high numbers were not due to the skipped shot all by itself. In all likelihood, the high numbers were due to a bounce. Ernest doesn't appear, from what data you have, to have spent much time in lower numbers. It's important to get spot checks because without them, you don't actually know what has been going on throughout the cycle. It's possible that Ernest's numbers have dropped lower, like you're now seeing. When numbers do drop, the liver reacts by dumping a stored form of glucose and counterregulatory hormones into the blood stream. As a result, numbers spike up and can stay up for as long as 72 hours.

It's also important to get a test before every shot. You need to know whether it's safe to shoot and your pre-shot test is the only way to know that. Since Lantus dosing is based on the lowest point of the cycle, spot checks are also important. The minimum needed are one spot check per cycle.

If you are going to shoot a low number, it's important to get at least a +1 and +2 test. Again, it's the only way to know if Ernest is safe.

Regarding this morning, if what's in your +1 column was the test right before you shot, that is, in fact your AMPS. Your PMPS would then be 12 hours from when you shot this morning.