Oscar finally switching over tonight - need advice; pmps 249

[Kelly & Oscar]

I finally got approval to switch Oscar over to Lantus today from our IM specialist. We have been on 2.2u of prozinc for the past 5 days and were getting ready to up it to 2.4 tomorrow. He has a constant trace level of ketones that have been present for months and won't go away. We've been on prozinc for 4 months. The specialist said to give 2u of lantus and hold it for 2 weeks. I have also heard that it may be wise to go 2 days or so with no insulin to clear the prozinc out of the system, but this makes me nervous with Oscar's ketones. Does the 2u dose for at least 7 days sound like an appropriate course of action for Oscar's particular situation?

 

[Ronnie & Luna]

Re: Oscar finally switching over tonight - need advice

Hi Kelly

what time is your shot time? How many + hours from now approximately.

Can you test a +11? So we can see where Oscar is at.

Hang on for experienced eye on Oscar's SS, ok?

 

[Kelly & Oscar]

Re: Oscar finally switching over tonight - need advice

Shot time is usually right now. 7pm give or take. His pm shot number was 249. I'll go ahead and give Yoda a shot and hang around for a few min or so for Oscar!

 

[Ronnie & Luna]

Re: Oscar finally switching over tonight - need advice

ok, can you add OSCAR's PMPS to your first subject line?

this will help others see that right away.

 

[Libby and Lucy]

Re: Oscar finally switching over tonight - need advice

I would definitely not let him go a few days without insulin with ketones present. I also would not hold a dose for two weeks if it isn't working, especially with ketones. You should be willing to fast-track up the dosing scale, if necessary, if the numbers aren't good or if the ketones get worse.

What is the amoxycillin for?

 

[Kelly & Oscar]

Re: Oscar finally switching over tonight - need advice

He had a bout of asthma attacks/coughing for no reason a few days ago. We were thinking it was the beginnings of a URI because he had been very well controlled on his flovent for a while now. The amoxacillin seems to be paired with the blue numbers though hmmmmm.....

So 2u for 5-7 days seems to be OK?

 

[Libby and Lucy]

2 units sounds ok, then see what the numbers and the ketones tests say before deciding how long to hold it. Usually we hold starting doses for 5 days, but if the ketones start to increase then we'll want to increase the dose sooner. Lantus isn't as good about overcoming ketones as some of the faster-acting insulins are, so the best strategy is to stay ahead of them.

ps... Yoda looks like he is ready for a dose increase too, if you want to try to bring his range down a little more and try to get rid of the pink. His only greens are in the 90's so there's room for a little more juice, say 2.5 units. I would do it sometime when you're around to be able to monitor.

 

[Kelly & Oscar]

2 units sounds ok, then see what the numbers and the ketones tests say before deciding how long to hold it. Usually we hold starting doses for 5 days, but if the ketones start to increase then we'll want to increase the dose sooner. Lantus isn't as good about overcoming ketones as some of the faster-acting insulins are, so the best strategy is to stay ahead of them.

ps... Yoda looks like he is ready for a dose increase too, if you want to try to bring his range down a little more and try to get rid of the pink. His only greens are in the 90's so there's room for a little more juice, say 2.5 units. I would do it sometime when you're around to be able to monitor.

Sounds good. I was debating upping Yoda's dose yet because it seems we have a small bounce reoccurring when he sees green numbers. I'll go ahead and open a condo for him too.

 

[Nancy and Cody]

Kelly,
Please hold on before you shoot this am. I asked for some experienced eyes to check on you. Did you check mid cycle last night?

Here was what I wrote before

FYI when I switched from prozinc to lev, the lady who helped me, had me skip a cycle because she was concerned that Prozinc may in fact have a "shed" (it is a human recombinant insulin and does seem to take 45 days to work well- why is that? - possibly because it builds a shed?)

She also mentioned that many many of the older type pzis --> to lantus cats she has helped switch over the years, bottomed out in the first 2-3 cycles. Please start SLOW and watch closely- set your alarm tonight. I do not know the onset of lantus, but I was surprised how slowly Lev kicks in (like +4), but then lasts so much longer than Prozinc ( like +13) Make sure you have some idea when to be extra vigilant.

Oscar is ketone prone? right? Make sure anyone helping you knows this. Is he completely healthy and not stressed right now? Haven't I read that ketones are more likely with not enough insulin, infection, stress, not enough food/fluids IN COMBINATION?

Are you well stocked on test strips, ketone strips? Have you posted over there to get some help in advance?

Don't be a stranger-

 

[Sienne and Gabby (GA)]

When members have switched from one long-acting insulin to another (e.g., Lantus to Lev), the switch was made immediately without holding insulin for a cycle. The dose can be reduced - but this is due to other differences between Lantus and Lev and there isn't similar information available about ProZinc. However, Oscar has ketones present. In my mind, ketones trumps pretty much anything else since skipping a shot could cause a rapid increase in ketone levels. The danger in that is significant.

I'd suggest continuing to give insulin and monitoring carefully the way we routinely suggest with a Lantus to Lev switch. There can be a drop in BG levels in the first couple of cycles but it is not guaranteed. Kelly is not inexperienced at managing FD.

 

[Libby and Lucy]

Kelly, if last night's 2 units left him at 114, please monitor closely today. That's a pretty low preshot for just starting out. Sometimes the first dose or two of Lantus can pack a punch so just stay on top of it. So far the +1 spike looks good, please get a +2.

I agree with not skipping a shot, ketones or no and whether or not there is a shed. Lantus doesn't work as well on high numbers as it does on lower ones, so I don't understand the logic of letting them get high before shooting their first shot of Lantus (and then being disappointed when the Lantus doesn't seem to work well).

 

[Kelly & Oscar]

Sorry I couldn't get a +2 today - I had to put a few hours in at work this morning. With that huge rise in 1 hour I felt more safe putting in morning hours than the afternoon hours where he might bottom out. At +6 today he is at 262. I'll keep testing though just to keep a check on things!

Just a note - our shot times are generally 6:15am/pm

 

[Sarah and Buzz]

Hi Kelly! Just wanted to say welcome to LL. You've gotten great advice already and I've got nothing to add except good luck! We will be watching to see how he does.