Lantus - what's protocol here?

Spiker

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mirror said:
It's on waking (pre bed was 7)
No exercise coz her legs killing her following the osseous canulation. No bolus
Stress - well she's had a physical body stress and is fed up with the illness.
What would you reduce to?
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OK if she is suddenly physically inactive all the time that makes sense as a reason for the continuing hypo(s) despite basal only.

I would cut it from 24 to 18 and if that doesn't work (another hypo in 24 hrs) I would cut it to 12. Then build UP from there, monitoring BG carefully.
 
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Jaylee

Jaylee

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mirror said:
Well we reduced the lantus to 26 last night. She woke up with 4.1 bm but was very tired
I asked her dad to give her the other meds she has and went to work.
Rang when I got there he's taken her to a and e hypo and she's on a drip.
If she comes back tonight apart from reducing to 24 units - any other ideas?
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She woke with a reading of "4.1"mmol. Was she given anything to eat??
 
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mirror

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No
Didn't realise it was going to be dropping as less than a week ago she was doing fine on 32 units and she had 26 last night!
Def dropping it hugely tonight.
 
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Jaylee

Jaylee

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mirror said:
No
Didn't realise it was going to be dropping as less than a week ago she was doing fine on 32 units and she had 26 last night!
Def dropping it hugely tonight.
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Could you please clarify what you answered "no" too?
Did you mean your daughter had not eaten in response to the 4.1 reading & was just given her "other meds"?
 
Spiker

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If your daughter is not being given bolus insulin does that mean she is not eating at all?

Again if her basal dose was not calibrated for a fasting state it is most likely too high and causing the hypos.

I really think she needs to be being cared for in a diabetes ward. Where in the country are you?
 
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mirror

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She's on a reducing steroid dose. Steroids increase blood glucose.
She's home now.
She's not been eating (under duress to meet the insulin)
She's coming out agreed to eat mcdonalds (smokehouse meal approx 115g carbs iirc)
Will do 18 units at bed
 
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mirror

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So suggest an amount of novorapid to inject?
Bm 7
115 g carbs mcdonalds
Normal ratio 1,5 or 2 to 10g
Or wait for an hour?
 
Spiker

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Tbh I am not that comfortable with the situation of advising on specific bolus doses in this complicated situation.
 
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Spiker

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mirror said:
I would be interested in your opinion at that time spiker?
Not anything else.
100% my responsibility
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OK in general with her frequent hypos unexplained I would be ultra conservative and reducing all doses and all ratios until an explanation emerged. I would be testing frequently but definitely erring on the side of high BG rather than low BG. High BG and frequent testing is not going to kill anyone. Low BG might, even with a lot of testing. Not trying to scare you or anything but hypos pose a much more acute risk than high BG does, particularly for a young woman who is unable to manage her own condition at the moment. :-(

And, as I keep saying, I think she needs to be under the care of diabetic specialists, somehow. I realise you had a bad experience with the DSN who was assisting the brain injury unit. But this is a complex and risky situation.
 
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Spiker

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Do you mind saying where you are in the country and/or which hospital(s) you are near?
 
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