? 10/20 Jake Urgent Dosing Advice AMPS 77 +1 45 +3 53 +5 43 +7 65 +9 65 +11 58

[Cloe & Jake]

Hello - I’d really appreciate any dosing advice, shot is due in one hour.

Jake has had decreasing insulin requirements and has had multiple dose decreases now, but I also think the new syringes we opened yesterday are inaccurate they seem to be giving about 0.5u extra beyond the zero line. I’m not sure how to dose tonight - I’ve ordered calipers but they won’t arrive for two days. I also have some human insulin syringes I’ve taken from work that are 0.5ml U100 but no half unit marks so I can really only accurately give full units with those syringes.

He needed glucose today when his BGL was 43 as he was very flat and lethargic.

Please let me know what you think

 

[Wendy&Neko]

Sorry I'm too late to help you with your dosing question but that was middle of the night for me. I see you shot half the dose, which should help drain the depot.

To answer the dose question, if you are following TR, your next dose would be 2.75 units. The larger 3.0 unit depot can influence 4-6 cycles after a reduction, and those lows came on your first cycle of a reduction. The depot draining partial dose should help remove that larger depot.

There are a couple complications of course. First, you are using the Freestyle Libre which tends to read lower than a blood glucose meter, and the TR method calls for reductions under 50 on a BG meter. So we don't really know how low he goes until you test those lows with a BG meter. Second complication is that I see you are still feeding some dry? You can't follow TR if feeding some dry.

And third complication is those new syringes. I used BD Ultrafine syringes and found, like you did, that there seemed to be room between the bottom of the zero line and the top of the barrel. Sometimes as much as 1/3 of a unit but it varied by bag of syringes. Neko's last dose was under the zero line, I estimated around 0.25 units. I was using calipers already, so that is how I managed it.

I can think of one way you can do things until your calipers arrive. Take out some of your previous syringes and fill with coloured liquid like pop/juice/tea. Practice twisting the plunger until a drop comes out. Keep practicing until you get consistent size drops. Now load those old syringes with 1 unit of insulin. Twist and produce drops until all the liquid is gone, counting the number of drops. Now do the same thing with your new syringes. Practice until you get the same size drops with the new syringes. Count the drops in 1 unit. If they are the same as the old syringes, all is good. If not and there are more drops in the new syringes, you'll have to load your regular dose and do some math to figure out how many drops need to come out. I can help you with that once you've gone through the experiment.

The link to your previous post, for continuity.

 

[Staci & Ivy]

I hope his depot drains and you can get back on track. Good luck with the syringes and hope the calipers workout beautifully!
Have a safe surf, Jake!

 

[Cloe & Jake]

@Wendy&Neko thanks for your advice - we haven’t seen a bounce despite another low of 41 at +2 and the half dose. AMPS is 83. I’m tempted to give another 1.5u dose. I wonder if these syringes just give a very different dose to the old syringes. I estimate that the 1.5 was actually around 2u but even so I’m surprised he has stayed in the under 110s overnight. Is there any situation where you would fast track dose decreases like this? He has earned 5 dose decreases in the last 11 days and to even be having these numbers despite a hypo and a half dose given, I’m tempted to just try it again for another dose. What do you think?