Dexter 08/21 - Very high but flat insulin curve overall.

[DexterMeowgan]

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Hey! I apologize we have been busy and not been making much progress. We tried a reduction to 1.5U since we believe he would've dropped under 90 on 08/17 and kept it until 08/19 AMPS when the numbers suddenly skyrocketed to 400+ AMPS.

We immediately realized the reduction was a failure, and pushed back up to 1.75U. I have gotten my partner to realize we need to change doses quicker than a week if the numbers are trending in the wrong direction which she actually did this on her own! I'm proud of her for that.

He is not responding as expected, though, although not back at 400. He had essentially no response to the insulin yesterday other than a flat curve, and the numbers trend higher today overall. I have a few questions.

1.) I feel this is not a bounce, would that be accurate?

2.) The insulin has been refrigerated since April every day but is reaching 4 months old. Would you recommend replacing it due to these higher flat curves or continuing use?

3.) Is this something we should be worried about ketones with the higher flat curve now, or when does that become an issue?

 

[Tim & Pookey]

Bumping you up before bed here. I got 6 months out of our vial, but if something looks off about it you could replace it to rule it out. Ketones better safe than sorry, if it’s easy enough to get a blood or urine test for them I’d say that would be worth it.

 

[Mary & Jude]

@Marje and Gracie, can you please help Dexter and Joseph?

 

[Marje and Gracie]

Previous post

Hey! I apologize we have been busy and not been making much progress. We tried a reduction to 1.5U since we believe he would've dropped under 90 on 08/17 and kept it until 08/19 AMPS when the numbers suddenly skyrocketed to 400+ AMPS.

We immediately realized the reduction was a failure, and pushed back up to 1.75U. I have gotten my partner to realize we need to change doses quicker than a week if the numbers are trending in the wrong direction which she actually did this on her own! I'm proud of her for that.

He is not responding as expected, though, although not back at 400. He had essentially no response to the insulin yesterday other than a flat curve, and the numbers trend higher today overall. I have a few questions.

1.) I feel this is not a bounce, would that be accurate?

2.) The insulin has been refrigerated since April every day but is reaching 4 months old. Would you recommend replacing it due to these higher flat curves or continuing use?

3.) Is this something we should be worried about ketones with the higher flat curve now, or when does that become an issue?

He needs more insulin. Under TR, you would raise the dose after every six cycles if you are not seeing at least blue nadirs and you are testing plenty. He had a couple of blues on this dose before you shot 1.5u for a couple cycles. Not sure why you decreased?

He looks to me like he has some glucose toxicity so I’d increase his dose to 2u unless he miraculously drops into blue tonight for a while. Of course, we always need to be concerned about ketones if numbers are high and especially if he’s acting lethargic, not eating, not drinking. I’d be urine testing ketones every day.

The age old issue of whether the insulin has gone over. It’s really, really hard to know. The only way you will is if you buy some new pens or a new vial if that is what you prefer.

Good luck with the increase.

 

[DexterMeowgan]

He needs more insulin. Under TR, you would raise the dose after every six cycles if you are not seeing at least blue nadirs and you are testing plenty. He had a couple of blues on this dose before you shot 1.5u for a couple cycles. Not sure why you decreased?

He looks to me like he has some glucose toxicity so I’d increase his dose to 2u unless he miraculously drops into blue tonight for a while. Of course, we always need to be concerned about ketones if numbers are high and especially if he’s acting lethargic, not eating, not drinking. I’d be urine testing ketones every day.

The age old issue of whether the insulin has gone over. It’s really, really hard to know. The only way you will is if you buy some new pens or a new vial if that is what you prefer.

Good luck with the increase.

We reduced to 1.5U because of how low he dropped (He was at 110ish within 5 hours last week) so fast and we believe at the time if we didn't intervene it'd be below 90.

We quickly realized with a day or so that we reduced too fast, and now he's just experiencing flat curves.

Tonight, we'll be giving him the normal 1.75U on a new vial and if it doesn't make him start dropping like normal we'll increase back to 2 and monitor.

 

[Marje and Gracie]

We reduced to 1.5U because of how low he dropped (He was at 110ish within 5 hours last week) so fast and we believe at the time if we didn't intervene it'd be below 90.

We quickly realized with a day or so that we reduced too fast, and now he's just experiencing flat curves.

Tonight, we'll be giving him the normal 1.75U on a new vial and if it doesn't make him start dropping like normal we'll increase back to 2 and monitor.

You show him in the 300s both times you shot 1.5u on 8/18.

He dropped from 298 on 8/17 to 113 at +5. That’s not fast I’ve seen them drop that much by +2.

It will help you avoid that scenario if you always get a +2. If he’s less than or similar to the PS at +2, he’s likely to have an active cycle or at least come down.

Good luck with the new insulin. I’ve found that, usually, it’s the cat & not the insulin but there’s always an exception.

 

[Mary & Jude]

Good luck with the new vial AND if you decide to take a dose increase.