It's been 7 cycles on this dose so far, and no joy, ie. green. I think maybe the reduction has failed. Can you measure 0.3 units?
Hi, sorry for the delay... I was AWOL yesterday, I guess!
I hope you had a good vacation!
I actually did have a bit of joy today, a green reading at AM +4, which was nice.
I haven't been poking him as much as I do sometimes... I guess we're both taking a bit of a break, so maybe he's had other greens I didn't catch?
More specifically to your question:
I think it's a two-part question,
can I measure 0.3 units, and more of a question for me -
why 0.3 units?
a) I'm not honestly sure if I can measure a 0.3, other than my best guess, like I have been doing?
I purchased calipers to measure small doses with the BD Ultrafine syringes with half unit markings that I use.
I watched the videos, looked at Steve Rapaport's Fine Dosing Visual Guide, read the info from Germany with a chart that can be printed on A4 sized paper (except I haven't figured out how to convert and print that with the el cheapo printer I have), etc.
I just don't see how the metal arms, no matter how accurately they can be spaced, are useful to eyeball a dose of less than 1 millimeter
inside the syringe when you must hold the metal caliper arms up
against the syringe.
I have seen calipers in use and know they are extremely accurate when the metal arms of the calipers can actually touch the item being measured.
I just don't see how they're accurate in this application - I would be happy to document what I am doing with photos and post them for help if I need to - If I'm being a dumb ass, let me know!
b) His BGs dropped below 50 three times on 0.4 units (July 31, Aug 3, Aug 5) - so I reduced to 0.2 units on August 6th.
He then went below 50 twice on 0.2 units (on Aug 7 and 11).
By TR guidelines I should have waited for a third lime green reading on a cycle before reducing from 0.2 units, but his vet called me that afternoon, on August 11th.
I am wondering why you are asking if I can measure 0.3 units.
Wouldn't a return back to 0.2 units be my next step if this reduction has failed?
When his vet called me, she looked at his spreadsheet to date, including the lows of that morning.
She thought I should try dropping the insulin altogether on his skip day, and give 0.2 units on the day he got budesonide.
That's when I asked the question about skipping days here, I got the impression that it's not a great approach.
I elected to just go to 0.10 units on a regular schedule, rather than on/off for now.
I have to check back with her next week when she is back from vacation.
His vet would be happy to see him from 6-12 mmol/L, with or without insulin.
That's essentially blue numbers - which I know is NOT the goal of TR and not what I have been trying to do.
Her biggest concern is his safety, and she wants me to keep the budesonide to keep any possible intestinal cancer under some control, but not to keep pushing his BG levels so low with his insulin.
While she thought I was doing a good job with him, she is concerned that he is going to hypo on me.
SO! That's the story to date.
Looking forward to hearing back from you,
@Wendy&Neko, please, with why 0.3 units is your suggested dose.
Thanks!
Laura (possible dumbass)
Edit to add: August 16 PMPS 137, +3 59
I was going to check him at +2 like I normally do, but he was happy looking out a window, so I waited until +3... nice to see another green. He seemed to feel good today - he was playful this morning, and was bound and determined to put a beating on his brother tonight before supper - I had to give him a time out in the basement to separate them. I will check him again in an hour as I am not sure if he is on the way up or down...
