?? charlie's been sick, new vet, antibiotic and new dose help

charliesmom1

charliesmom1

Member Since 2019
Charlie was not well over the weekend so I took him to a new vet since my last one was sort of clueless with his diabetes. He was very lethargic and not wanting to eat much. This has happened in the past but passes pretty quickly. She said he was dehydrated and gave him fluids. Also gave him an injection for nausea as well as an antibiotic injection. She took blood and ran a bunch of tests including fructosamine. Finally got the results back today and said his fructosamine number indicates it is being managed "fairly" but close to "poorly" whatever that means. His wbc count was very high so she prescribed Veraflox and said to give it to him for 10-15 days which seems as long time since the bottle says 7 days. I asked if this med will affect his glucose and she said it shouldn't. Moving forward she wants to me do a curve this week so she can have more information before changing his Lantus dose. My question is do I let her manage this moving forward and abandon the SLGS protocol I have been doing? I did not receive a copy of his labs but plan to call and ask for that, I forgot when I picked up his meds earlier today. BTW, he is feeling much better and acting more like himself.
 
I would like to help but Im not feeling to welll, so I'll try and get back to you tomorrow.

If you use the ? Prefix and are a bit more specific in the title with your question you may get some more input in the meantime.
 
charliesmom1 said:
My question is do I let her manage this moving forward and abandon the SLGS protocol I have been doing?
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That's really your choice. How are you feeling so far about everything done here?

Judging from your SS, it looks like you're getting places with Charlie though :) He seems like a big bouncer but getting blues and yellows is nice.

I think, if you're feeling up to it, trying TR could be an option since you do test enough IMO.

Do you know what the antibiotic injection was?

Fructosamine tests aren't that great if you're already testing. I only really see value in it if someone isn't able to test their pet and that's the only baseline test they can do. So in the future, I might politely opt out of that test to save you the money. Your SS would've been able to tell your vet that he's being managed "poorly"/"fairly".

Otherwise, have you been testing ketones? Did the vet test for that too? When a cat is lethargic and in high numbers, we're mostly concerned about DKA.
 
Crista & Ming said:
That's really your choice. How are you feeling so far about everything done here?

Judging from your SS, it looks like you're getting places with Charlie though :) He seems like a big bouncer but getting blues and yellows is nice.

I think, if you're feeling up to it, trying TR could be an option since you do test enough IMO.

Do you know what the antibiotic injection was?

Fructosamine tests aren't that great if you're already testing. I only really see value in it if someone isn't able to test their pet and that's the only baseline test they can do. So in the future, I might politely opt out of that test to save you the money. Your SS would've been able to tell your vet that he's being managed "poorly"/"fairly".

Otherwise, have you been testing ketones? Did the vet test for that too? When a cat is lethargic and in high numbers, we're mostly concerned about DKA.
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I don't know how I feel. I was feeling pretty confident before going to the vet, but she sort of made me feel like he should be regulated by now or something so there must be a reason he is insulin resistant as she says. She was not happy that he has lost weight since his diagnosis in May. He hasn't lost any weight in the past month at least, but she was quizzing me on what he is eating and am I sure he is eating it? I was like Yes! I guess I thought it was normal to lose weight maybe until he is regulated, or at least not gain any back until he is. I showed her his spreadsheet which she glanced at and then said she was ordering a fructosamine so she could see what he's been doing. I too felt that info was right in front of her with his spreadsheet.

I have been testing for Ketones and did the day I brought him to the vet. I don't know if she tested for that, but took urine and told me it had glucose. Well yes he is an unregulated diabetic cat. The injections given were Cerenia and Convenia.

Are there vets that will let you manage it, but be there if you need them? I got the impression from her that she will work to get him regulated and hopefully off of insulin at some point. She is very direct and basically said if I am not willing to commit to this then she isn't the right vet for me! I think I have shown I am pretty committed since he was diagnosed.
 
charliesmom1 said:
he sort of made me feel like he should be regulated by now or something so there must be a reason he is insulin resistant as she says.
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From my own observations working at a vet hospital... I feel like vets go too fast or too slow. Or a combination, if that makes any sense. We had a cat go on insulin and the freestyle libre was put on (takes readings continuously). After 2 days, the vet increased the dose by 1. Then of course, the numbers shot down and the cat bounced. Luckily, the vet decreased the dose again. And the numbers continued to be high and the client was frustrated but vet told the client to hold the dose.

Am I saying what they're doing is wrong? Not exactly. I think they're doing the best given the tools and information and knowledge they have. Some vet's opinion on what's regulated is higher in the 150s to 200s. I told my vet, my cat was hanging out in the 150s and she said that's great! Of course, my opinion was different.

In the end, you are Charlie's guardian and advocate and should do what you think is best for him and what is within your power.

As for the weight issues, lethargy, and decrease appetite, I wonder if other members may chime in. That's concerning of course. Have you tried different foods/flavours? How is Charlie feeling now?

And I vaguely remember someone talking about Covenia and how it should be given with precautions? I can't verify that what I'm remembering is fact!
 
That’s good you are testing for ketones. I would keep doing that daily while he is unwell and has an infection.

Testing as you are doing will give much more information than a fructosamine test IMHO. I would not waste any more money on future fructosamine tests when you are testing yourself.

I don’t think he is insulin resistant. He just needs more insulin. I’m not sure how much your new vet knows about FD, if she had to order a fructosamine test instead of just looking at the SS.

How is Charlie feeling now ? Is he eating? Is he still lethargic?
 
Crista & Ming said:
From my own observations working at a vet hospital... I feel like vets go too fast or too slow. Or a combination, if that makes any sense. We had a cat go on insulin and the freestyle libre was put on (takes readings continuously). After 2 days, the vet increased the dose by 1. Then of course, the numbers shot down and the cat bounced. Luckily, the vet decreased the dose again. And the numbers continued to be high and the client was frustrated but vet told the client to hold the dose.

Am I saying what they're doing is wrong? Not exactly. I think they're doing the best given the tools and information and knowledge they have. Some vet's opinion on what's regulated is higher in the 150s to 200s. I told my vet, my cat was hanging out in the 150s and she said that's great! Of course, my opinion was different.

In the end, you are Charlie's guardian and advocate and should do what you think is best for him and what is within your power.

As for the weight issues, lethargy, and decrease appetite, I wonder if other members may chime in. That's concerning of course. Have you tried different foods/flavours? How is Charlie feeling now?

And I vaguely remember someone talking about Covenia and how it should be given with precautions? I can't verify that what I'm remembering is fact!
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Crista & Ming said:
From my own observations working at a vet hospital... I feel like vets go too fast or too slow. Or a combination, if that makes any sense. We had a cat go on insulin and the freestyle libre was put on (takes readings continuously). After 2 days, the vet increased the dose by 1. Then of course, the numbers shot down and the cat bounced. Luckily, the vet decreased the dose again. And the numbers continued to be high and the client was frustrated but vet told the client to hold the dose.

Am I saying what they're doing is wrong? Not exactly. I think they're doing the best given the tools and information and knowledge they have. Some vet's opinion on what's regulated is higher in the 150s to 200s. I told my vet, my cat was hanging out in the 150s and she said that's great! Of course, my opinion was different.

In the end, you are Charlie's guardian and advocate and should do what you think is best for him and what is within your power.

As for the weight issues, lethargy, and decrease appetite, I wonder if other members may chime in. That's concerning of course. Have you tried different foods/flavours? How is Charlie feeling now?

And I vaguely remember someone talking about Covenia and how it should be given with precautions? I can't verify that what I'm remembering is fact!
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That's what I am afraid she will try to do as well. One day with a 12 hour curve may or may not be representative of Charlies pattern, especially since he is a big bouncer. I also agree on higher numbers being what they consider regulated. I still hold out hope that Charlie can get into remission.

It is very weird about his decreased appetite and lethargy. It just happens randomly and he always bounces back within the day. He does this swallowing behavior which I thought was mucus or something but that's what he does when he's nauseous according to the vet. Charlie likes the fancy feast pates and I give him a variety of flavors. He is definitely a grazer and does not eat much at a time. Charlie seems to be feeling good now, eating and acting well.

I was not given an explanation for the antibiotic injection they day I brought him in. She had no results to indicate an infection but she did mention he might have pancreatitis.
 
Bron and Sheba (GA) said:
That’s good you are testing for ketones. I would keep doing that daily while he is unwell and has an infection.

Testing as you are doing will give much more information than a fructosamine test IMHO. I would not waste any more money on future fructosamine tests when you are testing yourself.

I don’t think he is insulin resistant. He just needs more insulin. I’m not sure how much your new vet knows about FD, if she had to order a fructosamine test instead of just looking at the SS.

How is Charlie feeling now ? Is he eating? Is he still lethargic?
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Yeah I am really torn about whether to stay with this vet or not. She seemed to know about diabetes and claims to have experience treating it but then again totally disregarded my spreadsheet. I think I will get his lab results. Also do the curve she wants and see what she wants to do with his dose.

He is doing well. He is eating and no longer lethargic. That's also why Im questioning giving him this new oral antibiotic for 10-15 days as she prescribed, but she said WBC is high so I suppose I should follow through and hope he has no side effects.
 
I find my relationship with the vet one of the hardest things about Mowgli’s diagnosis. It’s tough because sometimes they aren’t supportive of active involvement from the caregivers. It can be frustrating. I think ultimately it’s really up to you if you want to follow your vet rather than the board. No matter what you choose everyone here will support you In whatever way we can!

Maybe wait to make a decision about sticking with your vet or not until you do your curve... see what advice she offers ...it could be in line with what you’re already doing. That would be great!

I agree with Crista and Bron. I don’t think anyone who looked at your SS would think that Charlie is insulin resistant. But I agree too that he may benefit from a dose increase.

RE: the anti-biotics: I personally would probably finish the treatment just in case. Infection, lack of appetite, and not enough insulin are the recipe for DKA. Even though he’s been feeling and acting more energetic lately, you know he has slightly elevated BG and he has been lethargic with less appetite recently, so I’d say it wouldn’t hurt to just finish the round.

I wonder if your vet is right and Charlie is nauseous... that could explain the lack of appetite. Some members here use slippery elm bark for feline nausea but I personally don’t know which brand they use or where they source it.

I hope you figure things out with your vet and that Charlie gets back to 100% soon :) :bighug:
 
Interesting about the WBC. There’s certainly something going on that may need to be investigated further.

As for nausea, if they’re nauseas, they won’t feel like eating. And the nausea could be from a variety of reasons. How are his stools? I wonder if he’s got some GI issues too.

If she suspects pancreatitis, did you do bloodwork to look for that? Specfpl or snapfpl?

You might want to try anti-nausea medication long term if possible and see how Charlie does. Medications like cerenia and/or ondansetron.

If he has pancreatitis, the treatment is as follows: fluid therapy, anti-nausea medication, and pain management. In some instances, anti-inflammatory treatments like antibiotics or steroids (which should probably be avoided of course). And of course, food!!
 
charliesmom1 said:
I don't know how I feel. I was feeling pretty confident before going to the vet, but she sort of made me feel like he should be regulated by now or something so there must be a reason he is insulin resistant as she says.
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FWIW I really believe every cat is different and your vet should probably know that too! Regulation takes different amounts of time for different individuals even if they’re feline.

Mowgli still isn’t fully regulated and we are going on 6 months. Please don’t get discouraged. You’re doing so well with Charlie :)
 
Ahhh….the old problem with the vet!! Do you listen to them or not? Always a tough one!!

But I will say that the people here have more real life experience dealing with this disease than the vast majority of vets.

Once I got here, China never went back to a vet for her diabetes. I chose to listen to the people here who live and breathe FD 24/7/365 over a vet that may have had a few hours of "formal" education in school.

When China needed other things like dentals and treatment for a nasty URI, I took her in and would just start the visit with "She's on X units of Lantus and her blood glucose runs between Y and Z" and that was pretty much the end of the conversation. If the vet did feel the need to give me some "advice", I'd smile, nod my head and say "I'll think about that".....and then come right back here.

Luckily, she had given me my script for Lantus early on and that's when I found Marks Marine in Canada ….they don't require a yearly script like pharmacies in the US do so anytime I needed refills, I just called them and they sent them!
 
Wow. Lots of good advise and opinions. Great condo. Wishing you well on your decision.

I will say this, there is a certain amount of comfort to come here. Almost always there is someone that can give their advise no matter what time of day. A lot of times we know what to do, but it is reaffirming when someone supports you.
 
Crista & Ming said:
Interesting about the WBC. There’s certainly something going on that may need to be investigated further.

As for nausea, if they’re nauseas, they won’t feel like eating. And the nausea could be from a variety of reasons. How are his stools? I wonder if he’s got some GI issues too.

If she suspects pancreatitis, did you do bloodwork to look for that? Specfpl or snapfpl?

You might want to try anti-nausea medication long term if possible and see how Charlie does. Medications like cerenia and/or ondansetron.

If he has pancreatitis, the treatment is as follows: fluid therapy, anti-nausea medication, and pain management. In some instances, anti-inflammatory treatments like antibiotics or steroids (which should probably be avoided of course). And of course, food!!
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I think nausea is the reason for his random lethargy and not eating because when he sits with me when he feels like that, he is doing the mouth smacking and swallowing. I have 3 other cats so have no way of knowing how his stool looks.

As far as I know she did not specifically test for pancreatitis but I will get the lab results tomorrow. It was something she said in passing, like maybe its pancreatitis. Her explanation today for the high WBC was that diabetic cats get inflammation and infections.
 
AmandaE said:
I find my relationship with the vet one of the hardest things about Mowgli’s diagnosis. It’s tough because sometimes they aren’t supportive of active involvement from the caregivers. It can be frustrating. I think ultimately it’s really up to you if you want to follow your vet rather than the board. No matter what you choose everyone here will support you In whatever way we can!

Maybe wait to make a decision about sticking with your vet or not until you do your curve... see what advice she offers ...it could be in line with what you’re already doing. That would be great!

I agree with Crista and Bron. I don’t think anyone who looked at your SS would think that Charlie is insulin resistant. But I agree too that he may benefit from a dose increase.

RE: the anti-biotics: I personally would probably finish the treatment just in case. Infection, lack of appetite, and not enough insulin are the recipe for DKA. Even though he’s been feeling and acting more energetic lately, you know he has slightly elevated BG and he has been lethargic with less appetite recently, so I’d say it wouldn’t hurt to just finish the round.

I wonder if your vet is right and Charlie is nauseous... that could explain the lack of appetite. Some members here use slippery elm bark for feline nausea but I personally don’t know which brand they use or where they source it.

I hope you figure things out with your vet and that Charlie gets back to 100% soon :) :bighug:
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Im thinking thats a good idea. I will give her a curve and see what she says. I have not consistently gotten 14 cycles at this dose but I know he has been at 1.25 for awhile because of that! Im hestitant to change right now because I leave in a week for 5 days and don't want there to be any issues for pet sitter especially since charlie really can go low and then bounce.

I agree and will do the antibiotics for the next 9 days until I leave.

Thanks for the slippery elm bark tip, I will look into it.
 
AmandaE said:
FWIW I really believe every cat is different and your vet should probably know that too! Regulation takes different amounts of time for different individuals even if they’re feline.

Mowgli still isn’t fully regulated and we are going on 6 months. Please don’t get discouraged. You’re doing so well with Charlie :)
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Thank you for the encouragement. I really appreciate this board!
 
charliesmom1 said:
Yeah I am really torn about whether to stay with this vet or not. She seemed to know about diabetes and claims to have experience treating it but then again totally disregarded my spreadsheet. I think I will get his lab results. Also do the curve she wants and see what she wants to do with his dose.

He is doing well. He is eating and no longer lethargic. That's also why Im questioning giving him this new oral antibiotic for 10-15 days as she prescribed, but she said WBC is high so I suppose I should follow through and hope he has no side effects.
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I would continue the antibiotic because if the WCC if high, there is most likely an infection /inflammation going on and that needs to be treated. As was mentioned above we don't want DKA in the picture and infections in FD cats need to be treated.

FD cats that are not regulated are often a bit dehydrated....Sheba was.......and I used to give her extra fluids every day with her meals to combat it. Dehydration can cause lethargy so try and add some warm fluids to the food if Charlie will allow it.. just a tablespoon is fine or start off with less if necessary.
I would never ignore lethargy.
As far as dosing advice goes....I would vote for the people on this forum as they live it 24/7 and really understand FD. But it is your decision and no one will judge you when you decide either way.
 
Chris & China (GA) said:
Ahhh….the old problem with the vet!! Do you listen to them or not? Always a tough one!!

But I will say that the people here have more real life experience dealing with this disease than the vast majority of vets.

Once I got here, China never went back to a vet for her diabetes. I chose to listen to the people here who live and breathe FD 24/7/365 over a vet that may have had a few hours of "formal" education in school.

When China needed other things like dentals and treatment for a nasty URI, I took her in and would just start the visit with "She's on X units of Lantus and her blood glucose runs between Y and Z" and that was pretty much the end of the conversation. If the vet did feel the need to give me some "advice", I'd smile, nod my head and say "I'll think about that".....and then come right back here.

Luckily, she had given me my script for Lantus early on and that's when I found Marks Marine in Canada ….they don't require a yearly script like pharmacies in the US do so anytime I needed refills, I just called them and they sent them!
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I tend to agree with that and have felt comfortable following the advice here. This vet kind of threw me and really acted like he is not being managed well at all and just kind of took over. I do have plenty of Lantus and refills from the first vet who didn't really care about charlie! So I am not tied to this vet for now. I just think it's hard to say to a vet that I will manage this on my own and have their backing of that decision. Maybe I need to keep looking for a vet who is on board with that.
 
Bron and Sheba (GA) said:
I would continue the antibiotic because if the WCC if high, there is most likely an infection /inflammation going on and that needs to be treated. As was mentioned above we don't want DKA in the picture and infections in FD cats need to be treated.

FD cats that are not regulated are often a bit dehydrated....Sheba was.......and I used to give her extra fluids every day with her meals to combat it. Dehydration can cause lethargy so try and add some warm fluids to the food if Charlie will allow it.. just a tablespoon is fine or start off with less if necessary.
I would never ignore lethargy.
As far as dosing advice goes....I would vote for the people on this forum as they live it 24/7 and really understand FD. But it is your decision and no one will judge you when you decide either way.
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I will do the antibiotic so thanks for the advice there. Yep I already add water to his fancy feast, thats the way he likes it! Also will just look at me if he has licked it dry and wants it refreshed with water!

Honestly I feel more comfortable going with this board and what I have been doing. Just wasn't sure how to approach that with a vet because sometimes charlie will need one like this past weekend. And of course they have to prescribe the Lantus, but as I mentioned I have plenty of that.
 
charliesmom1 said:
I will do the antibiotic so thanks for the advice there. Yep I already add water to his fancy feast, thats the way he likes it! Also will just look at me if he has licked it dry and wants it refreshed with water!

Honestly I feel more comfortable going with this board and what I have been doing. Just wasn't sure how to approach that with a vet because sometimes charlie will need one like this past weekend. And of course they have to prescribe the Lantus, but as I mentioned I have plenty of that.
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Well done on giving extra fluids!
I used to check Sheba gums most mornings to see they were slippery and not tacky, and lift up her scruff to see if it slipped back quickly. If I was concerned I upped the fluids.

If you need to go to the vet again (which I'm sure you will over time) just do as @Chris & China (GA) suggested. Just state that you are giving x amount of insulin and the BGs are between X and Y.......and the problem today is ............
That is what I did as well and my vet was quite ok with that.......in fact he used to ask me questions about FD and what I thought about this and that. I also used to give him new research to read which sometimes pops up here.. I was lucky I had a vet who was interested in educating himself more about FD.
 
LizzieInTexas said:
http://www.felinediabetes.com/FDMB/threads/vet-interview-screening-topics-check-list.156663/
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Thank you!
Bron and Sheba (GA) said:
Well done on giving extra fluids!
I used to check Sheba gums most mornings to see they were slippery and not tacky, and lift up her scruff to see if it slipped back quickly. If I was concerned I upped the fluids.

If you need to go to the vet again (which I'm sure you will over time) just do as @Chris & China (GA) suggested. Just state that you are giving x amount of insulin and the BGs are between X and Y.......and the problem today is ............
That is what I did as well and my vet was quite ok with that.......in fact he used to ask me questions about FD and what I thought about this and that. I also used to give him new research to read which sometimes pops up here.. I was lucky I had a vet who was interested in educating himself more about FD.
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Thank you for the tip to check his gums, I will do that! Also I can try that approach next time he goes to the vet. I might be on the hunt for a new one though since my current one will fire me when I don't follow her protocol!
 
charliesmom1 said:
14 cycles at this dose but I know he has been at 1.25 for awhile because of that! Im hestitant to change right now because I leave in a week for 5 days and don't want there to be any issues for pet sitter especially since charlie really can go low and then bounce
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You can change the dose now see how he does and then drop it back to a vacation dose for the pet sitter.
We usually recommend a vacation dose that's on the line, to make it easier for the pet sitter to shoot consistently. Then when you come back you go straight back to the original dose.

So if it were me, run the curve, as per slgs it's due any how, and take the dose up if that's what the numbers indicate.
 
Hi, I was wondering where you and Charlie went. With the dry food in the picture I believe TR is not an option.

If it is pancreatititis, which is painful, some pain meds, anti-naseau meds really do help get them over the flare quicker. Jones had cerenia and buprenorphine that we used.

The slippery elm bark helps with GI upset.

I agree with Gill - I think Charlie needs a bump up. Then you can drop back while you are gone.

The fructosomine test is like an average of the sugar levels over time. So the fact it is not saying uncontrolled is a win in my opinion considering Charlie is extremely bouncy. You are seeing more consistent blues and yellows in the those nadirs - I would also take that as a win.
 
Tracey&Jones (GA) said:
Hi, I was wondering where you and Charlie went. With the dry food in the picture I believe TR is not an option.

If it is pancreatititis, which is painful, some pain meds, anti-naseau meds really do help get them over the flare quicker. Jones had cerenia and buprenorphine that we used.

The slippery elm bark helps with GI upset.

I agree with Gill - I think Charlie needs a bump up. Then you can drop back while you are gone.

The fructosomine test is like an average of the sugar levels over time. So the fact it is not saying uncontrolled is a win in my opinion considering Charlie is extremely bouncy. You are seeing more consistent blues and yellows in the those nadirs - I would also take that as a win.
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Yes I will be sticking with SLGS. I got his test results today and his WBC is very high, 32.4 with a reference range of 3.5-16 so definitely needs the antibiotic she prescribed. Blood glucose was 208. She ran a PrecisionPSL which came back normal which states acute pancreatitis is unlikely. Two other numbers that were very high that she was not concerned about were Neutrophils and Eosinophils.

I totally agree that fructosamine is a worthless test and one I won't be allowing them to do anymore! I am not able to do a curve today, should I just go ahead and bump him to 1.5 starting tonight and see how he does? We leave next Tuesday evening.
 
Tracey&Jones (GA) said:
I believe he has room in his numbers to do the bump up without the curve. You may want to get one before you go though.
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I agree, I caught his usual low number time today and it was still in 200's. I will wait to increase tomorrow morning so I can watch him better. So as long as he does not go below 90 on this dose, I stay with it through next tuesday and then bump back down to 1.25 for pet sitter, correct? Also will do a curve before I go.
 
charliesmom1 said:
I agree, I caught his usual low number time today and it was still in 200's. I will wait to increase tomorrow morning so I can watch him better. So as long as he does not go below 90 on this dose, I stay with it through next tuesday and then bump back down to 1.25 for pet sitter, correct? Also will do a curve before I go.
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That is the plan for now....unless Charlie tells us otherwise. You can always post to confirm that vacation dose before you go.
 
charliesmom1 said:
Thanks as always! I will post again if we run into trouble or need dosing help!
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Help Tracey! So Charlie is always full of surprises! PMPS was 222 and +2 is 146. Seems to me I shouldn't be increasing to 1.5 tomorrow right?

I will stay up and get another reading tonight to make sure he doesn't go too low.
 
charliesmom1 said:
Help Tracey! So Charlie is always full of surprises! PMPS was 222 and +2 is 146. Seems to me I shouldn't be increasing to 1.5 tomorrow right?

I will stay up and get another reading tonight to make sure he doesn't go too low.
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Sorry I missed the action last night! He likes those drops early then bouncing right back up to the sky and beyond to the moon! Per SLGS you would hold.
    • If nadirs are more than 150 mg/dl (8.3 mmol/L), increase the dose by 0.25 unit
    • If nadirs are between 90 (5 mmol/L) and 149 mg/dl (8.2 mmol/L), maintain the same dose
    • If nadirs are below 90 mg/dl (5mmol/L), decrease the dose by 0.25 unit

I still think you still have room to go up to 1.5u. Maybe some one else will drop in and have some advice to help out.
 
Tracey&Jones (GA) said:
Sorry I missed the action last night! He likes those drops early then bouncing right back up to the sky and beyond to the moon! Per SLGS you would hold.
    • If nadirs are more than 150 mg/dl (8.3 mmol/L), increase the dose by 0.25 unit
    • If nadirs are between 90 (5 mmol/L) and 149 mg/dl (8.2 mmol/L), maintain the same dose
    • If nadirs are below 90 mg/dl (5mmol/L), decrease the dose by 0.25 unit

I still think you still have room to go up to 1.5u. Maybe some one else will drop in and have some advice to help out.
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I am going to hold and ride out this latest bounce. Not sure what I should do for vacation but will ask for advice after seeing how the next days go with him.
 
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