Debating on increasing Lantus dose

Hi All - thanks in advance for reading through. We recently switched to Lantus from Novolin N and today was dose #6. We ran a curve today and it is doing a much gentler curve but we're still getting high numbers, the nadir was 364. He's currently on 0.5u and after reading the sticky on tight regulation, I'm debating about increasing him to 1.0u.

I know depot insulins take a bit to build (5-7) days but after reading the TR sticky, there is a line in there that if after 6 cycles we're still seeing high curve numbers to increase 0.5u. I'm currently working from home so I can test him as needed during the day until we fine tune the dose he needs. Not sure if I should stick to the current dose for 2 more days or try out the 1u.

Looking for thoughts based on his data.

 

If I remember right I believe the "after 6 cycles" part only applies after the depot has completely filled, which it hasn't yet. That rule would apply for regular increases on TR. A more experienced Lantus user may be able to elaborate so hang on for more replies.

 

Thank you! I wasn't sure based on how it's written if I had to wait or it would be okay now. I'll wait until I hear more.

 

@tiffmaxee might be able to guide you.

Elise?

 

Hi. I believe I answered on your Lantus condo. Are you following SLGS or TR? Feeding any dry food?

 

I'm checking out the Tight Regulation method. We're only 6 doses in on Lantus, started at 0.5u. I wasn't sure if this can start now or we have to wait until the depot is filled (5-10 days)?

 

You feed dry so go with SLGS.

 

Can I ask why? Why does food matter on which method we can go with, I haven't read that yet anywhere? Since he's on the low carb dry and wet, I didn't realize we could only go with SLGS. Love to hear more. Thanks!

 

The study on TR was never done with low-carb dry food, I don't believe LC dry was on the market at the time. Dry food metabolizes differently than wet and as TR is an aggressive protocol method, there's a risk factor in introducing an unknown variable into the mix. Basically there's no research done using dry food on TR and it could be too dangerous a protocol to use with dry.

 

Gotcha, thank you for clarifying. A moderator commented on my post in the Lantus group and mentioned going up to 1u would be okay since even on 1.5u of Novolin he got into the blue and with his current weight and BGs 1u should be okay to make sure and monitor.

 

I saw that.

 

Good to know. I don't think it will change Wendy's opinion on the increase right now but you might want to mention to her Diago is still eating some dry. She may have different advice for the future. And it will be helpful to add the food he's on in your signature.

If you can kick the dry completely though I think TR would be great to use!

 

I absolutely will mention it on that one and add to my signature. Thank you both so much!