9/21/Oberon PMPS 383, +5.5 364, ketones 1.2; +6.5 ketones 1.3

Butters & Lyla said:
I still stand by my previous comment: we are going to get him out of that cotton candy machine one way or another. Just a matter of time.
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Not so far... heading up at PMPS. (Maybe still bouncing from last night's small dip?) This is cycle 5 at 4 U. Heading for an increase tomorrow evening, I think.
 
Wendy&Neko said:
Oberon, time to get out of that pink tutu!

Good thing you caught that yellow last night.
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Yep... if we hadn't done the +9 at 4 am we would have missed it completely. Makes me wonder what else we've missed overnight. Now that the school year's started, we'll probably be getting a +9 or +10 on weekdays (my husband gets up at 4), but not weekends.

So now we know he only gets a 0.25 increase tomorrow, not 0.5. Or should I hold this dose just a little longer than 6 cycles now?
 
With nadirs in the 200's you increase by 0.25 units every six cycles. Note that we change the size of increases should Oberon get to 5 units.
 
Wendy&Neko said:
With nadirs in the 200's you increase by 0.25 units every six cycles. Note that we change the size of increases should Oberon get to 5 units.
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Right, I picked up on that from someone else's post yesterday. With luck it won't be an issue, but he seems determined to stay pink...

I've been trying to figure out his dips. I understand the bounce after a dip, but what's causing him to dip in the first place? Pancreas briefly sputtering to life? Glucagon-producing alpha cells taking a nap? Gremlins? I suspect it doesn't really matter practically speaking, but I'm trying to understand more about what's going on under the hood.
 
Could it be the insulin that causes him to dip? The panicky liver comes in right after the lower number that he's not used to, and that's when the bounce sets in?
Gremlins are a way cooler idea, though. Maybe Oberon needs an xray, just to make sure? :p
 
His dips are usually, but not always, within a cycle or two of a dose increase, but after the bounce (usually over 400), he settles right back into the mid 300s. So I'm thinking it's that he's putting out enough glucagon to balance out the insulin, then when he gets a higher dose the glucagon has to play catchup to keep him where he wants to be. In the 300s. (Darn it.)
 
Bedtime test (+5.5) was 364, still high as usual. But he looks just a little off somehow. Nothing I can really pinpoint, and he's eating (though not rushing to the food). I decided to finally dig out the ketone meter I bought but haven't used yet and got an initial reading of 1.2. (He was negative for ketones when he was checked at the vet back in July.) How concerned do I need to be right now? I'm going to go read the stickies about ketones, but advice is welcome.

(To clarify, this is a blood ketone test, not urine test.)
 
Lisa & Oberon said:
I've been trying to figure out his dips. I understand the bounce after a dip, but what's causing him to dip in the first place? Pancreas briefly sputtering to life? Glucagon-producing alpha cells taking a nap? Gremlins? I suspect it doesn't really matter practically speaking, but I'm trying to understand more about what's going on under the hood.
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I have a theory. There is something causing insulin resistance. Note that glucose toxicity from spending time in high numbers in one such type of insulin resistance. The increased insulin temporarily gets over that resistance, and then it figures out what is happening and settles back into play.

Blood ketones of 2.4 or above are a vet visit. I would definitely keep an eye on this and test a little more regularly the next little while. Ketones can escalate quickly, overnight even. If he has some ketones, I might even suggest going to those 0.5 unit increases a little early. You've seen green both times you did 0.5 unit increases, just blues with 0.25 increases.
 
Wendy&Neko said:
I have a theory. There is something causing insulin resistance. Note that glucose toxicity from spending time in high numbers in one such type of insulin resistance. The increased insulin temporarily gets over that resistance, and then it figures out what is happening and settles back into play.

Blood ketones of 2.4 or above are a vet visit. I would definitely keep an eye on this and test a little more regularly the next little while. Ketones can escalate quickly, overnight even. If he has some ketones, I might even suggest going to those 0.5 unit increases a little early. You've seen green both times you did 0.5 unit increases, just blues with 0.25 increases.
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OK, thanks... I was trying to figure out whether this was a vet-right-now kind of thing. I can have my husband check ketones again at +9. (And order more strips... all we have are the 10 that came in the box.)

He's due to get a 0.25 increase tomorrow evening. Do you think I should go ahead and bump him up by 0.5 in the morning?
 
His increase isn't due until tomorrow night. If you only see pink tomorrow, I think you'd be safe going up 0.5 units. And you'll still be on a line. ;)
 
Ketones 1.3 an hour later (+6.5); I'm hoping that's meter variance. Ordered more strips just in case and they'll arrive tomorrow. Bed now...
 
Is he eating well and active? I would definitely keep an eye on those ketones.
Try and get him to eat some extra food and try giving him some extra fluids.
Food helps keep ketones at bay, as does insulin.
 
Bron and Sheba (GA) said:
Is he eating well and active? I would definitely keep an eye on those ketones.
Try and get him to eat some extra food and try giving him some extra fluids.
Food helps keep ketones at bay, as does insulin.
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Eating fine; about as active as usual. Last night he looked just a little wobbly and off somehow. Back legs were kind of knock-kneed, but he wasn't back on his haunches. Better this morning, I think, but he just ate and went to one of his favorite spots under the chair in the living room, so I haven't been able to observe much. I'll follow up in today's thread.
 
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