opinions please

[CarolK]

My son has just been for a hospital appt, they are every 4 weeks at the moment because of his licence revoke. When she looked at his meter, he has been having at least one hypo a day since beg of year. Whe I say hypo , 3.8, 3.9's, lowest one was 3.2. He has good hypo awareness, hence he tests when he thinks hes hypo and treats. However she said DVLA would not be too pleased with these results. She has given him a diary and told him to reduce his Lantus to 24 from 30 units and reduce his ratio on novo from 1 : 10 to 1 : 7.5. This seems like too big a reduction in his Lantus to me,(he also thinks this) but what would you do? Reduce it and suffer with the obvious high sugars (his next appt is in 3 weeks or do what you think yourself. He said he reduced it to 28 a couple of weeks ago and his sugars were too high. Any thoughts would be helpful. He is getting very stressed over this , and doesnt seem to think hell ever get his licence back.

 

[novorapidboi26]

why did he get his license revoked................

its ok to have hypos, as long as you can notice the symptoms and treat, that all the DVLA are concerned with............

if he is having hypos every day, then he does need a dose change, where specifically can only be attained from testing and analyzing.........

is he confident changing his own doses and interpreting his results......

often when people on Lantus change their dose to try and beat high sugars they can find they never reach a good balance, and so need to split the dose.........but you can only decide this if the results are there in front of you.....

 

[Tina63]

We've only ever reduced our Lantus in the early weeks under close direction/supervision from my son's DSN. She told us NEVER to reduce by more than 2 units at a time, preferably only one unit at a time, so his have only ever come down in 1s or 2s.

I have just found his old diary. Dropping from 30 to 28 saw his morning readings alter from mainly 6.x to upper 4s and low 5s. That was without altering his Novorapid ratios at all. It was then dropped about 10 days later to 26, then almost all his waking readings were in the 4s. Bizarrely though, when he dropped one more unit to 25, his waking readings went back up to the 6s. So, whereas I thought I was going to give you some useful information, this last bit seems to have contradicted it.

I know I have read people on here saying Lantus take 2 or 3 days to settle, so don't take notice of readings on your first day or so. I don't suppose I have helped at all now! Sorry if I have confused you more!

Tina

 

[Robster65]

I would personally try the DSN suggestion for 1 or 2 days with tests and then when it doesn't work (which I agree it is too much) he can show her the results and re adjust to his own ideas.

But he needs to make sure he's stayign above the magic 4 mark to play their game. They set the rules.

Maybe he could suggest a pump if he's finding MDI doesn't work so well ?

Rob

 

[Catwoman76]

We've only ever reduced our Lantus in the early weeks under close direction/supervision from my son's DSN. She told us NEVER to reduce by more than 2 units at a time, preferably only one unit at a time, so his have only ever come down in 1s or 2s.

I have just found his old diary. Dropping from 30 to 28 saw his morning readings alter from mainly 6.x to upper 4s and low 5s. That was without altering his Novorapid ratios at all. It was then dropped about 10 days later to 26, then almost all his waking readings were in the 4s. Bizarrely though, when he dropped one more unit to 25, his waking readings went back up to the 6s. So, whereas I thought I was going to give you some useful information, this last bit seems to have contradicted it.

I know I have read people on here saying Lantus take 2 or 3 days to settle, so don't take notice of readings on your first day or so. I don't suppose I have helped at all now! Sorry if I have confused you more!

Tina

Hi Tina I don't drive myself, but when I started a Carb counting course I had to change my Insulin intake at dinner because taking the full amount nearly put me in hospital, so the DSN said just take half and let me know how it is going, well it wasn't working because my breakfast reading was so high, but I had to stick with it and then I decided to have 3/4 's instead and that worked for me. So, he does seem to need to reduce his insulin, but it may take a little time to get the right dose for him. I'm sure he will get there in the end. Best wishes Sheena

 

[everydayupsanddowns]

Carol - How has it been suggested that you assess the impact of the changes to Lantus?

Bear in mind that:
a) It can take Lantus a good 3 days to settle into a new dose properly and
b) It's very hard to assess what basal is up to at different times of the day when you are injecting for and eating meals (eg you might be 'propping up' a shortfall in the morning with a higher breakfast ratio)

You might find this approach interesting:
http://www.diabetes-support.org.uk/info/?page_id=120

 

[Northerner]

I would also be reluctant to lower a lantus dose by 20% if I was injecting at those sorts of levels, simply because it makes sense to do these things gradually and monitor their effect. I went through a period where my lantus reduced from 20 units to 10, but I did this over a period of about a fortnight, not a couple of nights.

Interestingly, since I am currently on 3 units lantus, a reduction for me now (which I'm having to contemplate!) would represent a 33% drop in dose - equivalent to dropping from 30 to 20 units in one go! 😱

It's a shame he is above 21 units as it sounds like 29 units might work well for him if 30 leaves him low and 28 leaves him high. The single-unit lantus pens only go up to a dose of 21 units though, so it would mean 2 injections.

 

[imtrying]

the DVLA won't care about his hypos I don't think, only if he needs help, which clearly he doesn't.

I'd reduce the Lantus, but that's just me. Maybe reduce it 26 initially and see how he gets on at that level first? (if he's on a 2u pen) or try 25u.

But as Mike said, remember it can take 2 - 3 days for Lantus changes to settle down.

Good luck 🙂

 

[imtrying]

Interestingly, since I am currently on 3 units lantus, a reduction for me now (which I'm having to contemplate!) would represent a 33% drop in dose - equivalent to dropping from 30 to 20 units in one go! 😱QUOTE]

lol stop showing off Alan!!! 😉

 

[CarolK]

Thanks everyone, i do think its a lot to reduce by, but maybe as rob said he should do it and diary the consequences. When you say 4 is the magic number, obviously they dont want to see anything under that (so NO hypos) ! I did say that surely as he was aware and treating them that was the main thing, but she said not!
He had his licence revoked due to having a seizure with a severe hypo last August. I think he will just have to play the game and give them what they require if he wants to drive.
It is frustrating , because he has good hypo awareness, the seizure happened in his sleep, after he had been out drinking.
I think the awful thing is you feel like you are having your life picked to pieces in those appts. She kept mentioning the alcohol, but he has only been out twice since before Christmas, one of those being New Years Eve which was his birthday, I dont think thats too excessive for a 23 year old. Hence he comes away stressed.

 

[Monkey]

It's a shame he is above 21 units as it sounds like 29 units might work well for him if 30 leaves him low and 28 leaves him high. The single-unit lantus pens only go up to a dose of 21 units though, so it would mean 2 injections.

I've just had a new stash of lantus pens (the disposable ones, SoloStar) and they're in 1u increments, up to 80units.

 

[Northerner]

I've just had a new stash of lantus pens (the disposable ones, SoloStar) and they're in 1u increments, up to 80units.

I wonder why the Autopens can't manage that - even the 2-unit pens only go up to 42! 🙄

 

[Monkey]

I wonder why the Autopens can't manage that - even the 2-unit pens only go up to 42! 🙄

For some reason, I've always used lantus in a disposable pen. Vaguely remember that when I first started using it, there was an issue about reliability of the pen, and I've just never swapped. 42u in pregnancy was a small dose tho!