Samwise AMPS & PMPS +6 5/24

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sueandsamwise

sueandsamwise

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AMPS 377 1.4U

Sam will be on the PZI for another week or so until I find where I can get this insulin the cheapest. Plus, I have to wait for payday, next Tuesday. To bad my insurance doesn't cover it. :smile: She is starting him on 1U with a U100 needle. Don't know if thats a lot or not though.

+6 189

PMPS 407 1.4 u
 
That is an appropriate starting dose for Lantus. Check out the protocol stickies at the top of the lantus ISG. The initial dose should be held for 5 days before being adjusted. There is a build up in the body that needs to happen, and when initially starting lantus, it can take several days before that happens. Dose adjustments should happen no more than every 3 days, unless he earns a dose reduction due to low numbers.
 
My husband took Sammy so I wasn't there to hear her comments. She said that we would see lower numbers than before with the PZI. I'm not sure what that means. I'm kind of scared of this insulin now, I'd hate to have him hypo! She did say he looked great, still under weight but he's gaining and had a bit of gingivitus. I need to pump the DH for more info or call her. She put in big letters on the sheet no dose reductions unless I ask! I know he has to build a shed? of insulin? I hope this will be a good match for him. I'll head over to the Lantus board and ask some questions and look at the stickies.
 
Yes, the easiest way to describe it is a shed. Lantus and Levemir bind and unbind with a molecule in the blood. That allows the insulin to be much longer lasting, but the bound particles need to build up according to the dose so that a more constant amount is available to the system. I know it probably sounds confusing, and I remember someone posting a video about it somewhere on this board. I'll see if I can drum it up for you.

Re: dose reductions - any number below 40 *ever* warrants a reduction by 0.25u. Since Samwise is a more long term diabetic, you use 40 as the threshold rather than 50. When your vet said you will see lower numbers, she is probably referring to over all numbers due to the longer acting nature of Lantus. A good lantus curve is actually flat, which is why you see many people shooting a full dose into greens. This is something you work toward eventually as you fine tune the dose. (don't ever shoot a green at the very beginning. You have a new set of data to gather now!)
 
Found it. It is about Levemir, but Lantus works the exact same way.

The binding and unbinding works a bit like a time release mechanism. See this video: http://www.youtube.com/watch?v=LrtiKvSd ... re=related Its kind of long, but if you advance it to about 3:25 that is where a nice animation starts that explains it pretty well. The only thing that is missing is the explanation that the "signalling begins" means the cell is able to take up glucose.
Click to expand...

[youtube]LrtiKvSd2r8&feature=related[/youtube]
 
It's important to know too that if they hit a 40 or so on Lantus, it's not like PZI where you know the #s will shoot back up in a few hours. On the Ls (as I understand it, have not used them myself), they can ride in those low #s for hours. I know many peeps are (legitimately) super-scared of the 40s and will often underdose out of fear, so I mention it since I know you are braver :mrgreen: than many. Personally I would probably keep 50 as a starting point rather than 40, at least until you have a solid feel for things - it's quite a different insulin, and from what I've heard you kind of have to throw your PZI knowledge out the window.

And if the protocol or peeps on the board say you need a dose reduction, I would say you *absolutely* do. It's an aggressive protocol, so shooting a higher dose than is recommended over in L Land is really dangerous. Certainly call the vet if you want to confirm, but I get really nailbite_smile when vets say stuff like that to people. I think it is better to give guidelines, like reduce if you see a 40, rather than only reduce if we confer first. I've seen people stick with a dose b/c they didn't reach their vet, when the dose is dangerous. I'm pretty sure any vet would be on board with a dose reduction with #s under 40!!!!!

Ok, off my soapbox :mrgreen:
 
Yes Sue, let me chime in agreement that if the lantus peeps ask you to reduce....REDUCE, they are not as afraid of much lower numbers than we are and my opinion is if they say it is too much insulin it TRULY IS!
I'll love to silently watch your progress over there...I won't say a word as only the real advisors are 'allowed' to do so.
But I will be watching.
Paw and Fingers doing you know what.
The way L works is sooooooooooooo different than pzi that is may feel terribly hard at first...but it is a wonderful insulin and I love what it has done for Tom.
 
I know this is going to be so different from the PZI that I wish I had started with Lantus first instead of the PZI. This is starting to scare me because it is so different and you need to be on top of the dose schedule. No fudging I am going to have to change his shot times I think, since the 7:30 am and pm will be harder to keep on the weekends. I often fall asleep after the first wakeup and don't get up until after 8 on weekends. I'd hate to screw up Sam's dosing for sleeping! Aghhh! Okay, I've not started it yet and will not probably do that until after the Memorial day weekend since I have to wait until payday to afford the insulin. Wish me luck and I'm glad a have a bit of leeway and not have to jump in right NOW! nailbite_smile
 
You will do fine!!!!!! And hopefully Sammy's #s will get really good! Luckily you have a reasonable idea of his dose and it's not a super-high one, so I wouldn't overly worry.
 
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