Numbers up and down

Molly is on Lantus. But her BG is up and down thoughts? I hope I am posting to the right forum.

 

Adrienne has been posting on the Main Health forum "Help for Molly" since Jan 2019 which many of you have probably read and been contributing to.

 

Hi Adrienne,

Welcome to the Lantus Basaglar & Levemir forum! this is definitely the right place to post if you're using Lantus! I'm also from Canada in MST

I was wondering, do you follow one of our Dosing protocols here on the site? For Lantus there are 2: Start Slow Go Slow (SLGS) and Tight Regulation (TR). Have a look at the description of these methods Here and decide if one could work for you. If you decide on one, add it to your signature so that members here can provide feedback for dosing as you move ahead. Tying one of these methods might help you achieve more stability in Molly's numbers.

Another tip I've seen mentioned around here a lot is to feed smaller meals throughout the day instead of just 2 meals a day to try and steer the BG curve during the day.

I don't have a lot of experience interpreting spreadsheets so hopefully someone will be by to provide additional feedback

 

You are definitely in the right place if you are using Lantus!

The first thing that strikes me about Molly's spreadsheet (SS) is that you've held the 0.10 dose for way too long. There's a good chance that some glucose toxicity has developed (i.e., Molly has gotten used to being in those yellow numbers and treats that as her new normal).

Molly is also bouncing off of those lower numbers. It will be helpful if you can look over the dosing methods we use and once you decide on an approach, raise Molly's dose. I'd encourage you to bring her dose to 0.25u.

 

Start Slow Go Slow method might be better for me? where I work through the week and I'm not there to monitor her?

 

I'll Give you my schedule:
5:45am- Test, Feed Molly
6:00 am- Shoot
12:00 pm test Molly
6:00 PM Test, feed shoot
9:00 pm test and if low I retest

 

glad to see you here, have been following along basically since I joined ...

 

Regarding Tight Regulation, this post on managing TR when working full time may be worth looking at.

 

If you are able to grab that +6 after AMPS I think you could follow SLGS. If you're nervous about it you could follow SLGS at first and then change methods later if you like. TR is a really good option though, it has been peer reviewed by the scientific veterinarian community and has very good results for remission, so if you are able to do it I think it's the better treatment plan. that's just my 2 cents though! do what is best for you!

 

I'm Kinda confused with the TR? I think that option is better where I test Molly 4 times a day (depending). So after the 3rd cycle increase dosage if she's say in the yellows?

 

It definitely is confusing at first, but just read and study the sticky, ask your questions here, as you learn more it will start to fall into place

I believe when you first commit to TR you hold for 10 cycles, because the dose depot has to build which takes about 6 cycles. Then you would follow the 6 cycle dose change. 6 cycles of course depends on what BGs you have gotten over the past 6 cycles. I don't follow TR though, so you may want to wait for a member who follows the protocol to weigh in

 

Ok, so what I am reading on the TR is. After 5-7 days increase by .25. Hold for for at least 8-10 cycles. But if she drops lower than reduce the dosage and hold for another 8-10 days? is that correct? I'm sorry but what's a nadir again? Feels like I'm starting all over

 

Yes you got it right! And I believe once you become more "data ready" that you can start changing doses every 3 days or so if needed.

Nadir is the lowest point on a blood glucose curve, it is also known as "peak" since it is the peak of the insulin action.
Onset is when the insulin starts working
Duration is how long the insulin lasts

Try and start thinking of the secondary goal of your testing (primary is making sure they're safe) as learning what time these events happen for Molly, for example, if she usually goes the lowest between +5/+6, then you will know that is her typical Nadir. Mowgli's nadir usually happens between +3 and +6 .

 

Since you've been on Lantus using SLGS, you don't have to hold the dose to load the depot. You can increase Molly to 0.25u now to get her over that hump of yellows. I'd start tonight.

 

Continue with .25 for tonight?