10/10 Chino|AMPS=261|+9=91|PMPIDS=167|+2=407|+4=384

[Adrian and Chino]

Yesterday...

I love Levemir. He went down to 53 yesterday, bounced for 1 cycle, then went down to 91 today! But I think I screwed up his PM shot and I'm not sure how bad the outcome will be. There was a little lump at the injection site (like you'd have on your arm after a PPD) so I think it was an intradermal injection. I'm not sure if this makes it only half effective, or if it will be entirely ineffective But I'm prepared to give a small dose of R if the +4 is higher than the +2.

PMPIDS = PMPIntraDermalShot

 

[Chubba (GA)]

Hmm ... I often see a very small lump for a second or two after giving Gizmo's shot. I assumed this was normal. I guess I better relook at my shot technique... again!

ETA - Chino is sure looking good lately! Hope the shot is effective tonight.

 

[Adrian and Chino]

I've been Googling it and have found some interesting articles... It has been too long since I've had to cite one properly, so I'm copying and pasting and linking:

J Diabetes Sci Technol. 2014 May; 8(3): 453–457.
Intradermal Insulin Delivery
A Promising Future for Diabetes Management
Michael Hultström, MD, PhD, Niclas Roxhed, PhD, and Lina Nordquist, PhD

Subcutaneous injections are known to cause a substantial variability in dose delivered,11 and intradermal delivery may achieve a more controlled distribution with lower variability. Recently the use of active microneedle delivery was shown to be effective in conscious, chronically diabetic animals,35 which is important since earlier studies were mostly in short time diabetes without diabetes induced skin changes,36 and some studies have been performed on anaesthetized rats with minimal physiological registration.34

This study was done w/insulin lispro...

Comparison between Intradermal and Subcutaneous Insulin Delivery Via a Novel Biphasic Model of Insulin Absorption
Year: 2010
Abstract Number: 525-P
Author: MARC D. BRETON

Both the first and the second phases of insulin appearance were significantly faster with intradermal insulin delivery (30 vs. 60 min. to first peak, p=0.005, and 68 vs. 102 min. to second peak, p=0.018). The intradermal route was, as expected, also significantly faster overall.

I haven't been able to find anything yet that discusses the pharmacokinetics of a long-acting insulin injected intradermally.

 

[Adrian and Chino]

I often see a very small lump for a second or two

If it's gone after a second or two, it's probably nothing to worry about. If you've ever had the kind of TB test where the tuberculin PPD is injected just under the skin, that's the kind of lump I felt tonight.

 

[Doodles & Karen]

Doodles would get the bump from time to time so I'd just avoid that area for a while and move his shot placement. Sometimes they develop scar tissue. Looking good Chino.

 

[Adrian and Chino]

+2 = 407. This is higher than he bounced from yesterday's 53.

 

[Beenie (GA)]

Sorry he bounced so high. Hopeful Chino will clear this bounce quickly.