? AMPS 84, withheld insulin, and now he's at 250

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Hastings (GA) and Paula

Hastings (GA) and Paula

Member Since 2021
I'm currently updating my google sheets from the FreeStyle sensor history. The sensor will have been on for 2 weeks at about 2pm today, so I won't have hour by hour readings anymore. Hastings seems to have been spending longer at the low spots in his insulin cycle, and then this morning he was 84 at 0900! I withheld insulin (no ketones in his urine) but his BG is climbing fast. I'd really, REALLY like to get Hastings back on an earlier shot time after a scheduling SNAFU a few days ago. Should I a) give him his normal dose now that he's popped back up? b) give him a token dose and then shoot "early" (get him back on 0700-1900 schedule, but I'd really like to be on an 0600-1800 schedule) or skip the dose entirely and shoot him at 1800?
 
If you shot now it would be +14? And if you shot at 6:00pm it would be +21?

It looks like he's starting his bounce from that 40 last night. I am not experienced with ProZinc, but I assume that 40 earns him a reduction. With Lantus and Levemir, shooting late acts like a reduction, but I don't know if it's the same with ProZinc.

I would not shoot a token dose now if he is at +14 (nadir around +20?) and then another dose at +21 (your 6:00pm goal). Do I have those + times right?

Hopefully someone with ProZinc experience will be here to advise you soon.
 
Well, +15 now. He's holding at about 230-240. You're correct, 6pm/1800 will be +21. I will note that whenever I've tested him manually when the Libre had him at <60 mg/dL, he came in at 20-40 points higher on the ReliOn.
 
ANY drop into the 40's mg/dL is a dose reduction on ANY insulin. So reduce by 0.25U please.

(Exception, and there are always exceptions, would be with a long term diabetic diagnosed more than 1 year ago.)

Wanted to get a quick answer out before looking at the SS. Let me catch up on what is going on please.
 
Quick background, he was diagnosed several years ago, but was free-fed dry food and given 6u Novolin-N BID. When he was surrendered to the shelter in January they switched him to wet food only but did not reduce his insulin, which led to some hospitalizations for hypo. The vet at the shelter wanted to switch him to ProZinc, but they didn't because they were worried the hometesting required for the longer acting insulin and the expense would hinder him being adopted, so they put him on 1u Novolin-N BID, because it didn't drop his glucose too low and was cheaper. My vet put him on 2 units because he was still hanging out at 300-600, and then about 2 weeks ago, we switched to ProZinc and his numbers have been much less volatile, and seem to be trending downward.
 
With Prozinc, the delay does not count as a reduction, as Prozinc is not a depot type insulin, so the delay is not draining the insulin depot.

Any 2 insulin monitors will give different BG numbers. The Libre reads the interstitial BG levels, or what is in the fluid surrounding the cells. The normal BG handheld monitors test the actual blood glucose levels. It takes longer to get the glucose from the bloodstream into that fluid around the cells, so there is a bit of a delay on those readings. So whenever you get a low Libre reading, it's always a good idea to retest with your handheld meter.

This is from a different CGM than the Libre, but it gives you the basic idea. Follow the trends, not the individual BG readings. https://www.medtronicdiabetes.com/c...y-sensor-glucose-does-not-equal-blood-glucose

With the recent switch to Prozinc insulin, even with Hastings being a long term diabetic, I''d still recommend that 0.25U dose reduction. So down to 1.25U. I'm saying that because he has had a lot of lower BG readings in the last week or so. Prozinc lasts longer than NPH type insulins like Novollin or Humulin, which is why you are seeing better BG readings.

So this is a perfect time to readjust your shot schedule. With the skipped shot this morning, expect Hastings to be high at PMPS. Don't worry about that high too much. Getting him on a better shot schedule is more important.

Has Hastings ever had ketones? or DKA?

Did I miss answering anything?
 
He was being a snuggly boy so I poked him a few minutes early - 459 mg/dL on the ReliOn now. I'll give him his dinner now then a shot. He hasn't had Ketones or DKA that I know of. The lab tests I got from the shelter were negative for ketones and the few times I've been able to check his urine (he is very scandalized when I even look at him while he's in the box) have been negative.
 
Hastings and Paula said:
He was being a snuggly boy so I poked him a few minutes early - 459 mg/dL on the ReliOn now. I'll give him his dinner now then a shot. He hasn't had Ketones or DKA that I know of. The lab tests I got from the shelter were negative for ketones and the few times I've been able to check his urine (he is very scandalized when I even look at him while he's in the box) have been negative.
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You can get a blood ketone meter, so you don't have to... like invade his private space :oops::D:p
 
Hastings and Paula said:
Quick background, he was diagnosed several years ago, but was free-fed dry food and given 6u Novolin-N BID. When he was surrendered to the shelter in January they switched him to wet food only but did not reduce his insulin, which led to some hospitalizations for hypo. The vet at the shelter wanted to switch him to ProZinc, but they didn't because they were worried the hometesting required for the longer acting insulin and the expense would hinder him being adopted, so they put him on 1u Novolin-N BID, because it didn't drop his glucose too low and was cheaper. My vet put him on 2 units because he was still hanging out at 300-600, and then about 2 weeks ago, we switched to ProZinc and his numbers have been much less volatile, and seem to be trending downward.
Click to expand...
If you REALLY want to see less volatile cycles I would recommend considering (in the future) switching to Levemir. Lantus, too. Very good insulins with much less drama!
 
SashaV said:
You can get a blood ketone meter, so you don't have to... like invade his private space :oops::D:p
Click to expand...
Yes. As Sasha says... I recommend the Nova Max blood ketone meter. You use it just like the meters that you use to test for blood glucose. Easier than stalking your cat to the litter box. Very accurate. The test strips are expensive (about 1.90 each in the U.S. from ADW Diabetes Supply).
 
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