Miskitty
Member Since 2024
Hi all--hoping for some group wisdom!
I have a recently diagnosed, ~18-year old female with comorbid CKD. Managing diabetes with U100 Lantus glargine; however, due to the kidney disease, she eats Royal Canin Renal Support dry and canned mixture (which is not low-carb).
We've been using glargine for 3 weeks and I track her BG with a Freestyle Libre (human-calibrated) monitor. Overall, we've had fairly good results, but there's also been a lot of bouncing.
Her PMPS numbers have dropped progressively lower over the last handful of days, despite maintaining relatively high numbers throughout the bulk of the day. The last two days in particular have been marked by a sudden, large BG drop between +8 and +11. Tonight, for example, her PMPS reading dropped from 310 at +8 to 150 at +11 to 86 at +12 (pre-meal and pre-shot). It isn't the first time I've seen a precipitous drop at the end of one of the 12-hour cycles--either at night before PM meal or early morning before AM meal. I fed her her evening meal tonight and skipped her shot. I've continued to monitor and 2 hours post-meal, at the time of writing this, she is at 137 and climbing gradually without insulin on board.
My first question is: what is the minimum PMPS value that you'd consider safe to shoot? Yesterday, for example, her BG was tightly controlled and stayed between 120 and 200 all day. Very positive result, but her PMPS was ~170 and I was unclear about whether or not to shoot. I was concerned about skipping the dose and having her skyrocket overnight, but definitely didn't want to cause an overnight hypo episode, given how unpredictably and drastically she's dropped in the past.
My second question is: if her pre-shot readings remain within this "ideal" range, would it be prudent to feed and then wait a certain period of time before deciding to shoot? If so, what is the maximum amount of time to wait before just abandoning that dose altogether? I would assume that we're getting these nice values because her insulin therapy is working as it's meant to, but I'm confused about whether I should still shoot if she isn't technically "high?"
For additional context, she had one hypo episode last week. The evening before the episode, her PMPS was 369. +4, it made a steep drop to 180 and by AMPS she was down to 71 and vomiting (though there was nothing to throw up). She ate her full morning meal but 2 hours later had dropped to 40 with no morning insulin on board and I had to give her some Karo to bring her back up.
In addition to my questions above, can anyone offer any insights into why the curves might be looking like this? Steady numbers for the first 3/4 of a 12-hour cycle and then major drops toward the end, as the previous insulin dose should theoretically be wearing off?
Many thanks
I have a recently diagnosed, ~18-year old female with comorbid CKD. Managing diabetes with U100 Lantus glargine; however, due to the kidney disease, she eats Royal Canin Renal Support dry and canned mixture (which is not low-carb).
We've been using glargine for 3 weeks and I track her BG with a Freestyle Libre (human-calibrated) monitor. Overall, we've had fairly good results, but there's also been a lot of bouncing.
Her PMPS numbers have dropped progressively lower over the last handful of days, despite maintaining relatively high numbers throughout the bulk of the day. The last two days in particular have been marked by a sudden, large BG drop between +8 and +11. Tonight, for example, her PMPS reading dropped from 310 at +8 to 150 at +11 to 86 at +12 (pre-meal and pre-shot). It isn't the first time I've seen a precipitous drop at the end of one of the 12-hour cycles--either at night before PM meal or early morning before AM meal. I fed her her evening meal tonight and skipped her shot. I've continued to monitor and 2 hours post-meal, at the time of writing this, she is at 137 and climbing gradually without insulin on board.
My first question is: what is the minimum PMPS value that you'd consider safe to shoot? Yesterday, for example, her BG was tightly controlled and stayed between 120 and 200 all day. Very positive result, but her PMPS was ~170 and I was unclear about whether or not to shoot. I was concerned about skipping the dose and having her skyrocket overnight, but definitely didn't want to cause an overnight hypo episode, given how unpredictably and drastically she's dropped in the past.
My second question is: if her pre-shot readings remain within this "ideal" range, would it be prudent to feed and then wait a certain period of time before deciding to shoot? If so, what is the maximum amount of time to wait before just abandoning that dose altogether? I would assume that we're getting these nice values because her insulin therapy is working as it's meant to, but I'm confused about whether I should still shoot if she isn't technically "high?"
For additional context, she had one hypo episode last week. The evening before the episode, her PMPS was 369. +4, it made a steep drop to 180 and by AMPS she was down to 71 and vomiting (though there was nothing to throw up). She ate her full morning meal but 2 hours later had dropped to 40 with no morning insulin on board and I had to give her some Karo to bring her back up.
In addition to my questions above, can anyone offer any insights into why the curves might be looking like this? Steady numbers for the first 3/4 of a 12-hour cycle and then major drops toward the end, as the previous insulin dose should theoretically be wearing off?
Many thanks
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