Bear 6/22 8th day on Levemir & first dose increase.

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So far Bear's BG seems to be much flatter with no BG dives.
Hopes for improvement for Little Black Bear.

 

AMPS 421/ +5 245/ +8 182/
PMPS 164

Should I have waited longer for a dose increase?
With Lantus increases usually didn't effect Bear's BG until the third cycle after his increase?
Any thoughts or advice is appreciated.

 

Bear was spending most of his time above renal threshold on 2 units. Glad you increased. Good luck with the new dose.

 

Nice to see a flatter Bear with no more deep dives! His new increase should bring him slowly into better numbers.
Hope you have a beautiful Sunday tomorrow Lora! and Ti-Mousse is sending Bear a big hug!

 

I am just a bit on shaky ground.
Levemir seems like a much different animal than Lantus.
I need to have more understanding of the differences.
I know Levemir usually has a much later Nadir.
On the little data collected so far +7 seems like Bear's nadir.
That said I am sure it will move around a bit.
I know nadir is still what we gauge dose by.

What if Bear has low BG at preshot?
What is considered safe to shoot at preshot for Levemir?
My guess is that this is like a start over and I won't be able to tell what is safe without more time and data?

The reason I had doubts about an increase was Bear's BG changed quite a bit AM cycle and I don't know whether to contribute the change to the dose increase or whether because the 8th day his body has accustomed itself to Levemir?
If Bear's body has become accustomed to Levemir today and lowered his BG than an increase could be a mistake.
I hope I am making sense to you.

 

I am feeling a little nervous especially when I saw Bear's preshot.
On Lantus a 164BG would put me on watch duty to see if Bear was going to dive or bounce.
Bear has just been so volatile at times.
Lately life and death for Bear has been pancreatitis flares with dives and vomiting.
Yep, just a bit on edge after those experiences.

I would love a beautiful Sunday for Bear and I.
Plus my son made a surprise visit from Seattle.
Only my husband knew he was flying in, total shock to me.

I hope you have a great weekend too.

 

Hiya Lora. Levemir and Lantus are really similar in that they're both long-lasting depot insulins. Levemir starts working later than Lantus does, which pushes everything back. Obviously ECID still applies, but nadirs can happen as early as +6, or as late as +1 or +2 in the next cycle. The philosophy is still the same, but you will need to get more testing data to see how your Bear responds to the Levemir. My buddy Lou sometimes nadirs at +6 or +7, and he's had his lowest point at preshot a time or two. Lou's insulin generally starts working around +4 or +5, nadirs (which is sometimes a moving target), and then usually stays pretty steady until the dose wears off and the next begins. The same TR rules apply with Levemir. You shoot anything 50 or higher (obviously this can be different based on your own comfort levels). If Bear is too low at preshot, you can stall and wait 15-20 minutes without feeding to see if the BG is rising. If it is, you can give insulin as usual. In the two times it's happened to us, Lou kept decreasing, so we just skipped that dose of insulin (because he was under 50). 8 cycles is enough to tell you how that dose is working, so I would have increased as well. I switched from Vetsulin, to Basaglar, to Levemir. Honestly for me, the switch from Vetsulin to Basaglar was the hardest because absolutely EVERYTHING was different, so it was like I was brand-spanking new to FD. After learning the ropes here, the switch from Basaglar to Levemir was a piece of cake in comparison. Just keep testing and learning Bear's reaction and you'll be fine. Obviously we're here whenever you have any questions. Best of luck with the increase!!

 

As Amanda just said, you work with Lantus or Levemir the same way, with the same numbers as per the protocol you're following SLGS or TR. They are both long-lasting depot insulin; the difference is how Bear will respond and you'll know that by testing to find his onset and nadir which are often a little later with Levemir than with Lantus.

Enjoy a beautiful Sunday with your son; Bear should give you a break tomorrow as the depot will still be filling up!

 

Do you have a good idea when Bear’s onset is on Levemir? How much of a numbers bump does he get from his preshot meal? In addition to a later nadir, there is a later onset with Levemir. That makes it much easier to shoot low, as there is more time before the shot begins to starts to work and time for the numbers to rise, I only shot as low as 51. A couple times I got 40’s at preshot, but I would just wait 20 minutes and she’d be above 50 and safe to shoot. ECID of course.

Enjoy your visit with DS.