When to start Lantus?

Orion is switching from Prozinc. I'm expecting the Lantus to be delivered from Mark's on Wednesday. I already have the U100 syringes. I'm going out of town Friday and returning Sunday. I have a friend coming those days to take care of everyone and give Orion his shots. I'm wondering whether I should start the Lantus before or after I return. If I give his first shot Wednesday night I would be able to get a +2. Unsure about other hours. Thursday morning I could probably get a +2 and then nothing until +10 when I get home from work. I'm leaving Friday afternoon, so I could monitor a bit in the morning.

Also, I'm thinking of starting him at 2u of Lantus. What do you think? How many days should I hold a dose before increasing? I got the syringes with 1/2u markings.

 

Welcome to lantus. I would wait to start lantus until you are home. You will need to decide if you will follow SLGS or TR. I can't help with the starting dose since you are switching insulins and I'm not familiar with Prozinc. Lantus reaches its nadir usually between +5-7 and once started that number determines dosing changes moving forward.

I'll tag a few people who can help you. @Wendy&Neko @Sienne and Gabby (GA) @Marje and Gracie @Chris & China

 

I think I would like to do TR but am open to what others think.

 

I think I would also wait until you are back. That way, you can be there to monitor the effects of a New insulin more than just a day or so.

With so little testing data, I'm not really comfortable making a recommendation on starting dose. Obviously, 3.5u has gotten him pretty low on PZ and he could be doing that every cycle that you are shooting it. I wouldn't be surprised if you've been overdosing him and so it might be best to be cautious with the Lantus starting dose.

You don't have to immediately decide SLGS vs TR. I would hold the starting dose 10-14 cycles unless he's high and flat.

 

With TR, you always want to get at least one mid-cycle test in. If you start TR, do you think you'll be able to do some additional midcycle testing? I ask just because I'm not seeing any recent nighttime tests, and I don't know if that's a schedule thing or just a difference in how prozinc is typically managed.

 

+6 is difficult for me to get. My work schedule doesn't allow for it, so the only days I would be able to get this number are Wed, Sat, and Sun since these are my days off. I can probably get in a +2 at night but other hours would be difficult.

I'm able to get some data today if it would help.

 

Oh, no, it's not as stringent as that-- by "midcycle" we just mean between the shot times, not exactly in the middle at +6. If you could reliably get a +2 (or whatever) on workdays and then a test or two at night (+2 or later is best, since Lantus takes a little while to onset anyway), and then more thorough testing on days when you are off work, that would be fine. That's how lots of people manage TR while holding down jobs-- it's not easy, but it is do-able.

In the meantime, as Marje said, more Prozinc data would be very helpful for trying to figure out a starting Lantus dose, so maybe use this next week as a time to test out just how much testing you can comfortably do.

 

Welcome to the group!!

Probably spot checks are a better way of thinking about getting tests vs "mid-cycle". I agree with Marje, I think your kitty would be better served if you started Lantus once you are home. You might also want to take a look at the sticky on following TR if you work. It's entirely feasible. You might want to consider a timed feeder if you don't have one already.

Also, in preparation for starting Lantus, would it be possible for you to get at least a "before bed" test every night?

 

His +6 today was beautiful. I don't know what that 32 was about a week ago. This is why we are switching to Lantus. This isn't the first time he's had very different curves.

 

Can you define before bed? How many hours after his PM shot?

 

before bed means right as you are climbing in....

most of us have an evening shot time.... such as 6pm or 7 pm.... and if you go to bed at 10 pm..... grab a quick test...

I used to drink water before bedtime so I might get up in the middle of the night.... and when I did.... I would grab a quick test and go back to bed unless the numbers
told me differently.

 

His PMPS tonight was very interesting. I just can't make any predictions with the Prozinc.