7/13 Penny AMPS 64

[Courtnee P]

Hey everyone,

Penny has earned a dose reduction, but I am debating whether to give her a partial dose or skip her dose entirely this morning. Her AMPS was 64. I am anticipating a bounce so I want to give her insulin, but I know it might be recommended to skip. She is eating now. Insulin is usually given at 6:30am CST.

Her numbers in the last 12 hours: PMPS 274, +3 171, +5 112, +6 96, +7 82, +9 104

I went to bed after the 104 because I figured it was trending up. The lowest pre shot number at which I’ve given her a full dose is 96. And she WILL bounce. She is very sensitive to the low numbers.

Her spreadsheet is not updated at the moment.
Suggestions?

TIA for your help.

@Wendy&Neko

 

[Bron and Sheba (GA)]

If you get a lower than normal preshot it is best to stall, dont feed and see if the BG is rising and test in 20 minutes.
It is very hard to help you with the SS not up to date as I have no idea how she will react to the dose.
However with DKA in the past I would not skip the dose.
If you can monitor this cycle and have some higher carb food to give if needed, I would give a token dose.
What dose is she on now? ..with the reduction just earned?

 

[Courtnee P]

If you get a lower than normal preshot it is best to stall, dont feed and see if the BG is rising and test in 20 minutes.
It is very hard to help you with the SS not up to date as I have no idea how she will react to the dose.
However with DKA in the past I would not skip the dose.
If you can monitor this cycle and have some higher carb food to give if needed, I would give a token dose.
What dose is she on now? ..with the reduction just earned?

She will now be at 2.75U with the reduced dose.

 

[Bron and Sheba (GA)]

Sorry I am just getting back to you.
Are you able to test this cycle?
Have you retested the BG? it will be food influenced.
As you are following SLGS I would only give a token dose of say 0.5 units.
And get a +1 and a +2 and then test after that as needed.

 

[Courtnee P]

Sorry I am just getting back to you.
Are you able to test this cycle?
Have you retested the BG? it will be food influenced.
As you are following SLGS I would only give a token dose of say 0.5 units.
And get a +1 and a +2 and then test after that as needed.

Thanks for your help. I gave her .75U, a little more than 25% of the 2.75U. She has been around 300 since about 4 hours after she ate. I did not wait to feed and test her earlier, as her night numbers showed me that she was continuing to trend down, and I did not anticipate her going back up anytime soon. Her nadir is typically in the mornings and she doesn't go up until she eats. I have given her full doses at numbers around 90 before and she does just fine. I was just hesitant since she was in the 60s this morning. Again, thanks for your input!

 

[Wendy&Neko]

I am on the west coast and was not up when you tagged me. It's best to change your subject line to something like "need dosing advice now" on it to get eyes of people who are awake.

Now you've seen what happens when you do a token dose. Next time, try the stall without feeding that Bron suggested, to see if her numbers came up. With SLGS, you should not shoot below 90. I would have also done a second blood test, in case the first one was wonky. That 64 seemed out of place.

 

[Courtnee P]

I am on the west coast and was not up when you tagged me. It's best to change your subject line to something like "need dosing advice now" on it to get eyes of people who are awake.

Now you've seen what happens when you do a token dose. Next time, try the stall without feeding that Bron suggested, to see if her numbers came up. With SLGS, you should not shoot below 90. I would have also done a second blood test, in case the first one was wonky. That 64 seemed out of place.

Thank you, I will add that to the subject line in the future. The 64 was confirmed by her FreeStyle Libre sensor she currently has, which read 74. The 64 was using the ReliOn, so her true number was definitely somewhere in that neighborhood. How long is it appropriate to stall before a dose needs to be skipped altogether?

 

[Wendy&Neko]

How long is it appropriate to stall before a dose needs to be skipped altogether?

Stalling can be tricky. I'd start with 20 minutes or so. But it can be a couple hours. You cannot feed during that time, cause you want the numbers to be going up on their own. But if you stall too long, their numbers can drop without food. You also have to consider how late your schedule can be, and still shoot 12 hours later the next cycle.