Lantus - what's protocol here?

[mirror]

A quarter so far
My worry is if it keeps dropping and dropping and Omg no insulin given and still decreased blood glucose
I just want her to have a reasonable bm and be OK to have the next infusion on 7 Sept.
Obvs gonna discuss with diabetes consultant on 4 Sept ( never met him yet)
What if he recommends NOT to have it?
Maybe would him and the other consultant consult each other?
The specialist for her other stuff is my first port of call really as that's her shorter term quality of life vs general diabetes

 

[Spiker]

Maybe this new drug is the accidental cure for T1D? ^_^

 

[Spiker]

Seriously though, I am sure you will soon find the right workable level of Lantus.

 

[mirror]

Hope so
Thanks for hanging in for me Spiker, I appreciate your support.

 

[Spiker]

And yes I think it will be very important for the diabetes consultant and brain injury consultant to work together and make a joint decision.

Do you have a detailed log book with all her doses, BG readings and carbs? It will be essential to prove to both consultants that all these odd results really did happen. Don't lose the meter so you can prove that the low BGs happened.

 

[mirror]

Will be able to piece something together
Partly via this forum posts!
I think it is important to report as a side effect too for future patients

 

[ButtterflyLady]

A quarter so far
My worry is if it keeps dropping and dropping and Omg no insulin given and still decreased blood glucose
I just want her to have a reasonable bm and be OK to have the next infusion on 7 Sept.
Obvs gonna discuss with diabetes consultant on 4 Sept ( never met him yet)
What if he recommends NOT to have it?
Maybe would him and the other consultant consult each other?
The specialist for her other stuff is my first port of call really as that's her shorter term quality of life vs general diabetes

You could ask each consultant to contact the other, by phone and/or letter. They would be foolish not to, with such a complex case and the stakes being high.

You are doing great, btw.

 

[Spiker]

I am wondering if part of the problem was discontinuing steroids. Is that the case, that your daughter was on steroids and then they were stopped? If so that could have caused an increase in basal (Lantus) needs during the steroid treatment, and then after steroids were discontinued, if her Lantus had been increased during the steroid treatment, it would then be too high.

Does that fit the pattern at all? Before any of this other treatment began what was her Lantus dose?

 

[mirror]

She's still on steroids
40 mg due to reduce to 35mg tomorrow
First steroids dose was 60 mg
Lantus prior to admission - no clue
She was at university alone and independently managed her diabetes for the last 3 or so years
But definitely on something in the 20's to my best guess knowledge. On admission they put her on 28
It rose to 34 at highest
28 on discharge

 

[mirror]

Catch up with any posts tomorrow x
sleep time till 2.30 am!

 

[Spiker]

Have a good rest, I PMd you too.

 

[mirror]

2.30 and 4.30 bm was 3
Lucozade and snacks
6.30 bm is 7
Going to try and speak to someone soon

 

[mirror]

Diabetes nurse was lovely and said we've been doing the right thing
Said to halve lantus again tonight
If still getting lows to omit it totally but to check for ketones
And to give 1 unit of novorapid every 4 hours if she starts going high on no lantus.
Consultant neurologist on holiday till Tuesday but spoke to his secretary and waiting for a call back after she's spoken to one of his registrars

 

[Spiker]

Good news.
I would think you could keep halving the Lantus to 4... 2... 1 until you start to see a normal day.

 

[mirror]

Well we getting there
Bm went 12, 14, 18 was at half 12
Gave 1 unit novorapid
It's now at 13 an hour and a half later
No food
Were probably going to take her out to encourage her to eat something (wouldn't at home) should we think about injection?
What about lantus tonight? 6 again or 4?
I will ring diabetes nurse but have had good advice here

 

[Spiker]

On that basis I would be looking at raising the Lantus. If it was 6? try 8.

 

[Spiker]

Would be great if you can wait 4-5 hours after the 1u Novorapid before giving food so you can assess (only roughly) her correction ratio, ie how much 1u drops her.

Bear in mind that with a rising background BG this won't be a true value, it will understate the drop she would see if it her basal was correct and level.

 

[Spiker]

Normally we would not adjust Lantus every day, supposed to be every 3 days, but this was an emergency so don't worry about it.

Some say it takes 3 days for a changed dose of basal to fully take effect but I don't personally believe there is any evidence for this. The action profile graphs of glargine (Lantus) are pretty clear that the effect is minimal after 24 hours, even at high doses.

 

[mirror]

1 unit brought her down by 11 to 7.5 Bm over 4.5 hours. So fed her a can of soup.
DSN says reduce lantus again tonight as she was hypo at 2.30 and 4.30 am.

 

[Spiker]

Hmm if she is hypo in the night but rising without food in the afternoon and evening that sounds to me like you need to split the dose rather than reduce it. Split the existing dose in 2 and take them 12 hours apart. Low doses at these levels don't last 24 hrs.