Lantus - what's protocol here?

[mirror]

Done bm 11.1
Done lantus 18
Set alarm clock for 2.30

 

[mirror]

No novorapid given

 

[Blackers183]

Hi mirror, I hear that steroids can really play havoc with insulin/diabetes management.
Cheers
David

 

[mirror]

Bm 2.30 am 7.5
Bm 7.15 am 2.7
Will drop lantus again tonight

 

[Spiker]

Her BG is plummeting overnight. Seems unlikely that Lantus would cause that rate of drop. I frankly don't understand what is going on. But I agree with dropping the Lantus further.

You need to get a DSN or diabetes doctor involved. One you trust, obviously. :-(

 

[mirror]

No novorapid today
Earlier today eating to chase the insulin. Now creeping up
Teatime bm 9.2 ate 40 g carbs
Will do bm around 10 and decide. Probs 15 lantus. And up around 2.30 again for a bm.

 

[mirror]

Bm now 11
Lantus 14
Let's see

 

[Spiker]

There might be a case for splitting the Lantus into two doses, as she seems to have falling BG in the morning and maybe rising BG in the evening. Though it's hard to tell when you are not giving Novorapid for corrections or for food. I think some very conservative corrections and bolus doses would be advisable.

What is the objection to consulting with the existing DSN? Was he/she involved in the double dose incident?

 

[mirror]

Not got a DSN yet
Referal in post discharge
4am bm 5 Waking bm 4.1
Stayed around 4 till lunchtime (12pm)ate 48g carbs. 2pm bm 8
4pm ate 22g no bm
6pm bm 7
7pm 13g carbs
Gonna try 12 lantus tonight

 

[Spiker]

I think you are on the right track, @mirror

 

[mirror]

Spiker - thanks matey x

 

[Spiker]

Hopefully - maybe in a day or two - you will get the Lantus down to the the level where you will be able to start giving her very small bolus injections as well.

My heart goes out to you all. What a mission.

 

[ButtterflyLady]

Not got a DSN yet
Referal in post discharge
4am bm 5 Waking bm 4.1
Stayed around 4 till lunchtime (12pm)ate 48g carbs. 2pm bm 8
4pm ate 22g no bm
6pm bm 7
7pm 13g carbs
Gonna try 12 lantus tonight

It's a shame that the diabetes service didn't provide a DSN for you to contact day to day immediately after discharge. Having said that though, if you need DSN advice, I don't think there would be any harm calling the service and seeing if someone can advise you, and chasing up the referral.

Hopefully the most challenging days are now behind you and things will keep getting easier. My heart goes out to you all too.

 

[mirror]

She's around 7 today and ratio 1unit to 20g
It appears that it's a reported side effect of the new iv meds (versus the steroids increasing blood glucose)!

 

[Spiker]

Which meds?

So that's adding to the effect that steroids would already have on her BG?

 

[mirror]

See your pm spiker

 

[mirror]

Ok not great
Her and dad got home ate 70g lunch
No injection (so only 2 units bolus today)
She's just been 1.7 bm
Feeding her up
Lantus 8 tonight

 

[mirror]

Up to 3.9

 

[mirror]

Done 6 lantus (Was she EVER on so little ?!)
Hopefully we will be doing correction doses tomorrow not still being hypo!
Hope we stabilise at some point and can carry on with the iv treatment
(it's an off licence drug for a different condition than normal use and has shown a sign of success) if we cannot successfully use it then
it's pretty much bad news
In the good news section - appt with diabetes consultant at our regular hospital come through for next Friday
I am going to try and make contact with some sort of diabetes nurse tomorrow though ( haven't got any body but can say we're due to see Dr bocter on Friday)

 

[Spiker]

What a journey but it does look like you are getting somewhere. This new drug seems to have cut her insulin needs down to around a quarter? Incredible and a very hard change to cope with. Well done for managing it.