6/18 Hershey PMPS(336) +6(149) Almost +11(341)

Happy Monday! I see a lot of people I haven't met, so I'll give a quick intro. I'm Libby and am the usual poster (although Doug has posted a few times since we started Levemir ) Hershey, was diagnosed 11/11 at a weight of 8.5-lb. Our vet put him on ProZinc and off we went trying to learn this dance. Initially, he seemed to do well on the ProZinc - then, tried sliding scale - TID - then, sliding scale. A couple of weeks ago, we found ourselves given the opportunity to switch to Lev. After doing a lot of reading and asking A LOT of questions, we took the plunge.

June 13 PM - Hershey started .5u and we saw immediate improvement in his numbers. On the 4th cycle, he dropped to (32) and we were advised to decrease to .25u so we could try to find his dose.

This is the 6th cycle holding at .25u. It is difficult, at best, to have held this long considering how many pinks we've seen. But, we're trying to be patient. Am I correct in presuming that now we increase a little? And, while I think we're pretty close measuring the .25u, not feeling so confident about .3u. It seems accuracy is more important with the smaller doses. Any helpful tidbits y'all have picked up? When we first started, I could imagine measuring .25u (for example), but we did our best on the syringes with 1u markings, but we THANKFUL to find the syringes with 1/2-unit markings. I'm wondering if it's just a matter of time/practice to get .3u (or whatever).

Thank y'all, so much, for your assistance!

Libby (and Hershey, too!)

Re: Hershey - I've held the 6 cycles

Doug & Libby, welcome to LL!

I'm not good at patience either, so I've been sitting on my hands. Waiting 6 cycles can be tough! It's important, though, especially given Hershey's limited data on Lev. Clearing on the 6th cycle is common, so he might come down today.Let's see where Hershey goes today, but if he doesn't clear the bounce today then increasing would probably be called for.

There are people here with all kinds of techniques for finding in-between doses. I never had to get that specific - I just found a dose that I could consistently measure between 0.25 and 0.50. It doesn't matter what you call it, as long as you can replicate it.

Regarding increases when a dose reduction has failed, there are a couple of options. The protocol calls for going right back to the last good dose, which in this case was 0.5u. The idea is that going back to the dose that gave a breakthrough should give another breakthrough, earn a reduction again, but then you can try reducing by a smaller amount (so instead of reducing to 0.25u, maybe go to skinny 0.5u). Often it takes just a few cycles on the higher dose to get another breakthrough. Or, you can go right to the skinny 0.5u without going up to 0.5u first and see how that works. If you try one thing and it doesn't work, then next time you try the other technique, no big deal.

Have a good day!

Re: Hershey - I've held the 6 cycles

To help with the dosing some people find it handy to keep a sample syringe handy filled to the dose you want. Use water with food colouring or tea and then you can line up your insulin dose against the sample to keep it consistent.

Dose threat is on the table Hershey, lets see some action today...

Re: Hershey - I've held the 6 cycles

Welcome to Lantus Land and I'm glad you wanted to stop by!!

If you are going to follow the Tight Regulation Protocol to the letter, you would be increasing to 0.5u. I can understand if you think that dose may be too much and would opt to fatten the dose instead. If you take a look in the New to the Group sticky, there are photos of these hard to measure amounts along with a link to pictures of fine unit gradations.

Re: Hershey - I've held the 6 cycles

Hi Libby, Doug, and Hershey

Welcome to Lantus Land. I've been following Hershey's progress on lev since you first posted on Health.

With Hersheys numbers like they are, if you are going TR, I would tend to agree with Sienne about taking him to .5u and see if you can get him to breakthrough again. I do skinny doses like Libby is suggesting but I base it on Gracie's nadirs. If it looks like she just needs a tad bit more to bring the range down, I skinny. Otherwise, I take her back up to the breakthrough dose.

We use calipers to measure doses because the syringes are so inaccurate and Gracie is sensitive to small changes. I got the 4" digital calipers at Harbor Freight. If you want more info on how it works, just PM me.

Paws crossed for Hershey!

Re: Hershey - I've held the 6 cycles

Hi guys .. no dosing advice from me, but wanted to say welcome to LL!! Have a great day guys!

Re: Hershey - I've held the 6 cycles

welcome to the group libby, doug and hershey!

i like libby's idea to take the dose up to a skinny 0.5u if nothing much happens today. i think a skinny 0.5u (some would call it 0.4u) is worth a test drive since 0.5u dropped hershey too low on the 15th. if his numbers remain high after 4 cycles we could always re-evaluate and suggest adding that extra 0.1u back on. after all, it's often necessary to go back to the dose which caused a break through. i'd just like to see a "break through" with numbers that are a bit higher than what he experienced the other day.

just my thoughts...

Re: Hershey - I've held the 6 cycles

Thanks for the welcome and assistance!

Hershey says, 'haha Vyktors mum.' It seems he isn't scared by the threatened dose increase and is asking for some relief from the pinks. The .5u looked so promising last week. If only I could've caught & fed him before +6 (36). Or, if I had gone ahead and fed a little at +4.5 when he was (124), but being used to ProZinc, that (124) or even that (36) would've been short-lived. :YMSIGH: Hindsight and all that -

Not budging out of the 300's (thankful he's not going into the 400's, though), so will try the skinny .5u at 8pm. We hold it for 4 doses (instead of 6?) unless he goes too low, correct?

Thanks, Sienne, for the information links. Some of that I've never seen. There's so much information to be found here! I read some and will read more tonight.

Marje - I sent you a PM, but some people have had trouble receiving from me. But, YES, I would appreciate hearing more about the calipers.

Jill & Alex said:

i'd just like to see a "break through" with numbers that are a bit higher than what he experienced the other day.

Click to expand...

Me, too, Jill!

Re: Hershey - I've held the 6 cycles

Got your PM Libby and sent you the calipers info.

Re: 6/18 Hershey PMPS(336) Shot s.5u +3(278)

PMPS (336) +11.75 - Shot s.5u
+3 (278)

After almost 24-hours straight in pinks - YAY for yellow!!!! Guessin' I should test at +6? Had debated about using the auto feeder at night, but guess that should wait until I have a few more mid-cycle tests at this dose. Off to catch a nap before +6 -

Re: 6/18 Hershey PMPS(336) Shot s.5u +3(278)

Good luck with the new dose.

Re: 6/18 Hershey PMPS(336) Shot s.5u +3(278) +6(149)

Thanks, Sienne.

+6 (149) - Glad I didn't wait until +7, like I thought about doing...Feeding...

Re: 6/18 Hershey PMPS(336) Shot s.5u +3(278) +6(149)

That's a nice number
Carl

Re: 6/18 Hershey +6(149) +7(174) When to test again?

Thanks, Carl. I'm so glad he's getting some relief from those pinks!

+7 (174) - Ate ~ hour ago. When should I plan to test, again? Was planning to go to bed after +6 test/feed, but didn't think I'd be able to sleep until I tested, again. But, it's 3am and I could use some sleep...

It looks to me like nadir is ~+8 - +9 based on the limited information I have.

Any other night owls around to offer any insight?

Thanks!!
***************************************

Almost +8.75 (334)

Almost +11 (341)

Hi Libby,
Not sure on the nadir timing. Last night looked like +6 but the food then might have kept him from dropping later. Looks like he dropped a tiny bit at the end of the cycle but that was probably due to no food on board adding to his bg. It was a nice cycle though
Carl

Hi Libby,
Not sure on the nadir timing. Last night looked like +6 but the food then might have kept him from dropping later. Looks like he dropped a tiny bit at the end of the cycle but that was probably due to no food on board adding to his bg. It was a nice cycle though
Carl