3/5 Tom AM 226, no shot, +13 206 still no shot.. thoughts?

[Ilkka and Tom]

Hi folks, This is kind of unusual so I will crosspost from Lantus, in case anyone is watching (Pamela, Sheila, Vicky etc) this morning.

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Ok - I have an incredibly busy morning -- workers at the house etc -- took his bg and it was much lower than expected based on other preshots, 226, especially considering I could expect bouncing from yesterday... On a hunch I delayed the shot -- I was going to give only 1.25u anyway -- took the bg again 30 or 45 minutes later, and it was dropping, 206. Still no shot.


I have no problem **at all** shooting full dose -- whatever full dose is, since he is now only into his sixth day of insulin -- into a low yellow or blue number, but he is so recently out of remission and yesterday's drop was noteworthy enough that I am not sure right now. I have the syringe loaded but I think I will wait another half hour.

Thoughts?

Ilkka

 

[Marcy & Klinger (GA)]

Re: 3/5 Tom AMPS 226, no shot, +13 206 still no shot.. thoug

The 1.25 is a reduction from 2u's, right?
Will you be around to do some spot checks? If it were me, I would shoot the 1.25. I would hate to lose momentum and drain the shed.

 

[Ilkka and Tom]

Re: 3/5 Tom AMPS 226, no shot, +13 206 still no shot.. thoug

The 1.25 is a reduction from 2u's, right?
Will you be around to do some spot checks? If it were me, I would shoot the 1.25. I would hate to lose momentum and drain the shed.

Marci - yes -- I know how you feel and I also hate to lose an advantage gained. I am checking him momentarily.. it is really only at +13 now -- I miscalculated the PS time from last night. If it is not falling anymore, he gets his 1.25, at least.

Ilkka

 

[Sheila & Beau GA & Jeddie GA]

Re: 3/5 Tom AMPS 226, no shot, +13 206 still no shot.. thoug

Wondering what you decided to do. Agree that you don't want to lose the momentum/empty shed, but if he is still dropping, it would be good to reduce the dose even more - say 1u?

ETA: what was his starting lev dose in '09? I see he was at 1.6u when you started the SS and rapidly went OTJ after that. Could this be a repeat where doses will be falling every few days?

 

[Ilkka and Tom]

Re: 3/5 Tom AMPS 226, no shot, +13 206 still no shot.. thoug

Wondering what you decided to do. Agree that you don't want to lose the momentum/empty shed, but if he is still dropping, it would be good to reduce the dose even more - say 1u?

ETA: what was his starting lev dose in '09? I see he was at 1.6u when you started the SS and rapidly went OTJ after that. Could this be a repeat where doses will be falling every few days?

Sheila,

I ended up shooting 1.5u at +14 to a ~271. Eeek. I will monitor him as I can.. And before I saw your post I gave a lot of thought to exactly what you suggested -- 1u -- because of the reasons you suggest.. past history with him, etc. I wish I had read you before making the decision, might have swayed me. 1.5u is a more, well, assertive dose and it may be too much. Because of the way I ratcheted up to 2, it is hard to tell what dose might have been the right dose on the way there. Partly I am perhaps wanting the shed back (doesn't work like that, I know...) ; as I said in a reply over on Lantus, though, I don't recommend rapid raises in general. (You can read it here: http://www.felinediabetes.com/FDMB/viewtopic.php?f=9&t=38218&p=403713#p403713.)

you're right... Tom was on 1.6 from where the old ss starts. He had been up to 2 or 2.25 early on and I would be thrilled to see a similar pattern emerge of step-downs, although I am not simply assuming that they can happen. But I am comforted, not made anxious, by what happened yesterday because it shows that on not a supermassive dose, he can go low and not bounce way the heck up as a result.

Ilkka

 

[pamela and tigger]

Re: 3/5 Tom AMPS 226, no shot, +13 206 still no shot.. thoug

Just curious, did you feed him at that 206 this morning?

I am sure you know this, but it is suggested not to feed when you are stalling a shot since you don't want to be shooting into a food spike, i.e., a 'false number'. This food spike could wear off about the time the shot kicks in and then, well, you are shooting a lower, or true number.

When you are stalling you might want to check every 30 minutes to catch the rise instead of every hour.

At least that is how I understand it being explained by jojo and others in the past. Also in the lantus stickes.

So anyway, having said that it will be interesting to see how the rest of the day went.

You might still see a bounce from that 33 later, or not. We'll see.

 

[Ilkka and Tom]

Re: 3/5 Tom AMPS 226, no shot, +13 206 still no shot.. thoug

Just curious, did you feed him at that 206 this morning?

I am sure you know this, but it is suggested not to feed when you are stalling a shot since you don't want to be shooting into a food spike, i.e., a 'false number'. This food spike could wear off about the time the shot kicks in and then, well, you are shooting a lower, or true number.

When you are stalling you might want to check every 30 minutes to catch the rise instead of every hour.

At least that is how I understand it being explained by jojo and others in the past. Also in the lantus stickes.

So anyway, having said that it will be interesting to see how the rest of the day went.

You might still see a bounce from that 33 later, or not. We'll see.

Pamela,

Good point... Yes I did feed him and, that said, I think JoJo is a wizard and she is right about the principle.-- However in this instance it was not quite the same scenario -- I was not holding off the shot entirely because of the dose question, or because it was too low to shoot (in which case shooting a food spike i.e. artificially high number could be risky in a couple of ways), but because I wanted to see how long the bg would float at those levels without a shot, or whether for some reason it would fall regardless. I am sure the 271 PS which was a couple of hours after the AM reading factored in a food lift, but that is okay. I was only willing to give up so much of his shed for this info and more specifically I wanted to be 100% sure that, food or not, the bg would not fall by itself (very very unlikely, of course).

If you have a moment, glance at his chart today -- the ~184 +6 in the PM cycle lasted to +11. I did not get an AM number, though I gave him the shot on schedule. A +1 or +2 -- before the new dose kicks in -- would be interesting (but not enough to hold back his meal).

Ilkka

 

[pamela and tigger]

Re: 3/5 Tom AMPS 226, no shot, +13 206 still no shot.. thoug

Pamela,

Good point... Yes I did feed him and, that said, I think JoJo is a wizard and she is right about the principle.-- However in this instance it was not quite the same scenario -- I was not holding off the shot entirely because of the dose question, or because it was too low to shoot (in which case shooting a food spike i.e. artificially high number could be risky in a couple of ways), but because I wanted to see how long the bg would float at those levels without a shot, or whether for some reason it would fall regardless. I am sure the 271 PS which was a couple of hours after the AM reading factored in a food lift, but that is okay. I was only willing to give up so much of his shed for this info and more specifically I wanted to be 100% sure that, food or not, the bg would not fall by itself (very very unlikely, of course).

If you have a moment, glance at his chart today -- the ~184 +6 in the PM cycle lasted to +11. I did not get an AM number, though I gave him the shot on schedule. A +1 or +2 -- before the new dose kicks in -- would be interesting (but not enough to hold back his meal).

Ilkka

Oh okay, for a minute there I had a slight heart attack with no preshot value but then understood you had done a +11 and so we can 'assume' the preshot at +12 was 186 or higher. But what a drop he does after that.

The 344 could have been a bounce (probably) but also could have partially been from the HC food fed earlier in the day.

Just observations, nothing you don't already know. When do you take him back to the vet for a recheck?