1/21 Xander - PMPS 237, +3 288, + 5 307, +8 310, +11 364

[Brianna & Xander]

Yesterday's thread.

Thank you so much everyone for your responses last night! I don't want to get in trouble for responding in yesterday's thread but please know I read it and appreciate you all.

I'm adding another question mark prefix just because I don't feel like I have an answer to my actual question(s), which is probably my fault for not being clear enough. So my questions still pertain to the numbers from yesterday's post, not today's title.

1. Was his nadir yesterday the 175 from 9:50 AM (+13.25), or was it the 161 from 6:45 PM (almost 24 hours after his last dose)?

2. I understand that his overall trend should decrease with the wet food, but are sudden drops like what I saw at 6:45 PM normal? It had been so long since his last dose and he ate an hour before this, which I'd expect would at least cause a small increase.

3. Most importantly, how can I know if it's safe to shoot if I don't see the lowest number of his cycle until after (possibly by several hours) his next dose? (eg, if I have to shoot at 8:30 but I won't see the nadir until almost 10 AM, how can I know it's safe to inject?)

I read the Carryover and Overlap Wiki pages and understand the nature of Lantus, but aside from being able to use overlap to our advantage (which is says is an advanced technique) I didn't really feel like it answered my questions.

Thank you all again so much!

 

[Staci & Ivy]

I might suggest a brief question in your title to get some attention, like:
Do I shoot? Or: Need Info to Shoot?

I am hoping an experienced person can give you better clarification to help make dosing and shooting decisions easier, Brianna.

 

[Brianna & Xander]

I might suggest a brief question in your title to get some attention, like:
Do I shoot? Or: Need Info to Shoot?

I am hoping an experienced person can give you better clarification to help make dosing and shooting decisions easier, Brianna.

I just didn't want to use that because I'm not asking if I currently need to shoot (and don't want to distract from people who do need more immediate help), I'm just wondering what constituted nadir yesterday and how I can know based on it having been so late whether or not it's safe to shoot in those conditions). But if you think it's wise I can try that!

 

[Angela & Cleo]

1. Was his nadir yesterday the 175 from 9:50 AM (+13.25), or was it the 161 from 6:45 PM (almost 24 hours after his last dose)?

The 1/19/25 PM cycle was a bounce clearing cycle. Those tend to nadir at the end of the cycle which is close to the next shot time. In your case that was 1/20 AMPS.
Since you skipped the 1/20 AM cycle, what you most likely saw was the higher depot keeping the cycle pretty flat. What I mean is that 1/20 AM readings are all pretty much within meter variance of 20%. Here is more info on the Depot.

2. I understand that his overall trend should decrease with the wet food, but are sudden drops like what I saw at 6:45 PM normal? It had been so long since his last dose and he ate an hour before this, which I'd expect would at least cause a small increase.

I would check any off readings with a handheld glucometer if you can. Did you verify the 164 at +23 with a handheld meter? It seems a bit out of place. Sometimes the libre can give slightly off readings. Please also remember that the Libre reads interstitial glucose which differs slightly from a blood glucose reading.

3. Most importantly, how can I know if it's safe to shoot if I don't see the lowest number of his cycle until after (possibly by several hours) his next dose? (eg, if I have to shoot at 8:30 but I won't see the nadir until almost 10 AM, how can I know it's safe to inject?)

This will get answered with time, data and experience. Xander is very newly diagnosed and therefore you'll still trying to establish his trends and patterns. This will take some time. Be patient with yourself. You will soon learn how he responds to insulin and carb sensitive and all the other stuff we have in the stickies located at the top of this board.

I read the Carryover and Overlap Wiki pages and understand the nature of Lantus, but aside from being able to use overlap to our advantage (which is says is an advanced technique) I didn't really feel like it answered my questions.

I wouldn't call it an advanced technique but I would say that until you have more confidence, its a scary concept. Here is a link to Myths Debunked which helps explain WHY we should shoot

In the meantime, keep asking questions. Even if you think you know the answer, ask away!! If you're hesitant, just post here

 

[Brianna & Xander]

The 1/19/25 PM cycle was a bounce clearing cycle. Those tend to nadir at the end of the cycle which is close to the next shot time. In your case that was 1/20 AMPS.
Since you skipped the 1/20 AM cycle, what you most likely saw was the higher depot keeping the cycle pretty flat. What I mean is that 1/20 AM readings are all pretty much within meter variance of 20%. Here is more info on the Depot.

I think I understand, thank you!

I would check any off readings with a handheld glucometer if you can. Did you verify the 164 at +23 with a handheld meter? It seems a bit out of place. Sometimes the libre can give slightly off readings. Please also remember that the Libre reads interstitial glucose which differs slightly from a blood glucose reading.

I didn't; this is my second Libre since diagnosis because I'm fairly certain he won't tolerate the testing. I do have the supplies as backup, though, so if I get a really weird number I'll try to start getting comfortable with double-checking.

This will get answered with time, data and experience. Xander is very newly diagnosed and therefore you'll still trying to establish his trends and patterns. This will take some time. Be patient with yourself. You will soon learn how he responds to insulin and carb sensitive and all the other stuff we have in the stickies located at the top of this board.

I'm glad that it wasn't a huge deal to have skipped a dose. I felt so badly after his numbers had been getting so much better than they were and knew that they'd take a hit, but when I had no idea what might happen next it felt too risky. At least so far, his numbers have gone up but they haven't been hitting those 400+s like they were (yet) so that feels like a victory.

I wouldn't call it an advanced technique but I would say that until you have more confidence, its a scary concept. Here is a link to Myths Debunked which helps explain WHY we should shoo

Thank you so much for this one! The added "Don't Shoot a Dropping Number" post in the replies in particular is SO helpful. What they describe is exactly what happened (he was dropping, but suddenly rose very rapidly instead) and makes me feel a lot more comfortable with the idea that more than likely the number won't keep dropping dangerously (unless I started too low to begin with, obviously). It was just not being aware what was coming next that made me hesitate. Now I know what will likely happen and it feels less scary, at least with numbers over 175 lol

In the meantime, keep asking questions. Even if you think you know the answer, ask away!! If you're hesitant, just post here

Thank you so much for your response, it was very helpful!

 

[Angela & Cleo]

Thank you so much for your response, it was very helpful!

You're very welcome

I'm glad that it wasn't a huge deal to have skipped a dose.

Its all part of the learning process. We've all skipped because we weren't sure what is happening or what will happen. Now you have another piece of data

 

[SmallestSparrow]

Hi Brianna
I understand you’re not quite able yet to confirm Libre low numbers and it’s ok. Here are some other things you might try:

first check the patient is a rule in medicine (i.e. don’t rely on just a monitor or lab test). Next, the Libre can read falsely low if exposed to extremes of hot or cold. Cats are unlikely to sit in a fridge but have been known to sleep on a heating vent or butt to a fireplace. If he’s toasting the libre move him and see if the number changes. Next Libres read low if there is pressure in the area of the sensor. If he’s laying on it flip him over. If he’s got his t shirt twisted around or it seems tight, loosen/remove it. Maybe some of the inexplicable/scary lows were Libre error.

keep up the good work!

 

[Brianna & Xander]

Hi Brianna
I understand you’re not quite able yet to confirm Libre low numbers and it’s ok. Here are some other things you might try:

first check the patient is a rule in medicine (i.e. don’t rely on just a monitor or lab test). Next, the Libre can read falsely low if exposed to extremes of hot or cold. Cats are unlikely to sit in a fridge but have been known to sleep on a heating vent or butt to a fireplace. If he’s toasting the libre move him and see if the number changes. Next Libres read low if there is pressure in the area of the sensor. If he’s laying on it flip him over. If he’s got his t shirt twisted around or it seems tight, loosen/remove it. Maybe some of the inexplicable/scary lows were Libre error.

keep up the good work!

That's great to know about things that could be affecting the Libre, thank you! I'll definitely look out for those.