1/12 Boo Radley - Could use some advice

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Jessica & Boo Radley

Jessica & Boo Radley

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I've been MIA for a few....I just had 5...yes 5 back to back 12 hour shifts! The beauty is now I'm off until Sunday and sure could use some advice on getting Boo back on track.

As a recap, we started Boo on Prozinc not even 2 weeks ago (having been on Lantus since Aug 2011). He was just coming home from a DKA episode, so we decided to supplement Regular with the Prozinc as needed to ensure he stayed in reasonable numbers while recuperating. We nursed him at home for about 5 days (after vet) until I would say he was back to his "old self". During the "sick" time, his numbers looked GREAT with the dose and Regular supplementation....but now that he's back...... WOW, we are either sky high, or too low. I have to admit...I don't get Prozinc and should could use some "this is what i would do" thoughts.

Logically, I accept that these crazy highs are responses from the crazy lows...which is ultimately too much insulin. I've been experimenting to see if it's the Prozinc, if it's the Regular, if it's the dosing schedule.....and just can't seem to come up with the right solution. If I give just Prozinc, he seems to stay high, if I give tiny, tiny bits of R to supplement (0.25), he doesn't come down enough, if I give him just a bit more (0.5), he drops way too much.

I guess the other thing is that my initial data is "sick kitty" data...and my data now is crazy because of all of the experimenting.....I'm just wondering if anyone sees anything that would make a light bulb go off. I know I need to "start over" somewhere AND STICK WITH IT FOR A FEW.....I'm just not sure where (and also of course gun-shy of another DKA from being too high for too long....)
 
Not sure if I can help, but a few things I see.

He seems to run lower at night? Even when you eliminated the R at night, he runs low. That might be worth figuring out why - less movement, less food, more food, too much insulin at pmps?

And the lows overnight can cause your bounces at amps. ( not a definitive, but possibility). If you can get the cycle a little higher at night, you might have a lower amps to work with.

The .25 dose of R seemed to work better than the .5? It may have caused some of the bouncing.

Your challenge, Jessica, is that you have more than the usual variables to consider. We usually are dealing with making changes with the food or the dose. You have a second insulin thrown in there.

I have zero experience working with R and with PZI plus R. But if I were you, I would change one variable for a few cycles and see what you get. then experiment with another variable.
 
Sue - thanks for the insight. I completely agree that he drops lower at night and then of course....my AMPS are higher. Foods the same, dose is less, he is definitely less active, but this should cause higher vs. lower numbers. He seems to run a longer cycle in the a.m., so you maybe onto something with shooting later than +12 at night...interesting.....

I'm also not at all opposed to dropping the R all together. I wholeheartedly admit it has been a crutch since the DKA - I can affect his BS almost immediately, which I think was the right choice for recovery....but now, not so sure. I do agree that the 0.25 gives much safer numbers and much less of a drop. If I did drop the R all together, would you start lower on Prozinc alone to see what happens or would you stick with the 2.4 where we're at and see what happens?
 
I would stick with the 2.4, so you only have one variable at a time. Otherwise you won't know where the changes came from. Drop the R, stay with the dose for a couple days, and collect the data?
 
I wasn't necessarily advocating dropping the R but maybe going back to .25 when and if needed during the daytime cycle. (I have a healthy respect for DKA)

As long as you can monitor, I would stay with your dose. It may be too high. If so, we would expect a high curve, an inverse curve or a sudden drop. Then you'll know to reduce. Sometimes we encourage the new PZI user who may have started too high to do an experiment with a few cycles at a low dose, but with a DKA history, it is much riskier.
 
Carl and Sue - thank you for the continued suggestions! I think my conundrum is I agree with both of you! I am unquestionably humbled by a second DKA (I am a nurse, I OCD test, I hydrate, hydrate, hydrate, I Chem 10 test weekly for not only ketones and glucose, but protein, blood, lueks....I feed correctly....), but also recognize the numbers have gotten KOOKY and that it's nearly impossible to pinpoint exactly why because of the variables.

So...I think I will take a mish-mash of the suggestions and STICK TO IT, through the weekend to get an idea of any consistent patterns.

Thanks for thinking this through with me!
 
without question, the DKA is the biggest concern. Bob was DKA, and he almost died. DKA can kill. High numbers can be corrected. That was why I opted for "try it for a couple days and collect data". Just a couple days, to see if anything changes. If the numbers don't change much by removing the R, for instance, then go back to the R and try changing one other thing at a time until the puzzle is solved.

No matter where you go, we're here to try to help you figure things out, Jessica.

Two, three, heck, eighteen heads are better than one!
 
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