1/25 Buzz AMPS 82, +14: 62/Please advise

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Sarah and Buzz

Sarah and Buzz

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Worst pet parents of the year, right here. No one else need apply. :oops:

Although I am not the one who draws and administers the insulin normally (I give it maybe one out of every 6 or 7 shots), I still take partial responsibility for this. I posted about air bubbles in the syringe last night; that post is here: viewtopic.php?f=9&t=3896

So for last night's shot we started a new pen of insulin and we got 1.5u with no problem. This morning, her AMPS was 82, which is by FAR the lowest it's been since she came back from the falls. Could be NDW, could be that 1.5u is the correct dose, could be that it's too high and we passed the correct dose because we are too lame to even draw insulin correctly. Time will tell, I suppose. Time and testing.

So for the immediate future, here are my questions:

1. Can we inject some air into the pen each time we draw, to prevent this problem from occurring again? Monique said that some people on the German forum do that so it seems to be possible. I am just worried that for whatever reason, we are going to get this situation after a little bit of use with each pen.

2. I know to wait and retest. I have obviously NOT given her insulin this morning, but I did feed her as normal. She will have a food spike for a couple of hours yet; do I shoot despite that "false" high number or do I wait and not test until about 3 hours post-meal to see that the food has cleared and see if she brings herself down at all? What number should I get to before I shoot? 150? 200?

3. Do I stick with 1.5u when I do shoot? We don't know how low her nadir was last night because we only got a +2.

Thank you, everyone! I'm pretty happy about green but pretty mad that I may have been able to prevent all this red.
 
Re: 1/25 Buzz AMPS 82/Please advise

Sarah & Buzz said:
1. Can we inject some air into the syringe each time we draw, to prevent this problem from occurring again? Monique said that some people on the German forum do that so it seems to be possible. I am just worried that for whatever reason, we are going to get this situation after a little bit of use with each pen.
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DO NOT inject air into the pen. It's fine to withdraw the needle from the pen, and pull in a bit of air. You can flick the syringe with your fingernail to get whatever bubbles there may be to rise to the top (the needle end of the syringe should be pointing to the ceiling), then push the plunger our twist it to remove the air and correctly measure the amount of insulin you need. (You aren't "injecting" air into the syringe -- you are drawing air in.)

2. I know to wait and retest. I have obviously NOT given her insulin this morning, but I did feed her as normal. She will have a food spike for a couple of hours yet; do I shoot despite that "false" high number or do I wait and not test until about 3 hours post-meal to see that the food has cleared and see if she brings herself down at all? What number should I get to before I shoot? 150? 200?
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If you are stalling a shot, you should not feed for just the reason you noted -- the numbers will reflect a food spike and you won't know what number you are really shooting. You stall, wait 15 min. without feeding, and re-test. You repeat this until you see the numbers are either rising or Buzz is surfing. You don't want to shoot a dropping number. I would still test in 15 - 30 min. I'm concerned that the 82 is either an error given Buzz's other numbers or you really, really, really need more spot checks 'cause there's no way to tell where this number came from.

If you stall, you want to try to not shoot a reduced dose. A late shot acts like a dose reduction so if at all possible, you don't want to shoot a reduced dose on top of a delay. It has double the effect on the shed. You do not want to delay for more than 2 hrs (+14 from your last shot) since this is about the time where you will lose any overlap with the previous shot. In addition, another consideration with a delayed shot is that your next shot will need to be 12 hours from when you actually gave your last shot. Alternatively, you can shoot a big chicken sh*t (BCS) dose. This would be a dose reduction. Or, the final possibility is to skip a shot.

3. Do I stick with 1.5u when I do shoot? We don't know how low her nadir was last night because we only got a +2.
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Ideally, you would shoot the 1.5u but that's not always the case. The issue is not with nadir. You will need to to multiple spot checks no matter what. You should be doing a +1 and +2 if you stall and shoot if the number is low. If you can be home to monitor is also a consideration when it comes to the dose.

My concern regarding spot checks is that with this low of a PS, there is always the possibility that there have been other times where Buzz has had green #s and because you haven't been able to get checks, you don't know it this was the case and doses are increased. If there was a mid-cycle low followed by a rebound, all you will see is the high number at pre-shot. (Look at Gabby's SS on 11/2/09 for high PS and a green mid-cycle as an example of what would happen if I hadn't checked -- she would have gotten a dose increase rather than a reduction). It can be amazing how quickly a BG level can change so you can't rely on just one spot check all the time. I know we've been hounding you about spot checks but it's been precisely for this reason.
 
Re: 1/25 Buzz AMPS 82/Please advise

Well, we are approaching the 2 hour mark (two hours after when her AM shot would have been), so I guess I need to test and shoot. Since I already fed her, I don't really feel like I understand what I am supposed to do, but the fault is mine because my brain isn't really working well, not any gaps in your explanation.

When I said "Can we inject some air into the syringe each time we draw", I meant into the PEN, not into the syringe. If we can't do that, how will we prevent this same problem from happening again? I am not going to throw away 3/4 of every pen because no insulin will come out. I'm not saying that I am not doing something wrong, although I have been drawing insulin for 6 months and I'm pretty sure I know what I'm doing, but the question isn't right or wrong; the question is how I prevent this from happening again if I am not supposed to inject air into the pen to balance out the drawing out?

I'm going to go test her and see where she's at and make a decision based on that number.
 
Hi Sarah, I would say shed was full to overflowing.

I think in your case and little historical data you don't shoot unless you can continue to delay and check.
Looks as if Buzz is doing a little surfing.

Am I right in thinking he's bought his own number down after food?

I would suggest definitely getting a +11 (whether that is had you off shot this morning or from when you do shoot), post your number for advice on what the next dose should be. This is a significant drop.
 
kate and lucky said:
Hi Sarah, I would say shed was full to overflowing.

I think in your case and little historical data you don't shoot unless you can continue to delay and check.
Looks as if Buzz is doing a little surfing.

Am I right in thinking he's bought his own number down after food?

I would suggest definitely getting a +11 (whether that is had you off shot this morning or from when you do shoot), post your number for advice on what the next dose should be. This is a significant drop.
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I will be testing again in about 20 minutes, which will be +15 from last night's shot. I am not expecting a big rise in an hour, esp. not with the drop from AMPS to +14, but I think I had better throw all my expectations out the window right about now. ;)

In my mind, the only way that she could have gotten a drop of 20 points between +12 and +14, with a full meal AND no insulin, is if she brought herself down. Since she did go OTJ, we know that her pancreas does in fact work.

I'm not sure what you mean by +11?
 
Whether you shoot insulin this morning or not I would get a test in 11 hours (an hour before you would be due to shoot a dose) The reason for this if you do find that you want help with dosing advice.

As has been said elsewhere today, yes Buzz may be bringing himself down, it's whether he can maintain non-diabetic numbers on an on-going basis. This is why the protocol is to work down the dosing scale to .25,.1u-gives the Pancreas all the help and support it needs.

Spluttering or partially working pancreas can soon be overwhelmed again-does that make sense?
 
Yes, it absolutely makes sense. :) And thanks for the clarification on the +11 test.

I am going to test now, will post the number afterwards.
 
What's her WCR? How is she feeling, acting? Anything unusual, or just herself? I mean, her pancreas may have needed a 10 minute break there or something...and is back working. Looks like it's handling food and maintaining a good bg, you know?

Best-
Michele
 
Definitely surfing and those numbers are essentially the same if you include the 20% leeway with the glucometer.

I'm guessing this would throw you way off schedule and would therefore suggest you skip shot, get what would be your +11 and post for advice.

Lol-Traci and apologies Buzz-not always obvious from the name if kitty is a boy or a girl.
 
Michele and Esse said:
What's her WCR? How is she feeling, acting? Anything unusual, or just herself? I mean, her pancreas may have needed a 10 minute break there or something...and is back working. Looks like it's handling food and maintaining a good bg, you know?

Best-
Michele
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Buzz acts the same whether her BG is at 500 or 30, and that is not an exaggeration. When she was first getting regulated on PZI and her numbers were consistently in the low 100s for the first time in months, she was a bit more playful than she had been, but for the most part, we can't tell anything by her behavior. She certainly isn't acting like she feels BAD, though. She's affectionate and jumps up on the table for her BG check each time as normal.
 
kate and lucky said:
Definitely surfing and those numbers are essentially the same if you include the 20% leeway with the glucometer.

I'm guessing this would throw you way off schedule and would therefore suggest you skip shot, get what would be your +11 and post for advice.

Lol-Traci and apologies Buzz-not always obvious from the name if kitty is a boy or a girl.
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That's okay about the name! :) People do it all the time, and I would too. Buzz is a "male" name to me, and in fact she was named by her previous beans for Buzz Lightyear. We got her and her brother Cricket (for Jiminy Cricket) when they were 2 and didn't want to change their names.

Yes, it would be inconvenient to shoot now, but I will get in another check at around +17 just to see where she is. I don't want to lose this momentum, and if it means shooting in the middle of the night for a few days until we can get her back on track, so be it.

I will definitely post for advice before I shoot, regardless of when that is.

Thank you for your help, everyone! :)
 
I'm liking the story of their names :mrgreen:

Lucky was often referred to as a boy when in fact she was a girl.

Just one thing to bear in mind if you did want to shoot at some point before next shot is due is whether you'll be able to get spot checks in.

Your right you don't want to lose momentum. It may be that you cut by .25u, may need to be more. As the saying goes 'let the numbers be your guide...' :mrgreen:
 
I think that Lucky has a very "girl" face, at least in that picture. Maybe that's because I know she IS a girl? Anyway, she is cute regardless of gender. :) If Buzz were more tortie colored, rather than mostly black with a small amount of brown speckles/splashes, more people would probably know from her photo that she is a girl, as torties are almost always female.

At +16.5, Buzz is at 86. She is on the rise for sure. Now the question becomes: at what number should I shoot, and how much insulin should I give?
 
I'm just off to hit the sack.

Is there any food influence in any of her numbers?

When and how much is going to depend on your ability to spot check I'd say.

I'm erring towards a reduced dose because you still haven't got a huge amount of data-do you have any thoughts?

Slightly OT (off topic) it's so annoying that when you click an ss you either lose the condo temporarily and have to click back and forth or lose it completely and have to relog in-do you find that?
I will go refresh my memory of ss.Brb
 
kate and lucky said:
I'm just off to hit the sack.

Is there any food influence in any of her numbers?

When and how much is going to depend on your ability to spot check I'd say.

I'm erring towards a reduced dose because you still haven't got a huge amount of data-do you have any thoughts?

Slightly OT (off topic) it's so annoying that when you click an ss you either lose the condo temporarily and have to click back and forth or lose it completely and have to relog in-do you find that?
I will go refresh my memory of ss.Brb
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She has had no food since her AMPS, which has now been 5 hours ago.

If I shoot at an earlier time than normal tonight, I will be able to get more spot checks in. My gut instinct is to shoot 1.0u or 1.25, depending on what she is at when I do shoot. Ideally, I would like to shoot at around 7 p.m., which would be at +19.5. I agree with you on the "amount of data" reasoning.

As far as SS, if you right-click on the link it will give you the option to open it in a new window. This will eliminate having to click back and forth, or losing the condo. :) Hope that helps. Sleep well! :)
 
No, I don't think you have enough data to predict this one.

I definitely wouldn't be shooting more than 1u and then only if your going to get sc's through to +6.

Are you sure yu want to consider shooting this late? You should only really move shots up by 15 mins at a time, that's a lot of hours to recoup.

Your basically looking at refilling the shed now, but that's still a low number.

Just went to submit and you'd posted :-D

I'd go for the 1.u erring with caution.
Do you have plenty of strips and HC if you need it?

Brill thanks for the tip on ss-been bugging the hell out of me! :mrgreen:
 
kate and lucky said:
No, I don't think you have enough data to predict this one.

I definitely wouldn't be shooting more than 1u and then only if your going to get sc's through to +6.

Are you sure yu want to consider shooting this late? You should only really move shots up by 15 mins at a time, that's a lot of hours to recoup.

Your basically looking at refilling the shed now, but that's still a low number.

Just went to submit and you'd posted :-D

I'd go for the 1.u erring with caution.
Do you have plenty of strips and HC if you need it?

Brill thanks for the tip on ss-been bugging the hell out of me! :mrgreen:
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I do have strips and HC, and if I shoot at 7 p.m., I can get spot checks through +6 with no problems.

I don't need to recoup those hours, at least not right now. I can leave the AMPS & PMPS at the new times, 7a and 7p, so that's not a concern. Those times will actually work a little better for me in terms of being able to get tests in, at least that is what I am hoping.

So to recap if anyone else jumps in, I think I will give 1u in 2 hours. If anyone thinks otherwise, please advise. Thanks!
 
As long as your happy with that,cool.

Good luck and I shall take a peek tomorrow to see how you fair.

I doubt you need me to say it, but just in case, you have strips, HC, a plan, you know what your doing, your in control :mrgreen:

Ni ni
 
Are you SURE you've been messing up the dosing? Because I tend to think this could be just a plain ole breakthrough. It happens suddenly like that a lot of times with Lantus, when you hit the right dose suddenly everything changes.
 
No, I am not sure. I thought that mostly because the discovery of the pen problem happened at exactly the same time as her breakthrough, and it was so dramatic.

I will post her number in about 15 minutes, and then I would like to shoot 45 minutes after that. I would love any other advice regarding what to shoot before I actually give the shot.

Additionally, they are due for their next meal now, so is it okay to give that along with the shot as I normally would at PMPS? They are on a 3-meal schedule currently, so I will just switch the +6 meal with the PMPS meal.
 
OK, so she is now at 181 at +18.75. I feel like I should stick with 1.5u rather than going back down to 1.0u. As mentioned, I will be able to get spot checks in through +6 tonight, and should be able to do the same tomorrow for AMPS and PMPS.

Thoughts? FWIW, I am more afraid of her staying/going back to high numbers than I am of her going too low. Obviously I don't want to deal with a hypo situation, but I am confident about my ability to handle it if it happens. I have done it before. ;)
 
If you're comfortable with 1.5, then sounds great (that would be my choice too, but I don't want to pressure you). As you said, you have good availability to monitor for the next couple of cycles so we can see what is really going on.

I hope this really is the breakthrough! It sure is a nice string of numbers. :mrgreen:
 
No pressure, just confirmation. :) I really hate to lose all this progress, and don't relish the thought of waiting 3 more cycles to increase when I realize I should have stuck with 1.5u. ;)

I will post #s as the cycle progresses. I'm going to go ahead and shoot and feed before I get hamstrung by 3 hungry kitties.
 
Hi guys, it certainly was quite a day. :)

I feel like this condo has gotten a little confusing, so here are the numbers in black and white:

AMPS: 82, did not shoot
Tested throughout the day, finally shot at +19 when Buzz was 181. This is now the PMPS.
PMPS: 181
+3: 246
+4: 236

I will get in a +5 and +6 (poor little ears) tonight. Thanks for everyone's help. :)
 
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