11/02 Pepper AMPS 483, +3 386, +5.5 372 - Dose Advice?

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It's probably time to adjust Pepper's dose, but I think the vial of Lantus I was using was bad and his numbers soared into the stratosphere. I got a new vial and started it this am and his numbers came down 100 points by +3. I had doubts about that vial of Lantus and I'm really kicking myself for not getting a new vial sooner. Anyway, I think his numbers may be extra high because of the vial I was using before today, so I'm not sure what I should do. Should I wait and see how low his numbers go? Before his numbers started shooting up, his AMPS number was 226 on 10/29 and I suppose it may have gone lower than that during the night.

Re: 11/02 Pepper AMPS 483, +3 386 - advice?

It's a tough call. Chances are that the vial wasn't completely toast unless it was bad from the day you opened it. Pepper's numbers have been pretty much in the same range since you started on the old vial. You've had other days where there's been a 100 point variation. While it's possible that the old insulin wasn't the best, I also think there's a good chance that Pepper has built up some glucose toxicity from having been in the 300+ range for a while. Are you comfortable with evaluating dose every 3 days?

Personally, I'd raise the dose.

Re: 11/02 Pepper AMPS 483, +3 386 - advice?

I was concerned about that vial because the box was sliced open and taped back together with scotch tape and the first time I used it his numbers climbed into the upper 400's. I went back to his old vial for a few days and his numbers went down again. Then I tried the suspect vial again and his numbers went up into the 480s. Still, I understand what you're saying - that it might be glucose toxicity. How much would you increase the dose? Another half unit? And I should check back in 3 days for another evaluation? Thanks!

Sorry it took me so long to get back to you. According to the protocol, you'd raise by 0.5u. You can always raise by 0.25u if you're nervous but personally, I'd want to see Pepper out of these high numbers.

Thanks, Sienne. I've read the protocol but I just don't feel confident enough to decide on a dose increase without checking with the experts first.