Dosing Adjustment?

[scienceofcats]

Hi guys; I’ve been noticing Lola’s numbers creep up recently after switching to 0.5 units ProZinc, as she was on 1 unit before and had sugar low enough to make me nervous on 4/2/2018. Anyways, this morning her bG was 13.9 mmol/L (250 mg/dL). I gave her 0.5 units to be safe, but would you guys consider this just normal variation, or do you see a trend? Does 0.5 units still look right for her?

I realize I’ll need to catch her nadir, so will attempt that today. Anyways, if someone could look at her spreadsheet and give advice, that would be great!

 

[Kris & Teasel]

Hi guys; I’ve been noticing Lola’s numbers creep up recently after switching to 0.5 units ProZinc, as she was on 1 unit before and had sugar low enough to make me nervous on 4/2/2018. Anyways, this morning her bG was 13.9 mmol/L (250 mg/dL). I gave her 0.5 units to be safe, but would you guys consider this just normal variation, or do you see a trend? Does 0.5 units still look right for her?

I realize I’ll need to catch her nadir, so will attempt that today. Anyways, if someone could look at her spreadsheet and give advice, that would be great!

You really need to do a full curve on this dose before any changes are made. Pre shot tests are essential to know a dose is safe but middle of cycle numbers are very important in knowing how effective a dose is. If you're off today I strongly recommend a curve. Your last one was a month+ ago.

I know we keep harping on this but it's important to see the whole picture. If this was a jigsaw puzzle you'd only have two edges filled in.

 

[scienceofcats]

I just did a +5, and her bG was 12.2 mmol/L (220 mg/dL), which represents only a 12% drop. On the one hand, it makes me think that 0.5 units is insufficient for her. On the other hand, I remember that brief hypo episode, in which she went from a PMPS of 9.2 mmol/L (166 mg/dL) to a +2 of 4.4 mmol/L (79 mg/dL), which represents a 52% drop on 1 unit. I remember seeing someone say that ~50% drop from PS to nadir is good, so what I’m wondering is if it would be better to do sliding scale and resume maximum 1 unit, or perhaps decide on a good no-shoot number to stick to.

I do understand that I’ll need to do a full curve, although I’m not sure if I’ll be able to do it this weekend. We are in the beginning of a terrible ice storm I’m preparing for, and if we lose power, blood tests are going to be horrible to do - wouldn’t want to do too many of those. Make sense?

Anyways, any advice in the interim is much appreciated.

 

[Kris & Teasel]

I just did a +5, and her bG was 12.2 mmol/L (220 mg/dL), which represents only a 12% drop. On the one hand, it makes me think that 0.5 units is insufficient for her.

Quite likely but you need numbers to know for sure. She could have bounced up to these yellows.

On the other hand, I remember that brief hypo episode, in which she went from a PMPS of 9.2 mmol/L (166 mg/dL) to a +2 of 4.4 mmol/L (79 mg/dL), which represents a 52% drop on 1 unit.

Those greens were the numbers you want. The 4.4 wasn't a hypo. Hypo would be below 2.7.

I remember seeing someone say that ~50% drop from PS to nadir is good,

Yes, true. However, the ideal is a 50% drop from low/mid blues to high dark greens. You could have a 50% drop in reds/pinks. There's no way to get safely to low blues/high dark greens without more mid cycle (including an occasional full curve) data.

so what I’m wondering is if it would be better to do sliding scale and resume maximum 1 unit,

Sliding scale isn't the right thing for you at this time. It's a tool to use when you have a ton of data to work from. You're still in what we'd call the data gathering phase. Had you been able to do a lot more middle of cycle testing or more frequent curves since diagnosis we'd have more to go on.

The next dose to try would be 0.75 u, not 1 u. Half unit changes at this low dose are far too large.

 

[Kris & Teasel]

Apologies if I sound terse. I'm trying to be succinct.

 

[scienceofcats]

Makes sense. I’ve got some additional info, but I’ll make a new thread.