Blackie - Can use some dose advice or sliding scale advice

[Ele & Blackie (GA)]

I am hoping that you will all take a look at the spreadsheet and tell me what you think. I thought the 3.2 was too much, so went back to 3.0 and have had high numbers since. I tried to adjust dose based on numbers, but that didn't work either. Part of the problem is that Blackie's bg's may be fluctuating because of some other health issue instead of the insulin dose. We take him in for an ultrasound on Friday, the u/a culture from last week was negative.

If you use a sliding scale, could you please share it with me? I know it may be different than what we need because of our dose, but it would help me create my own. Or if you think I should stick to a dose, please tell me that too.

Blackie seems to feel fine, no changes in his behavior. I really don't like him being in the 300's all day, especially with his CRF.

Thanks for your support.

 

[Joanna & Bix (GA)]

Overall, it looks to me like you have gotten scared of shooting a full dose at lower PSs. When I look at Blackie's history, it seems like he really did best back in the day when you were fearless and more afraid of undershooting than overshooting. (I was the same way with Bix, so I say this in sympathy!!!)

Blackie did really well IMO on a fixed dose soon after you arrived here (it was scary-high of course at first, but you lowered it quickly and continued with good #s), and if there were a sliding scale at that time, I think it would be to *raise* the dose if you saw a higher PS, rather than *lower* it due to a lower PS.

I totally get reducing the dose when you get a good PS, I did the same thing with Bix (and always got high #s in consequence). Whenever I look at his SS though, what jumps out at me is that whenever you have a good PS it looks like you are lowering the dose for safety, and then the good results are lost.

In your shoes, I think I would try shooting more insulin and being hawklike to be sure he isn't going low. As long as nadirs are not approaching 50 and PSs are not below 150, I think there is room for more insulin. Personally it puzzles me that his dose is so much higher than it used to be, but my *guess* would be that he may need more insulin to get him to stay consistently in good #s, and if he can get there, you may find he goes back to a dose reduction path (but only based on #s starting to get on the low side, should that happen.)

Caveats: 1) I have not studied his #s at length, this is just my general take on things, 2) you know his patterns a lot better than I do, 3) I've been wrong a lot lately it seems like

My best advice I think would be to go back and look at what you were doing when he was in good #s consistently and see if you are doing things differently now. It may be that he has health issues that weren't there before and it's just not the same picture, but I hold out hope that if you got him there once, you can do it again. I think the infections are a vicious cycle - yes, they cause higher #s, but at the same time being in higher #s leaves more glucose around to cause trouble, so while it would be great if his #s would come down when infections clear up, it also seems to me you may need to take it from the other direction - force the #s to stay down and see if that aids in preventing more infections. Just guessing on that part, I don't know for sure that higher BGs can lead to infection, but it seems logical to me.

 

[Sarah and Buzz]

I don't have any dosing advice but I wanted to say I'm sorry things aren't looking better with Blackie's #s. I know how hard you have been working and how frustrating it must be. Sending good thoughts your way.

 

[Ele & Blackie (GA)]

Thank you both for your support. Joanna, you are right, I used to be fearless. It's these higher doses of insulin that scare me. I've been afraid he would drop drastically, but now I think that's an unreasonable fear. So I'm going to regain my fearlessness! This morning and tonight I shot 3.2. And I'll raise it again if I have to. I am going to make a determined effort to get his numbers down and not be afraid of steep drops. In the past Blackie always told me what was too much by giving me a low ps. I think I've raised my definition of what a low ps is, so I need to readjust it downward and know that Blackie will be okay. We almost always have someone here to spot check, so I shouldn't be so worried.

If anyone else has any feedback, I welcome it. Even if you don't think you're experienced enough, it will help me just to get other's viewpoint. Sometimes I'm too close to see what others might see.

 

[Donna & Buddha]

The first month or so of Blackie's spreadsheet looks like a little slice of heaven. What was life like in the time before the spreadsheet? Were the numbers as good? Is Blackie eating the same food?

It must be discouraging when his numbers were so good and it didn't require a lot of insulin to hold him there, and now to have higher numbers requiring more insulin. But that's what it is. And you are investigating possible reasons, with a culture last week and with the ultrasound on Friday.

Not sure what else to check. Is the insulin getting old? Are you still using a stash of the old PZI? I know the shelf life is supposed to be so many years, but that assumes that it was stored properly for all that time.

You know Blackie can do those good numbers. I'd stick your systematic, go slow approach. What you got isn't horrible (from my perspective!) Just a couple more days and maybe you'll know more.

 

[Alice and Tabby]

Just sending good thoughts your way as you know Tabby and I aren't doing very well. Not the two to get advice from. I hope things improve for you.

 

[Sarah and Buzz]

I think you hit the nail on the head, Ele, when you said that someone is almost always around to monitor. I mean, this isn't your first rodeo. You know how to test, you don't have problems getting Blackie to sit still or anything else that would cause testing to be difficult. You know how to feed and which type of food to feed when. You know how PZI acts in terms of when nadir is etc (although I know Blackie does throw you some curveballs) and how sharp of a drop/zoom he typically gets. Obviously you don't want to be shooting on dangerously low #s or anything, but I think you can definitely handle whatever he throws your way. I know you hate those high numbers, and I think you are way more frustrated with high numbers than you are afraid of low ones.

:RAHCAT