Olivia and her recent hypo(?) episodes, part 2 (Electric Boogaloo)

[FrostD]

Sorry I'm not usually on midday!

That was a really nice cycle actually. In your case, I would intervene based on rate of BG drop, not necessarily the number itself. If you start to see cycles like you did on the 11th and 12th where she's diving, I'd be intervening starting at +1/+2.

Cycles more like today and the 14th PM cycle I'd just keep an eye, but if she started dipping below 80/85 before +4 I'd start intervening. Steep dives like the 12th I'd be giving HC. If she had been about 10 pts lower today at each test, I'd have started giving MC.

Does that make sense? I don't mind an 80 at +4 since that's probably nadir, but an AMPS of say 110 dropping to 80 at +1 raises my heart rate a bit!

When intervening with food, it's usually 1-2tsp at a time unless she's really diving or in bad nunbers. You want to make sure she stays flat or increases for at least 2 hrs after the test, or past nadir, whichever is later - so if you give MC/HC food at +1, keep testing through +4 because she may drop again. But if you give MC/HC at +3, test til +5 and you're likely in the clear.

Sometimes a small meal at PM+9 (so about 3 hrs before AMPS) helps bring the AMPS down. Being higher in the morning is called the dawn phenomenon. Might be worth a try!

 

[mosi_yazhi]

Sorry I'm not usually on midday!

That was a really nice cycle actually. In your case, I would intervene based on rate of BG drop, not necessarily the number itself. If you start to see cycles like you did on the 11th and 12th where she's diving, I'd be intervening starting at +1/+2.

Cycles more like today and the 14th PM cycle I'd just keep an eye, but if she started dipping below 80/85 before +4 I'd start intervening. Steep dives like the 12th I'd be giving HC. If she had been about 10 pts lower today at each test, I'd have started giving MC.

Does that make sense? I don't mind an 80 at +4 since that's probably nadir, but an AMPS of say 110 dropping to 80 at +1 raises my heart rate a bit!

When intervening with food, it's usually 1-2tsp at a time unless she's really diving or in bad nunbers. You want to make sure she stays flat or increases for at least 2 hrs after the test, or past nadir, whichever is later - so if you give MC/HC food at +1, keep testing through +4 because she may drop again. But if you give MC/HC at +3, test til +5 and you're likely in the clear.

Sometimes a small meal at PM+9 (so about 3 hrs before AMPS) helps bring the AMPS down. Being higher in the morning is called the dawn phenomenon. Might be worth a try!

OH HIIIII! <3

So, I understand what you're saying, but do you have any like... baseline advice that isnt so involved?

Like, I think it's pretty obvious that Vetsulin probably just isnt the insulin for her. I'm HOPING to start her on a better insulin at some point, but its not a guarantee my application will be accepted by DCIN, and given my financial situation I cant afford it out of pocket right now.

Even if I get this job I'm interviewing for, it's got to be a little while before I can afford it and even then -- my working is going to take me out of the house and I wont be able to monitor her as much.

Like, at what BG do you think it would be safe to shoot the drop, and how often should I test her after, if I'm able to test? Testing her every hour on the hour for 12 hours was kind of a marathon for us, not going to lie.

Should I do another curve in a few days when she has a AMPS in the 140s, just so we're sure she will be in relatively safe numbers if I give a drop dose?

Also, if I'm understanding this right, what you said about the dawn phenomenon -- might she be able to self-regulate a bit better if I just have LC food available/free feed/feed more frequently?

I'm not trying to be nitpicky, I appreciate all the advice! I'm just trying to figure out how to make this sustainable for us until we get better footing.

 

[SashaV]

Feed 3 hours before AMPS, then her own insulin will kick in and bring it down... hopefully!

She's looking extremely good, being a new diabetic, on Vetsulin, in general. You're very lucky! There's no guarantee for anything, but I don't see you being here that long. So from my perspective, don't worry so much about the future

 

[FrostD]

OH HIIIII! <3

So, I understand what you're saying, but do you have any like... baseline advice that isnt so involved?

Like, I think it's pretty obvious that Vetsulin probably just isnt the insulin for her. I'm HOPING to start her on a better insulin at some point, but its not a guarantee my application will be accepted by DCIN, and given my financial situation I cant afford it out of pocket right now.

Even if I get this job I'm interviewing for, it's got to be a little while before I can afford it and even then -- my working is going to take me out of the house and I wont be able to monitor her as much.

Like, at what BG do you think it would be safe to shoot the drop, and how often should I test her after, if I'm able to test? Testing her every hour on the hour for 12 hours was kind of a marathon for us, not going to lie.

Should I do another curve in a few days when she has a AMPS in the 140s, just so we're sure she will be in relatively safe numbers if I give a drop dose?

Also, if I'm understanding this right, what you said about the dawn phenomenon -- might she be able to self-regulate a bit better if I just have LC food available/free feed/feed more frequently?

I'm not trying to be nitpicky, I appreciate all the advice! I'm just trying to figure out how to make this sustainable for us until we get better footing.

Lmao unfortunately with Vetsulin advice usually isn't as straightforward :/ it is heavily dependent on how fast the BGs are dropping and where you are in the cycle. I'm not usually on in the middle of the day when you'd likely need guidance, so that was my attempt at leaving guidance for future reference!

Let's start here - feed her a small meal 3 hrs before AMPS for the next 5 days and see if that brings that number down. Remove that meal 2 hrs before test time because we still want AMPS to not be influenced by food. As long as AMPS is less than 150 while you're doing that, no shot. Above 150, drop dose should be safe (but again, you hold the needle, you decide what you're comfortable with). If that doesn't work, then yes we'll want to curve drop doses in 140s on a day you have time.

She'll be fine on Vetsulin for the time being, her numbers are still great! I wouldn't sweat the insulin just yet, but yes it's likely that Lantus will be a little easier to handle.

Edit: re: testing. If/when you give the drop dose I'd check at +1 and +2. If she's not dropping too fast by then, you're probably ok. "Too fast" unfortunately is relative. Assuming you're only shooting drop doses, and only above 150...I'd say if she's 110 or less by +2 I'd be keeping a close eye.

 

[mosi_yazhi]

Lmao unfortunately with Vetsulin advice usually isn't as straightforward :/ it is heavily dependent on how fast the BGs are dropping and where you are in the cycle. I'm not usually on in the middle of the day when you'd likely need guidance, so that was my attempt at leaving guidance for future reference!

Let's start here - feed her a small meal 3 hrs before AMPS for the next 5 days and see if that brings that number down. Remove that meal 2 hrs before test time because we still want AMPS to not be influenced by food. As long as AMPS is less than 150 while you're doing that, no shot. Above 150, drop dose should be safe (but again, you hold the needle, you decide what you're comfortable with). If that doesn't work, then yes we'll want to curve drop doses in 140s on a day you have time.

She'll be fine on Vetsulin for the time being, her numbers are still great! I wouldn't sweat the insulin just yet, but yes it's likely that Lantus will be a little easier to handle.

Edit: re: testing. If/when you give the drop dose I'd check at +1 and +2. If she's not dropping too fast by then, you're probably ok. "Too fast" unfortunately is relative. Assuming you're only shooting drop doses, and only above 150...I'd say if she's 110 or less by +2 I'd be keeping a close eye.

OK, that sounds do-able! Thank you so much!

Also, sorry for the late reply - I got on too late yesterday to implement the night-time feeding to serve her AMPS, but was able to do it today. She was at 103, which is the lowest I've ever seen her in the morning. Hopefully this works out. I'll try to do another curve on her if this stays consistent, maybe checking every 2 hours, to see what 4 mini-meals do to her, rather than two larger meals.

Feed 3 hours before AMPS, then her own insulin will kick in and bring it down... hopefully!

She's looking extremely good, being a new diabetic, on Vetsulin, in general. You're very lucky! There's no guarantee for anything, but I don't see you being here that long. So from my perspective, don't worry so much about the future

Haha, fingers crossed! Her vet appointment is Tuesday, and we're gonna see where she's at for her dental extraction(s). Hoping nothing else flairs up that will prevent them doing the dental.

The place that interviewed me said they'd let me know by Friday. Cross your fingers the next week goes well for me!