2/1 Dakota AMPS 396 Bombed again - pm+6-42

[Squeaky and KT (GA)]

Good Morning World! Welcome to our home! Last Condo

1/31
PMPS 347 (food in it)
+3 - 192
+6.5 - 42
+7 - 68
+7.5 - 82
+8 - 122
+11 - 311

2/1
AMPS 396 (food in this)
+2 - 238

Sweet Doc jumped off the bridge again last night handing me a 42 at +6.5. I ended up syringing a bit of Karo water as he didn't want to eat much. Took me over an hour to get a 3oz can of food in him. He was groggy this time. I raised his dose up to 1.75u's yesterday morning, 1.75u last night and he does this. I'm dropping back to f1.5 and see if we can stabilize him again. He's kind of subdued this morning and is dropping off that AMPS too fast. He was out and about all day yesterday seemed to be feeling well, eyes sparkly and lots of life. Guess that 1.75u's is too much....he has eaten OK this morning, not overly well so I'll wake him up and offer food shortly.

EDIT TO ADD this paragraph: Another change the last 1.5 weeks or so - he's no longer spilling glucose in his urine. He's tested 'sweet' for well over a year if not the whole time. The test strips remain clean - decided one bottle must be bad when it quit showing so got another new one - same result...no or minimal glucose in urine.

We FINALLY got new potassium meds for hubby yesterday....one of the kinds he's been taking is heavy acid orange flavored effervescent which upsets his stomach badly. This one has much less acid and is unflavored. We haven't had a chance to use it yet but I imagine we'll be using it later today - he's slowly 'melting' in his recliner.

Looks like we'll have another dog to help find a new home for - one of our elderly neighbors just got a young lab/heeler mix about 3 months ago, pup is about a year old now. Owner was just dx'd with Stage 4 cancer that has spread everywhere earlier this week, he's already very sick - is opting for no treatment. I'm hoping someone else here in the area will take 'JJ', he's a large dog, we will NOT be adopting him, we have no room at all. He's a sweet dog but has been allowed to run the neighborhood and isn't going to like a fence unless he has companion dogs.

Dad has been doing as OK as his parkinson's/alzheimer's brain can be. He's back to begging to come home tearing my mother's heart apart every day. I SO wish there was something we could do to help but there's not. His body is healthy and will go on for a long time, it's just his mind and memory that's going. Everyone's thoughts and prayers sure are appreciated.

I'm tagging some of the ones from our last 'bomb' condo...I never did get any feedback on the actual thoughts from the last bomb cycle which is in that linked last condo above. @Libby and Lucy @Sienne and Gabby @Jill & Alex (GA) @Marje and Gracie

Thoughts and prayers continue for Laura and Skinky as they continue to fight - Skinks is one strong little kitty! We dance with Tonya's new kitty too!

HUGS to all that visit today! Let's DANCE!

 

[Marje and Gracie]

I wouldn't have dropped the dose back. Here's where we get into some of the stuff Libby was talking about that was very important.

Here's just what I'm seeing and would have done:

• always get a +2 test no matter how high he is
• if the +2 is much lower than the PS, I'd start feeding the curve with the appropriate carbs depending on what the BG is and how fast he is coming down; I'm not sure when you fed him last night but I would have definitely been on alert at that +3 and tested again before +6; in fact, I would have tested at +4 to see how fast he was currently dropping
• when you see he is dropping fast, anticipate the low...the nadir....and feed to bring him up before he gets there; the goal is to keep him above 40 so he doesn't earn a reduction.
• don't reduce at the first 40 especially when he's clearing and dropping fast; I've found that with Gracie, and some other cats, a new dose might not cause NDW but might cause them to get into lower numbers but then they flatten out a little bit more; you are experienced enough to have patience through that.

If it were me, I'd take his dose back up to 1.75u and give him a chance. Try to incorporate the methods above to anticipate the lows and not let him get to the 40s.

I'll have to look at the last bomb cycle because I thought we did address it but perhaps I'm wrong.

eta: I looked at it and I thought we did give some responses to why he bombed. Libby was really explicit. Can you let me know, please, what we can do to further explain or help? I want to be sure we address your questions.

Here are Libby's very detailed comments:

• Continue shooting BID but work up the dosing scale more aggressively than you have been (I know you have some limitations about night testing). Try not to hold doses too long because that can let any resistance take a firmer hold.
• Let the green happen. I can't tell what you've been using as a reduction number, but I would try either lowering that threshhold a bit or (maybe even better in his case) waiting until he gets there more than once before reducing.
• Don't be afraid to shoot lower, if you get an opportunity. You know he's going to bounce, so if you get a good preshot go ahead and shoot it, within reason. You don't really need to wait to see if he's rising because you know he will. Worst case you might have to feed a little extra early in the cycle if the bounce doesn't start right away.
• I think you would be fine to shoot at +10 or +11 occasionally if you know he's starting a bounce and if you're available to monitor.
• Consider the use of R at the beginning of a bounce (instead of shooting Lev at +10 or +11), only if you are available to monitor. Given your PM limitations, this might be a safer option because you can decide when to use the R based on what your availability is to monitor. Because we know he can get green if he wants to, I would be careful to only use R at the very beginning of a bounce. You don't want to give it at a time when he might be thinking about dropping on his own.
• If he gets to a higher dose again, or if you're at the vet drawing blood anyway, maybe consider IAA and/or acro testing.

Bolding is mine.

 

[Squeaky and KT (GA)]

@Marje and Gracie - thank you for your advice! I was actually trying to figure out where my thinking was wrong from the other crash condo. Yes suggestions were given for ongoing but I need to understand what happened then and why...the 2 things I really need to understand are these:

* Was it my splitting that dose that caused it? If so, why? I suspect since it happened again last night without that split, it was coincidence <- is THAT wrong?

The +7 shooting - giving half dose early in day then other half of AM dose at +7 - my thinking was giving the other half of the AM dose was technically treated by his body as a reduction of 1u. Is that thinking wrong? If so, why?

The only way I can learn this is to understand where my thinking is wrong and where to adjust it.

Again, I appreciate any feedback!!! I agree, I should have stayed with it for another hour last night instead of waiting 3 hours. I knew that PMPS had food in it so it should fall 2 hours later...I didn't MEAN for it to have food in it but I forgot to pick up their bowls after Bebo ate.

 

[Marje and Gracie]

@Squeaky and KT

Lyresa: I'm sorry I didn't get back here yesterday but it was Mike's birthday and we had his party with a Super Bowl party. I"m on my way out now but will be back this evening to explain. Thank you for your patience.

 

[carfurby (GA)]

I hope you can find a good dose for Dakota. Sending prayers for your DH and DF.

 

[Marje and Gracie]

Thanks, again, for yoru patience.

Here's what I'm seeing:

Normally in four cycles, you were giving f2u x 4 or a little more than 8u. However, on 1/23 and 1/24, he got 9 units. I'm not sure if your fat on the 2u would equal a whole unit.....most likely not. So...going into 1/23, his numbers were coming down and you had the depot from f2u to which you added another unit at +7. Those two shots were overlapping ....the 1u at +7 probably kicked in as the f2u was starting to wane. And then four hours later while that dose was still working, you gave another 1u, and when it kicked in around +2, numbers came down.

I know it seems like you gave the same amount of insulin then (1u @ +7 and 1u @ PMPS = 2u) but the 1u at +7 was an early shot. So you didn't give a half dose earlier in the day and then at +7. You gave a full dose at AMPS on 1/23 and then an early shot at +7 and another shot at PMPS. I think the overlap from the shots came back to bite you.

The drop last night is purely coincidental. The two situations were totally different.

The 347 last night could possibly have been the insulin pooping out early instead of a bounce starting. So when he onset after the PM shot, he came back down.

Does all that make sense?

 

[Squeaky and KT (GA)]

@Marje and Gracie - Thank you for taking time to write all this but HELP again please - see below instead:

........Normally in four cycles, you were giving f2u x 4 or a little more than 8u. However, on 1/23 and 1/24, he got 9 units. I'm not sure if your fat on the 2u would equal a whole unit.....most likely not.

Not 9 units - only 6.25 units:
1/23 AM he got f2.0 (not quite 2.25) (total f2.0)
1/23 PM he got 1u at +10 (total f3.0)
1/23 PM he got f1u at +12 (total 4.25 by using 2 'fat' as a quarter unit) 33 happened HERE
1/24 AM he got 1u at AMPS (total 5.25)
1/24 PM he got 1u at +7 (total 6.25)
1/24 PM - no shot so total was 6.25u's rather than what he normally would have had at 8.25

So...going into 1/23, his numbers were coming down and you had the depot from f2u to which you added another unit at +7.

1/24 I only gave 1u at AMPS, not 2u's - this was HALF his normal morning dose. The +7 shot didn't happen until 1/24 AFTER the 33 bomb the previous night

....I know it seems like you gave the same amount of insulin then (1u @ +7 and 1u @ PMPS = 2u) but the 1u at +7 was an early shot.

1/24 I didn't shoot anything at usual PMPS, I only shot the remaining 1u from AM dose at +7. The 33 bomb had already happened the previous night, didn't want to go there again.

So as you see, I'm STILL confused as he had less insulin, not more. Here's my 2 questions from above again:

* Was it my splitting that dose that caused that 33? If so, why?

* The +7 shooting - giving half dose early in day then other half of AM dose at +7 - my thinking was giving the other half of the AM dose was technically treated by his body as a reduction of 1u. Is that thinking wrong? If so, why?

My brain's tired...

 

[Marje and Gracie]

Ok...I need a remedial math lesson evidently. I have no idea where I got 9u. I do think I got confused with the shot @+7 on 1/24 and then an entry of 1u in the PMPS column. I see now that you enter your shot times and it says "4:00". Sorry....

So...going into 1/23, his numbers were coming down and you had the depot from f2u to which you added another unit at +7.

This is correct. I was referring to the f2u you gave him on 1/23 at AMPS; not on 1/24. Where I made the error above was that the early unit was at +10, not +7. So it should have read:

So...going into 1/23, his numbers were coming down and you had the depot from f2u to which you added another unit at +10 by shooting early.

....I know it seems like you gave the same amount of insulin then (1u @ +7 and 1u @ PMPS = 2u) but the 1u at +7 was an early shot.

Again, I got my +7 mixed up with my +10. It should have read:

....I know it seems like you gave the same amount of insulin then (1u @ +10 and 1u @ PMPS = 2u) but the 1u at +10 was an early shot.

So let me see if I can make sense of it for you using the correct times, which I had in my mind but typed incorrectly. Sorry....not much sleep Sunday night.

Going into 1/23, his numbers were coming down initially that day and you had the depot from f2u and then you shot early at +10 with 1u. I don't know if you fed him something at +9 that numbers started up or if his lev just nadired at +9. At any rate, those two shots were overlapping ....the 1u at +10 probably kicked in as the f2u was starting to wane (if you figure he got 12 hours duration from the a.m. shot). And then four hours later while the early dose was onsetting, you gave another 1u, and when it kicked in around +4/+5, numbers came down. So the early shot at +10 was bringing numbers down when he onset at +4/+5. I often see that with lev, when Gracie onsets, her numbers can really drop. I understand that you were trying to stop him from going up anymore when you shot early with one unit at +10. That would have been a great time to give a bit of R because the R has no depot and would have been wearing off just before the PMPS shot was onsetting. You probably would have seen him coming back down but maybe not so radically....hard to say.

I know it seems like you gave the same amount of insulin then (1u @ +10 and 1u @ PMPS = 2u) but the 1u at +10 was an early shot. So you didn't give a half dose earlier in the day and then at +10. You gave a full dose at AMPS on 1/23 and then an early shot at +10 and another shot at PMPS. I think the overlap from the shots came back to bite you. Can we say 100% for certain that splitting the dose caused the 33? Well....I can't because there's never any way to know 100% in a situation like this but it sure looks like it to me.

The +7 shooting - giving half dose early in day then other half of AM dose at +7 - my thinking was giving the other half of the AM dose was technically treated by his body as a reduction of 1u. Is that thinking wrong? If so, why?

I can't say it's wrong but what I see is that you gave a BCS at AMPS but then you gave a really early shot. I just think with all the changes to his shot times and doses, the depot was really messed up. I wish I could tell you why what happened on 1/24 happened unequivocally. But quite often a BCS doesn't affect the current cycle but does affect subsequent ones. If you shot early before you got to the subsequent one, that might account for why he stayed in good numbers longer.

Better sense now that I'm rested and had coffee?

 

[Squeaky and KT (GA)]

@Marje and Gracie - THANK YOU! I'll reread it repeatedly until it all sinks in....

I DO know something 'broke' at the same time this all happened - just look at his beautiful (for him) spreadsheet since then! We've NEVER seen this many blues and GREENS GREENS GREENS - ever! WOOT WOOT!

THANKS AGAIN!

 

[Marje and Gracie]

You're welcome. I'm sorry the first post was so crazy. Geez....I looked and looked at his SS before I wrote that; I was, admittedly pretty tired and I should have waited but you were already patient.

I think he's in green because of the dose ....shooting consistently and shooting greens above 50 will help. Not reducing until he goes below 40 once or between 40-50 three times will also help (whichever comes first).