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Switching to Lantus question...

Discussion in 'Parents of Children with Type 1' started by mph, Jan 2, 2008.

  1. mph

    mph Approved members

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    Hi out there:). Our CDE is going to call me tomorrow morning for a 2 hour "advanced carb counting" class via phone.....how accommodating. What do I ask her (while I have her on the phone)???????? Any suggestions? I always seem think of something good to ask the D team AFTER hanging up, kwim?

    Any advice how to transition "more" easily from NPH?????? We have never changed insulins yet. Do I go for the insulin pens? I was thinking about just getting either Humalog OR Lantus in a pen to help dh not to confuse them (he has had a hard time keeping the Humalog and Humulin N vials straight;)). Are the pens any more "discreet" for injecting on the go?

    Nick is 7.5. He is 4 foot tall and 50 lbs. Dx 5/06. He takes 16 total units of NPH(15 in am and 1 at night) and 2-3 units of Humalog daily (and still tends to run on the low side). Is there any way to "guesstimate" what a "reasonable" dose of Lantus might be? The nurse told me they would start him out on a low dose of Lantus and work up till we "get it right." If they tell me 5 units to start with, do I question that or say, "sure"? I have had to tell them what I am comfortable or NOT comfortable giving him before when they suggested new doses of Humalog and NPH (especially when sick) because he tends to go low pretty easy and is JUST starting to feel them (whahooooo:D)!!!

    Thanks for reading this:)!!!!!!!!!
     
  2. hawkeyegirl

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    We had a really seamless transition from NPH to Lantus. The doctor came up with a recommended dosage for the Lantus, and it happened to be dead on. I'd listen to your endo's recommendation on that.

    We tried the Humalog pen and didn't really like it. We almost always had leakage with it, and we occasionally have to give 0.5 unit, and the smallest amount you can give with it is 1.0. (You can give half units above 1.0, but not below.) We ended up going back to syringes. With the Lantus pen, it only goes in whole unit increments, so I don't think they typically use them for little kids.

    Good luck! We've been really happy with Lantus.
     
  3. Boo

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    You may want to ask the CDE about whether or not they want you to subtract for fiber in your carb count. (We don't--some people do, some don't, and some do only if fiber is over a certain amount). You might also want to ask if they'd advise you to count any portion of fat and/or protein along with your carb count (we do cover a portion of each). Both of these go beyond the "basic" carb counting, but if this is supposed to be an "advanced class", then it seems that they would be appropriate questions.

    As for the pen...we only used lantus for a short time and never had a lantus pen. We had humalog pens and did use them occasionally--mostly just for eating out, and for shots on the go. They are easier to tote around than syringes and vials, and we found them to be much more discreet in public. (Not that I cared, but my son did). We also seemed to have a lot of "leaks" with the pens, so I never quite trusted that he was getting the full dose. Therefore we didn't use them at home for the bulk of his shots. Many people swear by them however.
     
  4. twodoor2

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    Your son is three inches taller than my 4 (almost 5) year old, but she weighs 54 pounds (yes, I have a very large 4 year old). She is on 5.5 units of lantus a day, so I think the amount your endo started your son out with is a good conservative number for his weight.
     
  5. still..hopeful

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    My daughter has been dx for about three months now. She is on Novalog and Lantus. We have only used the pens so I have nothing to compare it with. I find them to be real easy to use. Our Novalog pen goes in half increments and starts at zero so we can give her a half unit if we need to. Alyssa is five and 40 pounds. When we were in the hospital she was on 5 units of Lantus per night. Now she is on 2 units because she would keep waking up low. I would start where you endo suggests and then adjust one unit at a time until you get the correct dose. Alyssa's Novalog pen is blue with designs and her Lantus pen is gray. That helps a lot because when we first came home from the hospital we were still using the pen they gave us and they were both gray! Talking about some stressful times. I was constantly double checking and triple checking to see which pen I needed and which pen I was holding.
     
  6. twodoor2

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    I didn't know you could do half units with the Novolog pens, starting with only one half unit, I thought they started at one and a half units. I still use syringes because I am one of those weird people that can get insanely small amounts into a syringe. I have a high power magnifying glass with a super bright LED light (if you look at the light directly, it will blind you), and I have super amazing eyesight (I can actually read the microprint hidden U.S. paper currency) and a very steady hand. It's just a hassle with a syringe in public places. The pen is more convenient I would imagine.
     
  7. Ashti

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    Switching to Lantus

    The Hanas Type 1 Diabetes book suggests the following for switching from NPH to Lantus: (page 156)

    If taking NPH once a day, begin taking the same number of units of Lantus in the evening.

    With twice a day it is better to decrease the combined doses by approximately 20% and give it as one dose of Lantus.

    If giving large doses on NPH it is a good idea to lower the dose even more to reduce the risk of hypoglycemia, and then increase the Lantus dose aiming to wake up at 80-160 mg/dl.

    The examples they give in the book are:

    Morning NPH Evening NPH Lantus

    0 U 12 U 12 U
    0 U 36 U 32 U
    8 U 14 U 18 U
    12U 26U 30 U

    So since your total NPH is 16 units, this example might have you starting at around 12 units. Of course your endo may vary :p, but this gives you a rough estimate.

    Good luck! Ashti :)
     
  8. mph

    mph Approved members

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    THANKS for all the great suggestions!!!!!!!!!:)

    MUCH appreciated!!!!!!!!!!!

    Here we go, moving onward to Lantus!!!!!;)
     
  9. still..hopeful

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    Novalog pen

    Alyssa' Novalog pen is called the Novo Pen Junior. Although it starts at 0, each click is a half unit. I just went and wasted a half unit just to double check myself and I did get insulin to come out. Our last day in the hospital they introduced us to the pen and they had to give her a half unit correction using it. It just seemed easier and quicker than having to draw up the insulin. Alyssa did not seem as scared with the pen as she did with the syringes. The pens have been all we know and still being new at this myself, I am scared to try anything else.:eek:
     
  10. twodoor2

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    What would be perfect is if the pens could do quarter units. That would be my dream right now.
     
  11. Mary Lou

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    I know this is a carb-counting class, but I would ask if there are any "free snacks" for your child.

    when Brian was on Lantus, we didn't have to inject fast-acting for any snack 10 carbs or less. I've heard that some children can tolerate a 15 carb snack without fast-acting, and some can't tolerate even 5.

    What this meant for us was that Brian didn't need an injection for his morning snack at school, provided it was 10 carbs or under. He's a pretty light eater, so that was easy enough to do when he was in grade 1. I don't think it would work for him now that he's 9, although the market has been getting nice berries and snacks this week have rolled in at 9 carbs...

    Definitely ask about the protein and fat conversions. We count protein, but only if it is a substantial amount (6 ounces in one meal, for example). We don't convert for fat, but am going to try it the next time we eat pizza!

    Good luck!!
     
  12. taximom

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    When we switched from NPH to Lantus our Endo came up with the dosage for Lantus and so far it's been pretty right on, as well as the carb ratio. We tried the pens (for novolog) when we made the switch and my son (and I) didn't really care for them. I guess he's just used to syringes. He didn't like the "sound" of the pen and the fact that we had to hold it in longer. I always got some "leak back" and always a little "drip" on the end of the needle, even after holding it in for quite awhile. I never felt like I was getting an accurate dosage. We went back to syringes, but I draw the novolog out of the pen with a syringe. To me, it is still more convenient than a vial, especially when eating out. The pen vial stays protected in the pen, it comes in a great little protective pouch thing and I don't waste as much insulin every month.
    I wish the pen had worked out better, but it wasn't for us (at least not at this point). Maybe you'll have better luck. I also thought that you couldn't start at the 1/2 unit....only after 1 unit, you can go up by halves.
     
  13. vallecito93

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    I would love to take the class you are taking by phone......
    Some of this may have been said by others but anyway, Autumn was on MDI of NPH in the a.m., Humalog at mealtimes and Lantus in the p.m. until yesterday and then Dr. switched her to Lantus 6 units in the a.m. and Humalog for meal times. We were having problems with her going to low at night. I use pens for all. Our insurance charges us $40 per Rx. and when you get 5 vials in the pen form, which lasts us 5 months, compared to 1 vial a month we had to switch. We use both the pen needles and then just draw out of the vials with the syringes when we need to do a 1/2 dose. The NPH pens and Humalog pens look exactly alike. I would stay with the vials because the tops are a different color if that is a concern of yours. Right now this works for us. Autumn doesn't do her own injections yet so this might not work later on.
     

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