Lantus - what's protocol here?

[Spiker]

So am I right in thinking that when she had the seizure at 5am she had had no insulin since the 1u Novorapid and 1u Lantus at 1240 the previous afternoon and no regular Lantus since the 3u the night before (Friday night)??

If so this is incredibly hard to understand. I really think you need an endocrinologist on this asap. She is behaving as if she has reactive hypoglycaemia or some other disorder of a functioning pancreas. Or at very least honeymooning plus some other problems.

I think you really need professional support. This is a very unusual case with a vulnerable patient who can't manage herself and can't give proper feedback. She probably needs to be on sliding scale with IV insulin and IV glucose and hourly BG until she stabilises. That's what a hospital would do in this situation and I frankly don't see how you are going to manage it at home. You can't have repeated seizures with a person who already had brain injury. You haven't said what the original cause of the recent brain injury was, maybe it's unknown, but a severe hypo is one possible cause.

 

[Spiker]

How functional is she and is there any chance she is giving herself insulin without you being aware of it? In the night maybe?

 

[Spiker]

Given her condition is there any chance she is trying to harm herself? Or injecting out of habit or out of confusion?

She needs to be in a hospital setting under an endocrinologist and working with the brain injury people and someone who understands the off licence drug, working in a coordinated fashion. You can't continue to wing this. The situation is way too complex and unusual. You are out of your depth and so are we who are trying to help. :-(

 

[ConradJ]

I completely agree with Spiker.

I'm at a loss as to what to suggest, other than things that go against scientific evidence, personal experience and conventional wisdom... and this is not really the place to offer such things.

As Spiker says, you need an endocrinologist on this asap: call your hospital and ask for the on-call diabetes consultant - and don't take no for an answer.

From what you've been saying, your daughter needs some slow burning carbs prior to sleep; if she can eat peanut butter then half a slice of wholewheat bread / toast and a thick spreading of peanut butter should help provide her with slow digesting carbs to try to offset the night - time hypos.

 

[mirror]

She's not injecting herself
We understand she'll probably end up in hospital
Like to keep it till after bank holiday when the consultants are back in if possible
Our local hospital is dire unfortunately. The ward She will end up on is a liver ward I expect. Main patients are alcoholics.
First call Tuesday assuming we get there is the consultant neurologist.

 

[ConradJ]

She's not injecting herself
We understand she'll probably end up in hospital
Like to keep it till after bank holiday when the consultants are back in if possible
Our local hospital is dire unfortunately. The ward She will end up on is a liver ward I expect. Main patients are alcoholics.
First call Tuesday assuming we get there is the consultant neurologist.

If the local one is dire and you don't feel you can trust them, then you need to go to the next choice; either way, you need to speak with an endocrinologist asap.

 

[Spiker]

In hindsight the hypo seizure she experienced under the hospital's care may not have been due to the Lantus double dose they gave, since a hypo seizure has recurred when she had almost zero Lantus on board.

 

[Spiker]

Also, anyone who has a hypo seizure or a hypo coma should be hospitalised for observation. That's the normal NHS procedure. The patient can waive or refuse that, but it requires a confidence that everything is fine. I don't think that confidence exists in this case.

I agree a liver ward full of alcoholics sounds grim. A diabetes or endo ward would be miles better. Is that not possible?

 

[mirror]

Anyone know a good hospital for diabetes in Merseyside /Lancashire?

 

[Jaylee]

She's not injecting herself
We understand she'll probably end up in hospital
Like to keep it till after bank holiday when the consultants are back in if possible
Our local hospital is dire unfortunately. The ward She will end up on is a liver ward I expect. Main patients are alcoholics.
First call Tuesday assuming we get there is the consultant neurologist.

Hi, sorry to throw this in the mix..
Reading some of your earlier posts. (Up to 5 years back.) you also have a younger T1 son.

"Wood for the trees" & all that.

Is there a possibility of a "mix up" on the insulins???

 

[mirror]

Hi
No
Son is a different kettle of fish
This insulin is 100% from the hospital with hospital labels and all.

 

[mirror]

I know we're going to be ending up in the hospital
But I really want it to be Tuesday when the regular people are in!
We of course will go if it gets worse
We've spent a nice afternoon out walking round a local event, quick drink (non alcohol) at a little pub.
Nice.
Eaten etc
Need to keep pushing the carbs
Not got rising bms..

 

[ConradJ]

Anyone know a good hospital for diabetes in Merseyside /Lancashire?

I don't know about those areas, but I've heard that the main one in Salford is excellent with diabetes.

 

[Diane fluteplayer]

that's not neccesarly out - because normally she is on a ratio of 2 units per 10g of carbs - don't know what the mcdonalds was as I wasn't there - but it could easily be around 60g (although they 'don't carb count in hospital' apparently - they just go by what the doctor prescribes and cant vary it) - she has been an inpatient since april and is due to come out in theory on Friday - however they said they want to review the insulin on Friday and keep her in... god knows they will come up with some stupid excuse why they are not in the wrong ?
could it ever be right to give the insulin in the morning, instead of the night - and then give full dose in the next night?
They are so tricky I want to know my facts before our scheduled meeting on Thursday this week.

I use Lantus and a couple of times when I have forgotten my evening one I have had a reduced dose in the morning, followed by my normal dose at night, but as late as poss. I seemed to get away with it but I tend to run high and I monitor and adjust closely. It doesn't sound as if the nurses there know what they are doing sufficiently to make that kind of adjustment. I'm horrified that they "dont carb count" How on earth do they decide on the dosage for short acting? The thought of having to stay in hospital scares me more than anything else - fortunately I haven't needed a hospital stay since diagnosis. Have you got a copy of Carbs and Cals? I have a version downloaded onto my iPod. It's a great help. Hope your daughter's ok now. Best of luck.

 

[Diane fluteplayer]

This author gets on very well with Lantus. With the correct basal dose administered Lantus works just fine for me.

You are right. But you need individual help to get the basal dose right in the first place (and of course it can change over time). I was originally put on 28 units at night; since my DAFNE course I am on 19 units and it all works much better.

 

[ButtterflyLady]

Consultants and registrars* are available on call for hospital doctors to consult with after hours.

*Not sure what these are called in the UK; in NZ a registrar is the level just below consultant and they are usually very good.

 

[Spiker]

Consultants and registrars* are available on call for hospital doctors to consult with after hours.

*Not sure what these are called in the UK; in NZ a registrar is the level just below consultant and they are usually very good.

It's the same ranking in the UK.
But call outs are rare and only a major hospital will have consultants in all specialties on site. I have often had to wait for morning to get anyone with a diabetes specialism, even in major London hospitals that have specialist inpatient diabetes units.

 

[Spiker]

Quote above reminds me - do you have her medical notes? Do you know what her dose regime has been since she was admitted in April? Essential info.

 

[Spiker]

I'm horrified that they "dont carb count" How on earth do they decide on the dosage for short acting?

Yes it's unbelievable. Not even on a diabetes ward. Even if they let you do your own doses, the carb (and other nutrition) data simply isn't available. The nursing and clinical staff don't know, the catering department don't know, and the d**n dietetic department that plans the d**n menus don't know.

 

[ButtterflyLady]

It's the same ranking in the UK.
But call outs are rare and only a major hospital will have consultants in all specialties on site. I have often had to wait for morning to get anyone with a diabetes specialism, even in major London hospitals that have specialist inpatient diabetes units.

Yeah I can imagine it's really hard to get specialist diabetes input in hospital I certainly don't envy mirror and the dilemma she faces... needing good hospital care for her daughter but having trouble getting that at the moment.