3/31 Frank AMPS 463 PMPS 324

Poor Frank, As usual with high Bgs, I can see it in his eyes..they look cloudy. Fortunately, he still wants to eat. Anyway, I increased the dose this AM to 2.5U.

Yesterday's Condo

 

I like this PMPS!

 

I just took a look over Frank's Spreadsheet.

If you want an unsolicited opinion from a Levemir user, it looks to me like 2.5 works really well, and anything lower is inadequate.

It looks like every time you've ducked to to a low preshot, you've regretted it. Check the history.

So in my opinion, you can change your scale to be more consistent and see better numbers every day. When you see a number that's too low to shoot, don't change the dose -- that will screw up the next 24 hours or more.

Instead:
1. Wait an hour and then shoot your normal dose anyway, or
2. If you can be around to test at nadir, shoot normal dose and test then.

the only time a dose reduction is good is when nadir dose is unsafe (like below 50). And in that case, a quarter-unit reductino looks like it's too drastic for Frank. Try reducing by a minimal 0.1 units instead.

Best of luck,
Steve and Jock

 

Steve may have a point about where Frank's optimal dose is. However, I don't think you were posting over here until relatively recently, or I can't remember why you were taking 0.5u reductions early on. In any event, you've been working Frank's dose back up the ladder in a safe way. I'm ambivalent about the test only at nadir approach. Gabby has some fast, early drops. If I didn't test when I test, those drops would be missed. I'm a big fan of a +2 test (or whenever onset is) since it can give you some insight into how the numbers are going to go.I think the +3 test works for you and Frank.

You're doing a great job with Frank. He'll get to his optimal dose. It's hard being patient.

 

You are doing great..Liking the lower pmps--Frank will be in lower numbers before you know it..
Consistancy & Patience, that's what we all need here. I wasnt real good at the patience thingy, but learned it here.. ohmygod_smile ohmygod_smile ohmygod_smile
Hugs & just know that there's always tomorrow-- :mrgreen: :mrgreen:

 

I am very happy to hear your opinion. Thanks for offering yours.
I also think 2.5 will be good for Frank. I still do have fear of shooting low PS numbers, especially on work days when I can not test.
When you say to wait an hr then shoot normal dose, do you mean to feed at normal time then shoot 1 hr later OR feed/shoot 1 hr later???
Thanks for your point of view.

 

I am having a hard time with patience...it's true. When I see those 500's my heart just breaks, I feel something's wrong. I guess I plain ole get scared for Frank. Thanks guys for supporting me through this wild and craaazy time. I need you guys to make it through this!!

 

Your fears and habits are well-adjusted for a deeper curve like PZI, but for Lantus (and given Frank's numbers) I think it will be good to train yourself to shoot without fear. It seems obvious that he's much happier just taking the same dose all the time, and every time you reduce the dose, it screws him up for a day or two. And as you said, you fear the high numbers too (and for good reason.)

I don't think in your case it matters when you feed. Lantus isn't one of those insulins you try to use to counter a food spike anyway. But if it makes you happier to see a higher number when you shoot, feed immediately then retest and shoot an hour later.

Again, I'd be trying to train myself to just always shoot the normal dose at the normal time, regardless of how low the number is at preshot. You know it will be 2-3 hours later before the Lantus actually starts working, and you know from experience that by then his number will be higher if you wait or shoot a smaller dose. It sounds like you've either used a faster-acting insulin before, or have been listening to a lot of people accustomed to them.

Best,
Steve

 

Steve, I have found your info very helpful. I get lots of pointers here from post replys and my reading . I can feel overwhelmed as the info trickles in leaving me feeling somewhat helpless to tie it all together. Thanks for a great summary of information. After reading your posts, today I have confidence.....but will it last?
Please visit my condo anytime you'd like! :smile:

 

Thanks, Delma!

You're probably wondering, if I'm suggesting you give the same dose regardless of preshot, when it's right to reduce dose.

The answer is -- when you see a nadir point (lowest part of the curve) that's lower than you feel comfortable seeing. (for me that's below 50, but your mileage may vary). At that point, (please try to avoid giving syrup or sugar or panicking), but it's a good time to try lowering your next dose the smallest possible amount, like from 2.5 to 2.4.
Note also that your previous dose adds a bit to the current one (that's the "insulin depot" people talk about), so think about total dose over, say 24 hours. The next dose down from 2.5/2.5 over a 24 hour period is 2.4/2.5 over a 24 hour period. Dropping suddenly to 2.4/2.4 might sometimes even be too much.

If your condo is in Gettysburg, maybe I'll take you up on that in the summer!



Steve

P.S. the "Maintaining Regulation" section from Levemir 101 viewtopic.php?f=10&t=682&p=4998#p4998 applies pretty much the same to Lantus I'd say. Check it out.

 

Again, thanks for sharing your wisdom, Steve.

Six cycles back, I increased Frank's dose to 2.5U. Despite, he's stayed high in red and pinks. But today I'm waiting for him to show me some blues. Finally lower, his AMPS was 308 which is pretty unusual for him lately.

BTW, My condo isn't in Gettysburg, so you're out of luck this summer! :smile:
Are you a Civil War buff that you would choose Gettysburg?

 

if you keep the changes very small, you can raise dose as often as every 2 days when you're seeing high numbers. 2.5 -> 2.6 -> 2.7 changing every 2 days works well as long as you ease up as you get closer.

Gettysburg is the host of the US leg of the Gilbert & Sullivan festival this year, normally only in Buxton England!

 

Seemingly such an odd town to have a Gilbert and Sullivan festival. I haven't been there for a while but as my son says "it's mostly a battlefield" However, it's an old, historic place which most likely will add to the festival. Probably has an old theater, too. You're in Scotland...very far from here. You'll be skipping it this year? Take Care, Steve.