Newly joined and currently giving insulin - how to "start over"?

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hellolucy

hellolucy

Member Since 2017
Originally posted this in the "Main - Feline Health and FAQs" forum but was recommended I move it to the ProZinc board :)

Lucy is currently on 4 units of ProZinc (using a U40 1mL 28G x 1/2" syringe) twice a day and has been for several weeks. Prior to that, she was on 3 units 2x a day, 2 units 2x a day, and 1 unit 2x a day, each for several weeks. Increased per direction from the vet. Her glucose readings have been all over the place, mostly high 300+, using the Alpha Trak 2 meter. I am worried I have not been doing this whole process correctly as I've been listening to what the vet has been telling me and only doing curves, not daily testing. I'd like to "start over" for lack of a better description. I am worried that I have either missed her ideal dose or she is becoming insulin resistant. Is this wise, and if so, how is it done? I've seen the Go Slow method mentioned several times but since she is already on insulin, I'm not sure how to follow this. Do I decrease her insulin dose and begin testing twice a day prior to food and dosing while tracking her numbers in the spreadsheet? I am going to buy a Relion from Wal-Mart today based on reading the reviews of it here as the AT2 strips' prices are nuts.

More information on Lucy and primary goals are in Introduction post.

Thank you in advance! Can't wait to make Miss Lucy feel better.
 
Hi Lucy's mom! And welcome! The fact that you already know how to test will be a big bonus in getting Lucy regulated. Since you've read the protocol already, you know that generally small increases of .25u are recommended, so I understand your concern with making those big jumps and maybe having missed the best dose (for now - it is a moving target). If you can set up a spreadsheet and input any data you have, that would help people get started with suggestions. Here is the link to the spreadsheet we use:

http://www.felinediabetes.com/FDMB/threads/fdmb-spreadsheet-instructions.130337/

And here is a short tutorial to get it linked to your signature:


Please let us know if you need any help getting that set up. There are a few people who are great at helping if you get stuck and we can connect you if you need it.
 
Djamila said:
Hi Lucy's mom! And welcome! The fact that you already know how to test will be a big bonus in getting Lucy regulated. Since you've read the protocol already, you know that generally small increases of .25u are recommended, so I understand your concern with making those big jumps and maybe having missed the best dose (for now - it is a moving target). If you can set up a spreadsheet and input any data you have, that would help people get started with suggestions. Here is the link to the spreadsheet we use:

http://www.felinediabetes.com/FDMB/threads/fdmb-spreadsheet-instructions.130337/

And here is a short tutorial to get it linked to your signature:


Please let us know if you need any help getting that set up. There are a few people who are great at helping if you get stuck and we can connect you if you need it.
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Very helpful video! :)
 
Djamila said:
Hi Lucy's mom! And welcome! The fact that you already know how to test will be a big bonus in getting Lucy regulated. Since you've read the protocol already, you know that generally small increases of .25u are recommended, so I understand your concern with making those big jumps and maybe having missed the best dose (for now - it is a moving target). If you can set up a spreadsheet and input any data you have, that would help people get started with suggestions. Here is the link to the spreadsheet we use:

http://www.felinediabetes.com/FDMB/threads/fdmb-spreadsheet-instructions.130337/

And here is a short tutorial to get it linked to your signature:


Please let us know if you need any help getting that set up. There are a few people who are great at helping if you get stuck and we can connect you if you need it.
Click to expand...

Thanks very much! And agreed, the video is definitely helpful. I have the spreadsheet created and ready to go in Google Drive. The vet has only had me doing curves every few weeks so am going to start doing the 2x daily readings tomorrow morning after I pick up a new ReliOn meter. Once I have that, I'll add the hyperlink in my signature and let the numbers flow!

Would you recommend for now then to continue giving her 4 units/4mL of insulin twice per day while recording the numbers and go from there?

I feel hopeful already :)
 
Djamila said:
Have you done a curve on 4u yet? If you did, do you remember the lowest number you got?
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I haven't done a curve on 4 units yet as she was just recently increased. It was the vet's multiple recommendations to increase her insulin by 1 unit that got me searching around as something felt off and I was lead here! Once I pick up the ReliOn meter today, I am going to begin tracking on 4 units 2x a day and entering the data in the to spreadsheet morning and night. I also want to try to do a curve this weekend.
 
hellolucy said:
Thanks very much! And agreed, the video is definitely helpful. I have the spreadsheet created and ready to go in Google Drive. The vet has only had me doing curves every few weeks so am going to start doing the 2x daily readings tomorrow morning after I pick up a new ReliOn meter. Once I have that, I'll add the hyperlink in my signature and let the numbers flow!

Would you recommend for now then to continue giving her 4 units/4mL of insulin twice per day while recording the numbers and go from there?

I feel hopeful already :)
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Do feel hopeful! This will get better and we can help you get her on track. The main thing to keep in mind is that it's a marathon, not a sprint. You'll read that often here. Patience wins always. :smuggrin:
 
hellolucy said:
I haven't done a curve on 4 units yet as she was just recently increased. It was the vet's multiple recommendations to increase her insulin by 1 unit that got me searching around as something felt off and I was lead here! Once I pick up the ReliOn meter today, I am going to begin tracking on 4 units 2x a day and entering the data in the to spreadsheet morning and night. I also want to try to do a curve this weekend.
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You should have a hypo kit prepared just in case: honey or karo syrup, high carb gravy style wet food, spare vial of test strips for the meter you'l be buying. I'm not trying to spook you. This is something we all need.
 
Even with Maury's numbers starting so high, like Kris said, one of the first things I did after his diagnosis was get stuff together for a hypo kit. I wanted to be prepared ahead of time and I hope I never need the full kit :).

The minimum testing is twice a day for preshots but the numbers in between really help us get a better picture of what the dose is doing to her. Obviously, most people work so it can be more difficult but try to get more mid cycle numbers when you can :).

I have been unemployed for a while so I am gathering as much data as I can to try and regulate Maury so when I do start working, I might be more comfortable if I know how he is doing. But let's be honest, I am going to worry about him when I can't be here all day because he is my baby :cat:. I have already been getting worried for when I have to go away for a few days in the fall! :p
 
Hi Lucy's Mom. Just want you to know without a doubt that you are doing the right thing - first by questioning treatment and second by coming to this amazing site for help and encouragement. We have been going through the same thing the last couple of months and are so thankful for the help and guidance we are finding here. Luckily we have a daughter @Lisa & Leo who found this site several years ago so we have so much support. Cooper was started on an inferior insulin in January and then switched to Prozinc at too high a dose, all with no home testing. We have been working the last month and a half to start him over and gradually increase to find the right dose for him. We have made good decisions and some not so good but are learning more and more each day and with all this help and encouragement we are hopeful we will be finding Cooper's "sweet spot" soon. And we wish the same for Lucy and you. Good luck!
 
K T and Cooper said:
Hi Lucy's Mom. Just want you to know without a doubt that you are doing the right thing - first by questioning treatment and second by coming to this amazing site for help and encouragement. We have been going through the same thing the last couple of months and are so thankful for the help and guidance we are finding here. Luckily we have a daughter @Lisa & Leo who found this site several years ago so we have so much support. Cooper was started on an inferior insulin in January and then switched to Prozinc at too high a dose, all with no home testing. We have been working the last month and a half to start him over and gradually increase to find the right dose for him. We have made good decisions and some not so good but are learning more and more each day and with all this help and encouragement we are hopeful we will be finding Cooper's "sweet spot" soon. And we wish the same for Lucy and you. Good luck!
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Thank you for the welcome and encouragement! Is there a specific process you followed to start over with Cooper's insulin? Sounds like Lucy is in the same boat with what I feel is a dose of insulin that was just increased too rapidly. I know every kitty's journey will be different but am trying to gather all of the information and experiences I can before Lucy and I are off to a running start! :)
 
Hi,
Cooper was originally on Humulin N 2U and then 3U twice a day with "no need to test." We researched a lot and then requested vet prescribe Prozinc and we started home testing. We were told to start the Prozinc at 3U twice a day. As you can see from Cooper's spread sheet he was bouncing up and down on the 3U. Our daughter and the folks of FDMB encouraged us to follow the "low and slow" procedure, reduce the amount of insulin per shot, and then slowly increase as he produces four or five reasonable cycles that will support an increase. We have increased slowly, with some bouncing and some high flat cycles where he has seemed to be resistant to the insulin, but not so extreme as before. I have constantly checked with my daughter or folks on the board for guidance whenever we have done an increase. If you look, there are a lot of notes on the spreadsheet where my daughter, @Lisa & Leo and I discuss what to do next. This is all still very new to my husband and I but we have learned so much - and you will to. Have spent hours reading threads on here and picking up all kinds of valuable information. Good luck!
 
Hi Lucy's mom! Were you able to get a meter and start testing? If so, how's it going? Is there anything we can do to help?
 
Djamila said:
Hi Lucy's mom! Were you able to get a meter and start testing? If so, how's it going? Is there anything we can do to help?
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Hi! I did finally receive the strips for the AT2. We tried testing Lucy last night before her dinner and were incredibly unsuccessful. I had to poke the poor girl probably 3 times. No matter which time we tried, the AT2 meter and strip would just not give us a reading. It seemed like a large amount of blood, too. I don't understand. Same thing with this morning. Anyway, I was finally able to get enough blood for a reading tonight (still seems like a lot which was my initial issue with this - maybe I'm just not used to seeing that large of a droplet of blood come out of her poor ears, it just seems like a lot to me based on what others are saying. I've tried "dipping" both sides of the AT2 strips as I know a reading is only needed on one side, laying it flat, etc.). I've added it in to my spreadsheet.
 
Congrats on getting a test! It's always tough at first, but it will get easier for you and for Lucy, and before you know it, it will be no big deal.

A couple of things that might help:
1. You might try it on yourself to figure out how much blood you need, and the easiest way to get it into the test strip.
2. warm up Lucy's ear first. Some people put some uncooked rice in a small sock. I sewed two heart shaped pieces of felt, and then stuffed it with uncooked rice. Then you put it in the microwave - mine takes 30 seconds, it will just depend on your microwave and how big your rice packet it - and then hold that up to Lucy's ear for 30-60 seconds before testing. This will increase the blood flow and make it easier. Sam won't let me hold it on his ear that long all at once, so I kind of use it to rub all around his head, and just hold it on his ear for a few second at a time until his ear has had enough time to feel warm.
3. Some people find it helpful to put a tiny bit of neosporin on the ear first because it helps the blood to bead up instead of running into the fur.

Please let us know any questions or frustrations you encounter. We all have our own little tricks that help, so hopefully one or two of them will work for you and Lucy too. And if nothing else, we can all sympathize!
 
Congrats on getting a test! It does get easier...her ears will actually learn to bleed as you test more. They grow more capillaries and bleed better over time. Until then, I suggest looking at her ear with a flashlight. You'll be able to see the vein and where its best to poke. .that was the biggest help for me.

We also suggest taking a break after 3 tries.. If you don't get blood take a 10 minute break. It'll help you both calm down some for another try.
 
Thank you all for the tips and encouragement! I've tried multiple times this weekend without success. The biggest problem is she really, really hates it. I just tried again while she was sleeping in her "noodle bowl" (which is what we call it, actually called the Hepper) and she pushed her ears in to the bowl to avoid it. I am not being overly aggressive or harsh and hate seeing her so annoyed. I am giving her a small treat afterward to try and persuade cooperation with positive reinforcement. I've used a warm washcloth and held it on her ear for 15 - 20 seconds prior each time. I'll keep practicing/trying and and will record the numbers (any, at all...hopefully I'll have more than one in my spreadsheet soon) as I get them. Thank you again!
 
Maybe for the next couple of days, try taking her to wherever your testing spot is and just petting her and rubbing her ears and give her a small treat several times throughout the day. That way, she starts to get used to it just being a good thing, and when you add the prick, it might not bug her as much.

I know it's tough...Gypsy wasn't a happy camper when we started. I found the burrito trick to be most helpful...I wrapped her in a towel so she couldn't get away and she calmed down and let me test. After about a week, I no longer needed the burrito. I was surprised, but she really seemed to be somewhat comforted by being wrapped up like that and it got her used to the treat she got afterwards...and all was good from there!
 
Rachel said:
Maybe for the next couple of days, try taking her to wherever your testing spot is and just petting her and rubbing her ears and give her a small treat several times throughout the day. That way, she starts to get used to it just being a good thing, and when you add the prick, it might not bug her as much.

I know it's tough...Gypsy wasn't a happy camper when we started. I found the burrito trick to be most helpful...I wrapped her in a towel so she couldn't get away and she calmed down and let me test. After about a week, I no longer needed the burrito. I was surprised, but she really seemed to be somewhat comforted by being wrapped up like that and it got her used to the treat she got afterwards...and all was good from there!
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This sounds amazing!! I love the "burrito" description :cat: I've given her baths and done this so I believe this will work. I'll have to try out the treats without testing idea and then move on to creating a Lucy purr-ito. Thank you very much for this suggestion! This makes me hopeful as part of the reason I have so much trouble is her *extreme* squirming.
 
hellolucy said:
Thank you all for the tips and encouragement! I've tried multiple times this weekend without success. The biggest problem is she really, really hates it. I just tried again while she was sleeping in her "noodle bowl" (which is what we call it, actually called the Hepper) and she pushed her ears in to the bowl to avoid it. I am not being overly aggressive or harsh and hate seeing her so annoyed. I am giving her a small treat afterward to try and persuade cooperation with positive reinforcement. I've used a warm washcloth and held it on her ear for 15 - 20 seconds prior each time. I'll keep practicing/trying and and will record the numbers (any, at all...hopefully I'll have more than one in my spreadsheet soon) as I get them. Thank you again!
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Some cats don't like warm, wet cloths on their heads/ears. Maybe make a rice sock? Put about a half cup of dry rice into the toe of a clean old sock, tie it off and heat in the microwave until it's very warm but still touchable. I think this dry heat object is more tolerable to them.
 
I've been doing the treats for the past several days and plan to attempt the burrito very soon (maybe tomorrow) in order to do a glucose curve which I will post in the spreadsheet. I took Lucy to a new vet today. I've previously been taking her to VCA hospitals and haven't been happy with their constant insulin increases. The vet said she wants to get Lucy started on Lantus (Glargine) insulin. She asked me to look a bit more in to it to make sure I'm comfortable prior to proceeding. She also wants a full glucose curve prior to switching. She said Lucy seems a bit dehydrated but okay otherwise. We also did a blood panel and urinalysis just to have a baseline to compare everything to with the results back in one - two days. She also recommended I switch Lucy from her current diet (Wellness Core canned) to something made more for weight management and gave me two cans of Hill's Prescription Diet Digestive/Weight Management. She seemed like a pretty knowledgeable vet and did not try to upsell me on anything. How does everyone feel about her recommendations?
 
Can you list what her increases have been and the dates? I don't think the Prozinc has had a fair trial yet but it is hard to tell without data.
 
Without seeing her recent numbers and whatnot, it's hard to say. Can you fill out the spreadsheet?

I agree that the ProZinc hasn't really been given a fair trial yet. Lantus is a good insulin, but I wouldn't switch until you know ProZinc isn't working.

The food change isn't a very good idea. Wellness is a good low carb food, but Hills is a higher carb food that isn't nearly as good for kitties.
 
I am nervous about filling in the spreadsheet with previous numbers for two reasons - one, they are not a full glucose curve. She absolutely hates getting this done so the "curve" is not actually a curve - I was usually able to get maybe 3 readings over a day. Two, the only recording I have of the numbers is on the AT2 device and I have no idea how many units she was receiving at that time or what type of diet she was eating (dry vs. canned). I can call the vet and ask them for a record if that might help but the data is pretty limited - they just have the times and numbers. Let me know what you all think! But...the burrito trick worked wonderfully today and I am one more reading away from getting a full glucose curve on her today!! :) I would have never come across this trick without this community. This is the first time I've been able to successfully do this so am pretty darn excited, but also very disheartened by her numbers. Anyway...I've loaded her numbers in to the spreadsheet and will add in the last one in the next few hours:cat:
 
Oh goodness...don't worry about the numbers not being a curve. Look at different people's spreadsheets. Some of us test a ton, some of us just do spot tests. Just enter whatever you have. Anything is helpful. If you don't know the units, just skip that part, and enter it for the dates when you do know it - even if that's just the most recent bit.

I'm so glad to hear it's going well for you today! The numbers may not be what you wish they were right now, but she will make progress, and having this data is a huge step in getting her to a healthier range. Well done!
 
Congratulations on getting the spreadsheet set up! All numbers are data that will build up the picture over time. It's very hard to know what's going on since you've just begun. I will say, though, when I see high numbers on a newly diagnosed kitty who's receiving a high dose I wonder about chronic bouncing from insulin overdose. You need to gather quite a bit more data to be able to know whether this might be the case.
 
Thank you both! I will call the vet tomorrow and ask them to email me her numbers and insulin unit dosage at that time if they have it (I'd hope they do - will add it in to the spreadsheet either way from the AT2 device if ). Once I enter those numbers in, would you recommend doing another curve next weekend to try to establish a pattern and figure out if she is indeed suffering from insulin overdose? Should more data be obtained on 4 units 2x per day prior to lowering the dose?
 
What's your schedule like during the week? Are you at work all day? at night?

The pre-shot tests are important every time. But if you can get any mid-cycle numbers during the week they are really helpful to know if Lucy is dropping, and how much.

If you work like many of us, one trick is to do the test/feed/shoot as soon as you get up, and then get an "out the door" test right as you leave (assuming it's a couple of hours later - if you get up and out the door in 30 minutes, this trick won't work so well).

You can also grab a test as soon as you get home, if you're home a few hours before kitty dinner time. Or get a test in before you go to sleep at night.

These extra tests can be super helpful in figuring out what's going on with her dosing, even without being a full curve. Just whatever you can grab beyond the two pre-shot tests.

Since there isn't a lot of data, a curve next weekend might be helpful, but it depends on how much mid-cycle data you can collect during the week.
 
hellolucy said:
Thank you both! I will call the vet tomorrow and ask them to email me her numbers and insulin unit dosage at that time if they have it (I'd hope they do - will add it in to the spreadsheet either way from the AT2 device if ). Once I enter those numbers in, would you recommend doing another curve next weekend to try to establish a pattern and figure out if she is indeed suffering from insulin overdose? Should more data be obtained on 4 units 2x per day prior to lowering the dose?
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Data from the vet might help. however, it's quite common for those numbers to be higher because most kitties are stressed when they're there. Yes, continue gathering data at this dose for now. No need to do a full curve until later (maybe). Aim for preshot BGs daily and at least one other test near the middle of the cycle or just before bed if you're away from home on work days. A good scattering of BG tests at different times in the cycle over many days says more about what a dose is doing than a full curve on one day.
 
All data is good data. Any tests you can get other than just preshots throughout the week would help. A lot of people get a before bed test to help, or a "on the way out the door" test. Sometimes people get up during the night to get a test...I used to do that when I just woke up on my own. I'd run downstairs for a quick test since I was awake anyway.

GREAT JOB today!
 
I am usually only off on weekends and gone all day so will aim to get mid-cycle numbers during the weekend and take a reading just before I go to bed as she usually eats an hour or so after I get home. I am off for the next 3 days though so will be able to get some mid-cycle numbers in then :) ! I've also added her last number in to the spreadsheet from the curve yesterday. Thank you all for the encouragement! Still can't believe how well that burrito trick worked yesterday.
 
The vet just called back and said all of Lucys' blood work and urine analysis is normal except for the glucose readings being high which was expected. I gave her the numbers from the curve yesterday and she said she does suspect insulin resistance/bouncing and thinks we should begin by lowering her to 3 units (versus the current 4) for a few days and do another curve or two. In the first few months I was attempting to do curves on Lucy at home, I remember her mid-cycle number being in the upper 100s/lower 200s several times and let her know this. She says this further confirms that Lucy's ideal dose was missed since the previous vet increased it irresponsibly quickly without having the full picture of a correct curve. I also let her know I'd like to give ProZinc a fair shot doing it the right way now that I can successfully do full curves at home and she was totally fine with that. Can't wait to get Lucy in her ideal spot!!
 
Lucy's previous vet emailed me her (limited, nonetheless helpful) previous readings as well as insulin dosing at that time today! They've been loaded in to the spreadsheet. Yong - let me know how you feel about reducing based on these updated numbers :cat:
 
I'm curious that the only blue is way back at 1u. That could be meaningless since it's just one data point, but the other cycles all look flat.

Also, have you only been giving one dose/day....or is it just that the only data is from the daytime cycle?

So was the vet doing a fructosamine (or whatever it's called) test every two weeks and changing the dose based on that? Or was the vet getting one mid-cycle test and basing it on that?

So many questions! I love mysteries...
 
Djamila said:
I'm curious that the only blue is way back at 1u. That could be meaningless since it's just one data point, but the other cycles all look flat.

Also, have you only been giving one dose/day....or is it just that the only data is from the daytime cycle?

So was the vet doing a fructosamine (or whatever it's called) test every two weeks and changing the dose based on that? Or was the vet getting one mid-cycle test and basing it on that?

So many questions! I love mysteries...
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All of the units in the spreadsheet are measurements of the listed unit at 2x per day (for example - she is receiving 4U 2x per day at the moment which has been increased from 3U 2x per day, then from 2U 2x per day, and the initial 1U 2x per day). The data in the spreadsheet is just limited to a specific time frame - the measurements from when I wake up in the morning (8 - 9am on weekends) and measurements throughout the rest of the day. I usually am asleep by 10:30 - 11:30p, so there are no late nighttime measurements here.

The numbers that the vet sent me that I've loaded in to the spreadsheet are actually numbers I provided them from my in-home AT2 tracking (no measurements at the vet) as well as her dosage at the time. She was very, very resistant when I obtained all of those which is why there are only 2 - 3 per day. I called these numbers in to the vet and he would call me back with his advice as far as increasing her dosage.
 
Yong said:
I'm with Djamila, the only blue you saw was on the 1U cycle. I'm wondering if she's been on too high a dose and if you can just go back to really "starting over" with the 1U twice a day or if it should be gradual. @Kris & Teasel @Rachel
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That's the feeling I have too. She's been raised to a high dose quickly and in large increments. If you try a restart at 1 u there's no need to linger at a dose more than 3 cycles. Then go to 1.25 u for three cycles, 1.5 u for three, 1.75 u for three and so on.
 
And as for the testing, please don't feel like you need to get ten tests a day or something. Most days I only have four tests - the two pre-shots, and two mid-cycles. If I didn't work at home so much, there would only be three tests - I just get that daytime mid-cycle because I'm here. My previous job, there's no way that would be happening. So all that to say, while testing is important, doing a curve every day is totally not necessary. If you can get the pre-shots done, and grab mid-cycle numbers as you and Lucy can stand it, you'll get enough data.

The testing gets easier as it becomes more routine. At this point, Sam knows he doesn't get breakfast or dinner without a test. So he hops up there and waits on the counter (his testing place) until I come poke him. Don't get me wrong - he doesn't exactly love getting tested, but he also isn't running and hiding anymore either. It's going to get easier.
 
Yes, I think a restart could help. That blue does indicate that it's possible the dose was raised too fast and your "ideal dose" was missed. The good news about restarting is that it's easier to slowly raise the dose than to lower it...lowering it can be nerve wracking as you never know how much he needs to go down...but increases are easy if you stick to every 3 cycles.

I know we've asked you a lot about testing, but as Djamila said, you don't need a ton of tests. It's actually more helpful to get tests at different times of day throughout a week or so...helps get a good picture. Any mid cycles you can get as you increase would help so we can see what each dose does.

Side note...are you testing for ketones?
 
Thank you everyone! I am going to restart her at 1U and continue posting any numbers I have as I get them in the spreadsheet and get another full curve this weekend. I also am currently using U-40 needles as that is what the VCA says is "required" to use with ProZinc. Can I purchase syringes that are 1/2U instead to use so I can see the lines when raising her dose in small increments (if it gets to that)? I did buy the ketone strips when I first joined the board and was reading through some of the posts but was not able to successfully use them prior to her vet appointment. The vet did say though that her urine showed no signs of ketones so that's good!

The successful curve I did 2 days ago actually did become a bit easier at the end because she knew she would be getting a small treat after it was over ;)
 
I took a pre-bedtime shot tonight 3 hours from her insulin dose and it was 117 (in spreadsheet). Her value earlier was 408 at 4 hours post insulin. Those seem like huge fluctuations. She's also been acting tired all day. Not to the point where I'd take her in to the vet but she is just acting a little bit differently. She ate all of her dinner though. Is this something you would expect to happen by dropping her from 4U to 1U overnight? Or should I wait until tomorrow to take some more numbers and see what's going on?
 
Sorry we weren't around last night! Did you happen to get a preshot number? That's super helpful when we're trying to figure out what happened. If the preshot number was actually pretty low, that drop wouldn't be a surprise at all. Without that, it's hard for us to tell you for sure if that is a big drop.

I will say that it's very possible that the 4 units was just too much insulin (it can look similar to too little). If you skipped the ideal dose, and restarted at 1 unit, it's possible Lucy is reacting well.

For the next few days, preshots and any mid cycle numbers you can get will be super important and will help you determine when to raise the dose and when we hit that ideal dose. Great job testing after the shot!!
 
Yes, I think that huge BG fluctuations can make them feel tired or unwell. I'm very impressed by that blue last night. As Rachel said above, it's really important the you test systematically as you work on this dose finding phase - every AM and PM before feeding and injection as well as at least one test near the middle of a cycle and/or before bed.
 
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