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Lantus - what's protocol here?

Discussion in 'Type 1 Diabetes' started by mirror, Aug 18, 2015.

  1. Jaylee

    Jaylee Type 1 · Moderator
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  2. mirror

    mirror · Well-Known Member

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    Thanks
    I've emailed them
    Sounds good
     
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  3. mirror

    mirror · Well-Known Member

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    Another update
    Now need insulin
    Think I know what's caused it at least partly although effect started prior to this
    Need advice on how to up the insulin to avoid hypo and dka went to pub quiz last night and did have a low there of 2.8 and overcompensated with carbs leading to bm 18 at 3.30 bm
    Then 7.50 5.3bm
    11.05 6.9 bm
    13.05 23.1 bm
    14.40 24.3bm 1 novorapid
    16.45. 19.6 bm
    18.50 26.6 bm 3 units novorapid
    18.40 27bm 3 novorapid
    Unsure how much lantus tonight?
    Advice please
    ( worst falls and no insulin coincides with being on antibiotic co-amoxiclav
    Off for a day.rising bms
    Only food today 32g carbs at 11 am
     
  4. Spiker

    Spiker Type 1 · Well-Known Member

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    Have her tested for allergy to the coamoxiclav.

    Any time her BG goes 10+ you must give insulin. Those drops from 21 down to 9 are probably being achieved entirely by renal dumping. That is hammering her kidneys every time.

    Having said that the lack of ketones would suggest that somehow after 20 years she is producing her own insulin.

    Do you use a blood ketone meter or urine strips (sorry if I asked that before)? Urine strips can give false negatives, especially if ketosis has been going on for some time.
     
  5. Spiker

    Spiker Type 1 · Well-Known Member

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    **** 3 NOVORAPID IS TOO MUCH ****

    We've already established her insulin sensitivity is at least 15 mmol per 1u.

    3u will cause a hypo even at that high BG. It will drop her a theoretical 45-60 mmol/L. Probably less than that due to raised insulin resistance at high BG. But still very dangerous.

    Have you done DAFNE or BDEC? You need to be working from a set of ratios (carb and correction) and constantly watching the BG test results to revalidate or adjust those ratios.

    This is scary and really not appropriate. :-(
     
  6. Spiker

    Spiker Type 1 · Well-Known Member

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    As well as doing before and after blood tests (0 hrs, 2 hrs, 4 hrs) for meal and correction doses, you need to do the same kind of calibration to see how much carb she needs to raise her so many mmol/L when correcting a hypo.
    All these numbers need to be very conservative until you validate them over repeated sets of tests. Because her condition is so complex and variable you need to be testing these assumptions all the time and change them, in the conservative direction, whenever the tests cast doubt on assumption.
     
  7. mirror

    mirror · Well-Known Member

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    use a blood ketone meter
    right - so shes got a bm of 24.3 and has 1 unit of novo rapid at 14.40
    2 hours later its 19.6
    1 more hours later (should have read 17.40 previously) its 26.6 - at this point my husband decides to give 3 units (i thought possibly 2)
    40 minutes later its risen again (or at least stayed the same) to 27 so he decided to give 3 more novorapid
    this was at 18.40 apparently
    i will check bm now - so around an hour an a half after

    spiker - youve been fab and i am trying here. can i post tonight and get advice whether lantus is appropriate please?
     
  8. Spiker

    Spiker Type 1 · Well-Known Member

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    Do not stack doses under any circumstances. Do not under any circumstances inject fast acting insulin more frequently than every 4 hours. It needs at least 4-5 hours for the full effect of Novorapid. Even if it is still rising at 2 hours don't inject again until 4 hours. This is a very common mistake and it causes hypos.

    Are you confident that the insulin is not spoiled, needle not jammed or clogged, injected into clean new site, leave needle in for count of ten, etc?
     
  9. Spiker

    Spiker Type 1 · Well-Known Member

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    Vulnerable and ill person with steroids and off label restricted meds, extremely complex unexplained BG behaviour, you really need at least a good DSN on the end of the phone and preferably back in a hospital setting. I thought she was going back in to hospital yesterday?

    She needs IV insulin, IV glucose, sliding scale, liver consultants and endocrinologists on tap. Treating this at home via blind Internet advice is just taking too many risks. Apart from anything else you and the father are not always acting as a unified team. We can't resolve disagreements between the two of you.
     
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  10. Spiker

    Spiker Type 1 · Well-Known Member

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    No one who is supporting your daughter, certainly including me, has any idea what is going on with her glucose and insulin metabolism at the moment. It completely defies explanation and constantly changes in unpredictable ways. She needs to be in a hospital under the supervision of experts, whether you like those experts or not. It's very clear that your daughters hypo seizure in hospital could have been as unpredictable and unavoidable as the one(s) she has had since under your own care. Get her to a hospital and get expert advice. Even if you overrule it, get a team of specialists and hear what they have to say.

    Good luck with the liver tests tomorrow.
     
  11. Spiker

    Spiker Type 1 · Well-Known Member

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    Sweet Jesus, 6 units of Novorapid in one hour? On your last known data that's a theoretical drop of 90 mmol/L!!!
     
  12. mirror

    mirror · Well-Known Member

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    I'll let everyone know how it goes in a while when things are resolved
    We spoke with DSN who said didn't think we needed to come in by the way
    Thanks for your help and well wishes
     
  13. Spiker

    Spiker Type 1 · Well-Known Member

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    You need to do BG every 15-30 minutes until that Novorapid is out of her system around midnight.
     
  14. Spiker

    Spiker Type 1 · Well-Known Member

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    You told the DSN you had discontinued all insulin on a T1 for over 3 days and she said don't bother coming in?
     
  15. mirror

    mirror · Well-Known Member

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    She said ' oh am I out of a job?' and laughed
    We had a blood test inc liver function test to be reviewed on Friday at consultant diabetic appt hopefully
     
  16. slip

    slip Type 1 · Well-Known Member

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    I agree with @Spiker the best place for her is hospital with iv insulin and glucose to get her bg stable - the level of care spiker suggests I'm afraid just doesn't happen if you walk in unaided so to speak.

    I just hope she doesn't drop too suddenly after the 6 units of novorapid......then again it might mean she ends up in hospital, I know you don't want her in there but it's the best place for her and you & hubby probably could do with a break.

    Keep strong though
     
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  17. mirror

    mirror · Well-Known Member

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    We as parents have no say at all whilst she's in hospital
    She went in originally in mid April and 'could ' have come out 2 months later. But we stupidly agreed to rehab that was not suitable and during this time she started cutting herself and had a very low mood and very neutral / biddable /institutionalised versus the spunky argumentative funny girl who is hard work.
    We fought for over a month to get her home
    Although the diabetes has been a struggle it was worse in the hospital along with everything else.
    The hospital crisis was while she was on 32 lantus and it was way worse than a seizure. Found unconscious (meant to be on 15 min obs as on a dols) and glucagon not an option or multiple canulation attempts in feet. Had to do an osseous canulation.
    No wonder she doesn't and we don't want her in hospital unless 100% necessary.
     
  18. slip

    slip Type 1 · Well-Known Member

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    Understand mirror, but she wouldn't be in the same ward/same nursing staff involved with the previous stay would she?
     
  19. Spiker

    Spiker Type 1 · Well-Known Member

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    What a grim time you and her are having
     
  20. mirror

    mirror · Well-Known Member

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    It's a district hospital limited options
    Diabetic patients either end up on the liver (alcoholic) ward
    Or if dka high dependency unit (as previously)
     
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