Josie 3/27 - still having dosing issues

[Holly and Josie]

I am still struggling with getting the right dose for Josie. Yesterday's PM cycle:

PMPS - 200
+1 - 221, gave .25
+3.5 - 296
+6 - 271

AMPS - first tested and got 463!!! Retested with a better sample and got 412, gave .50
+4 - 179
+5 - 131
+6 - 102

This is just crazy. .25 is clearly not enough and she skyrockets to the 400's. But then .50 can cause her to drop from 400 to 100?

At this point, I don't even know what to give her. If she has just stayed flat in the 200's last night I would have maybe stuck with the .25 for awhile. However, the jump to 400 was just too high and made me think that dose is just ineffective. I felt fairly comfortable giving .50 this morning since she was at 400. I would have given less if she'd been lower. Just a few days ago she was given .50 for a similar number (423) and stayed flat. That's all I really wanted... to get her down to the high 200's/low 300's. I am shocked by her numbers today.

Don't get me wrong, I'm pleased with the good numbers, but if she can go THAT low at 400, I have no confidence in giving her even a skinny .50 at 250-350. But based on last night's numbers, .25 isn't enough.

I am so confused and at the point where I just feel like I am rolling the dice every time we give her a shot. I keep saying this, but surely there is a "right" dose. But I am beginning to feel like maybe there's not.

 

[Carl & Polly & Bob (GA)]

Re: Josie 3/27 dosing woes

Holly,
Yesterday you had to stall in the AM before shooting, right? How many hours between that shot and the PM shot last night?

My only advice is to try to stop looking at it on a one-cycle-at-a-time basis. Last night, not much happened on .25, but that doesn't mean it is not a good dose. It just means not much happened on that specific cycle. I agree, drastic difference between what you saw on .25 vs. what you saw on .5, but each was just one cycle.

Try to see patterns, and more important, try to see duplication. If you see 3 or 4 cycles where the .25 doesn't do much, then you can make a better conclusion from that data than trying to evaluate it based on one 12 hour period. Likewise with the .5. If it always does too much, then it is too much. Make sense?

Looking at recent cycles, I agree the .5 is a little too much. The cycle on the nights of the 23rd and 24th for instance, Josie went pretty low, and the following AM cycles on the same dose look like bounces caused by the greens overnight, so while they appear high and flat, there's a reason for that (the low greens the previous nights). Other doses of .5 look like they run too long, and you're having to stall before shooting the next shots. So, based on what has happened over 6-8 cycles on that dose, I'd say .5 is too high.

I think you should go with .25, but stick with it so that you have a chance to see a pattern repeat before you can conclude it isn't enough.

My 2 cents... :smile:

Carl

 

[Holly and Josie]

Re: Josie 3/27 dosing woes

Holly,
Yesterday you had to stall in the AM before shooting, right? How many hours between that shot and the PM shot last night?

My only advice is to try to stop looking at it on a one-cycle-at-a-time basis. Last night, not much happened on .25, but that doesn't mean it is not a good dose. It just means not much happened on that specific cycle. I agree, drastic difference between what you saw on .25 vs. what you saw on .5, but each was just one cycle.

Try to see patterns, and more important, try to see duplication. If you see 3 or 4 cycles where the .25 doesn't do much, then you can make a better conclusion from that data than trying to evaluate it based on one 12 hour period. Likewise with the .5. If it always does too much, then it is too much. Make sense?

Looking at recent cycles, I agree the .5 is a little too much. The cycle on the nights of the 23rd and 24th for instance, Josie went pretty low, and the following AM cycles on the same dose look like bounces caused by the greens overnight, so while they appear high and flat, there's a reason for that (the low greens the previous nights). Other doses of .5 look like they run too long, and you're having to stall before shooting the next shots. So, based on what has happened over 6-8 cycles on that dose, I'd say .5 is too high.

I think you should go with .25, but stick with it so that you have a chance to see a pattern repeat before you can conclude it isn't enough.

My 2 cents... :smile:

Carl

Hi Carl...

Thanks for your reply!

As to your question... let's see... she was supposed to have the AM shot Monday morning at 1:30am. But we stalled until 4:30 am. So that cycle was 15 hours. Then, last night she should have had the PM shot at 4:30 pm, but I had to get home, test her, feed her, etc. so I stalled until 6pm. So that cyle wound up being 13.5. This mornings shot was giving right at 12 hours. Does that make sense?

What you're saying makes sense to me. I was beginning to think maybe I didn't give .25 enough of a chance. And I wouldn't have given up on it, if she hadn't gotten SO high. It's like the insulin just ran out or something. Because it was maintaining her reasonably well (200's) for awhile. I guess I panicked at the 400+ pre-shot.

I think you are right that .50 is absolutely, definitely too much. If it's almost too much at 400, then it's too much. But I'm wondering if .3 or .4 would be a more happy medium? As I said, it almost seems like the .25 "ran out". Maybe just a bit more would not?

Another factor that I didn't mention is that I gave the shot last night whereas my husband gave it this morning. So I wonder if he gave the .25 if it wouldn't work out better. Unfortunately, we are now on at 6am/6pm schedule (not by choice) and he won't be home to give it tonight. I wonder if it would be better to wait until he gets home (unfortunately not until 11:30pm) to give an effective shot than for me to give another (possibly) crappy one? That would get us back on schedule, which would be nice. But that would be 5.5 hours without insulin. So maybe it's not a good idea.

 

[Carl & Polly & Bob (GA)]

Have you watched each other give shots and how do your techniques differ? Sounds like you just need a confidence booster maybe?
Carl

 

[Holly and Josie]

Have you watched each other give shots and how do your techniques differ? Sounds like you just need a confidence booster maybe?
Carl

I watch him give shots. He's never watched me, except for the first time, because if he's home I always want him to give the shot. I know I should practice more but I always feel like she should have the best possible shot so when he's home I hate to give it.

It's true that I have very little confidence with it. It takes me at least 5-10 minutes to get the insulin in the syringe (always afraid of a bubble or misjudging the amount of insulin) and then giving the shot makes me super nervous. I have been a nervous wreck since I gave a fur shot last week. But that's the thing: last week it was SO obvious it was a fur shot. Her fur smelled VERY strongly of insulin and it was damp. That didn't happen last night. It just seemed sort of ineffective. And in fact, her numbers last night were worse than last week with the fur shot.

I would say our techniques vary in two ways: when I have to give the shot I have to give it in the scruff, where as he always does in the flank. I hate that, because I know the flank is better. But I am more shaky doing it there. And he is faster than me. Also, she often cries when I give her the shot and rarely does with him. I don't know what I'm doing wrong. Although, I have given effective shots before so I know I can. I just know there is always a chance I'll mess it up.

 

[Catannc]

I will just throw in my 2 cents. What is the ratio between .25 and .5? .5 is twice as much insulin as .25, at these small doses you need to make smaller adjustments. So .25 is almost enough and .5 is too much. I would change those doses to .3 and .4, you're correct about that.

As for the differences between the two of you shooting, when I had to work and DH was shooting I would leave a selection of doses in syringes in the fridge. For teeny doses the best way to keep them consistent is have the same person draw them every time. Also, I always snipped off the needle on a used syringe and set it to the dose and kept it as a comparison for new syringes.

 

[Holly and Josie]

I will just throw in my 2 cents. What is the ratio between .25 and .5? .5 is twice as much insulin as .25, at these small doses you need to make smaller adjustments. So .25 is almost enough and .5 is too much. I would change those doses to .3 and .4, you're correct about that.

As for the differences between the two of you shooting, when I had to work and DH was shooting I would leave a selection of doses in syringes in the fridge. For teeny doses the best way to keep them consistent is have the same person draw them every time. Also, I always snipped off the needle on a used syringe and set it to the dose and kept it as a comparison for new syringes.

Just now seeing this!

You make a good point that although it doesn't seem like much of a difference, .5 is twice as much as .25. I really think .25 isn't enough. Tried that dose again and her numbers were awful.

I wasn't sure if you could prefil the syringes or not. I mentioned it to my husband and he didn't think it would work. Sounds like it does!

 

[Catannc]

It does work, and if you end up decreasing and not needing a pre-dosed larger syringe you can remix the syringe by pulling in some air and treating it like the bottle, shoot out the air, then rotating the plunger to squeeze out drops until you're at your new smaller dose. Anyways, I only filled one syringe for each of our dosing possibilities and taped paper labels with the dose on them to the syringe. Then when I got home I'd replace whichever dose got used, I still have a 0.1u sitting in my fridge from almost 3 weeks ago!

I actually found that I liked this for myself as well, I could fill the syringes in the evening when I could actually see straight and use them in the morning.

 

[Holly and Josie]

It does work, and if you end up decreasing and not needing a pre-dosed larger syringe you can remix the syringe by pulling in some air and treating it like the bottle, shoot out the air, then rotating the plunger to squeeze out drops until you're at your new smaller dose. Anyways, I only filled one syringe for each of our dosing possibilities and taped paper labels with the dose on them to the syringe. Then when I got home I'd replace whichever dose got used, I still have a 0.1u sitting in my fridge from almost 3 weeks ago!

I actually found that I liked this for myself as well, I could fill the syringes in the evening when I could actually see straight and use them in the morning.

Thanks for that info. This may be kind of a dumb question, but do you just keep the syringes laying flat in the fridge? For some reason my husband thought that you'd have to somehow keep them upright and that it would be hard to do (not sure why that would be hard) but I would assume you'd just keep them flat.

 

[Catannc]

Yep, just lay them flat, i kept mine in the little butter drawer with the lid so nothing hit them.