Josie - give shot or wait?

[Holly and Josie]

I was away from the board on Saturday and Sunday since my husband had the weekend off work. (It was SO hard not to post, but it would not have gone over well if I had.) However, that doesn't mean Josie's cycles were any less interesting. I won't rehash all of them here, since they are on my spreadsheet. However, I do want to get some opinions on yesterday's PM cycle, which was WEIRD!


PMPS (1:30 pm) - 315, gave a skinny .50
+3.5 (5 pm) - 291
+6 (7:30 pm) - 179 (fed a snack)
+9 (10:30 pm) - 100
+11 (12:30 pm) - 68!!! Fed about 1/3 of her food and waited a half hour after that to see if numbers would go up or down.
+12 (1:30 am) = 86 Fed 1/3 more of her food
+15 (4:30am) - 242 Fed the rest of her food and gave a very skinny .50

So, I don't know what to think of the above #'s? I'm not sure if it was her pancreas at work or she just peaked really, REALLY late. It almost looks to me it's the latter because she just sort of slowly got lower, but then when we fed her, the numbers went up. I was under the impression that when the pancreas is at work, the numbers will hold or go down. By why would she peak at 11 hours? What would cause that?

 

[Carl & Polly & Bob (GA)]

Re: Josie - VERY late peak or pancreas at work?

Some people call this a "sputtering pancreas". To me, it looks like her pancreas did something with that snack you fed at +6, and it kept her numbers down for a few hours. When you fed the 68, Mr. P. didn't do his thing, plus the insulin wore off, leading to the rise by +15.

Are you using U100 syringes? If so, something you can try is to draw up some colored water into a used one to what you would call .5. Then slowly squirt some back out a drop at a time until you feel like you're halfway to zero. You can even count the drops, then redraw and practice a couple times. Once you are comfortable that you have around .25 in the needle, set it aside. That can be your "template" for the next shot. Just draw up insulin into a new syringe, and compare it to the one with the colored water in it.

The object is to find a dose that will let you shoot every twelve hours so that there is insulin in her body during as much of a 24 hour period as possible.

Carl

 

[Holly and Josie]

Re: Josie - VERY late peak or pancreas at work?

Some people call this a "sputtering pancreas". To me, it looks like her pancreas did something with that snack you fed at +6, and it kept her numbers down for a few hours. When you fed the 68, Mr. P. didn't do his thing, plus the insulin wore off, leading to the rise by +15.

Are you using U100 syringes? If so, something you can try is to draw up some colored water into a used one to what you would call .5. Then slowly squirt some back out a drop at a time until you feel like you're halfway to zero. You can even count the drops, then redraw and practice a couple times. Once you are comfortable that you have around .25 in the needle, set it aside. That can be your "template" for the next shot. Just draw up insulin into a new syringe, and compare it to the one with the colored water in it.

The object is to find a dose that will let you shoot every twelve hours so that there is insulin in her body during as much of a 24 hour period as possible.

Carl

Thanks for your reply!

I just looked up "sputtering pancreas" and although I'd never heard of the term, it sounds exactly like what I'd suspected was gonig on with her: sometimes her pancreas just works out of the blue. And while that's a good thing, it scares me because I feel like it's puts her in danger. I'm terrified of what's going to happen every time we give her a shot.

That's interesting about the snack because that's sort of the opposite of what I was trying to acheive. We were going to be leaving for a few hours and I fed her, hoping to keep her numbers steady. Apparently it just brought her BG lower. It worked out fine, except, of course, it threw off our dosing schedule once again!

I just bought new U100's, smaller than what I had purchased before, that hold 30 units. These have 1 units marking, unlike the ones I mistakenly bought before that held 100 units and had only 2 unit markings. I wish they had half unit markings, but they don't. I was planning to start using them tonight.

When you say draw it up to .25, is that how much you would try giving her? That's .25 on a U40 syringe, right? So a smidge over .5 on a U100 syringe?

So, basically, not having any insulin in her body for a few hours is a bad thing? Even if her numbers are decent?

Sorry for so many questions!

 

[Rob & Harley (GA)]

Re: Josie - VERY late peak or pancreas at work?

I agree with Carl, you should lower your dose so you can get shootable PS's. She's gone low twice now.

 

[Holly and Josie]

Re: Josie - VERY late peak or pancreas at work?

I agree with Carl, you should lower your dose so you can get shootable PS's. She's gone low twice now.

I agree that I need to lower my dose. I went from a .50 to a skinny .50, but I guess that wasn't enough?

Now, am I right in thinking that going low at 11+ doesn't have quite the same risks as going low at an early point? Since the insulin should be leaving her body? Not that I want her to go too low at any point, just trying to figure out if I was crazy for thinking there was less risk last night than there was a few nights ago when she was low at +4.

Also, trying to figure out if she is at risk now. She's been hanging out at 120 from 5+ - 8+. My husband will be leaving her in about a half hour, 9.5+. I will not be home until 12.5+. I was thinking she'd be OK because the insulin should be leaving her body, but now I'm afraid she won't be and no one will be there to help her. I'm actually getting upset/scared thinking about it. He will test her soon. Would there be anything he could do now to make sure she doesn't go to low?

 

[Carl & Polly & Bob (GA)]

Re: Josie - VERY late peak or pancreas at work?

Holly,
The numbers (.25 and .5) I mentioned.... I thought you were already using the U100's. You were shooting the .5 with a U40 syringe?

So, basically, not having any insulin in her body for a few hours is a bad thing? Even if here numbers are decent?

No, it isn't a bad thing. What you want to try to avoid is having numbers so low at shot time that you can't shoot at all. If you have to totally skip a shot, then she goes without any added insulin for 12 hours, leaving her body to "fend for itself". That's fine if she is producing some insulin. But on a day that her pancreas takes the day off, it would lead to a higher reading by her next shot time. That might lead you to dose too high, and then 12 hours later you are in the same boat, having to wait or skip a shot. Two small shots 12 hours apart are better than two bigger shot 24 hours apart.

So, when you shot that .5 or skinny .5, what type of syringe were you using? Based on that answer, we can help you out with what to shoot from a U100 syringe.

Carl

 

[Holly and Josie]

Re: Josie - VERY late peak or pancreas at work?

Holly,
The numbers (.25 and .5) I mentioned.... I thought you were already using the U100's. You were shooting the .5 with a U40 syringe?

So, basically, not having any insulin in her body for a few hours is a bad thing? Even if here numbers are decent?

No, it isn't a bad thing. What you want to try to avoid is having numbers so low at shot time that you can't shoot at all. If you have to totally skip a shot, then she goes without any added insulin for 12 hours, leaving her body to "fend for itself". That's fine if she is producing some insulin. But on a day that her pancreas takes the day off, it would lead to a higher reading by her next shot time. That might lead you to dose too high, and then 12 hours later you are in the same boat, having to wait or skip a shot. Two small shots 12 hours apart are better than two bigger shot 24 hours apart.

So, when you shot that .5 or skinny .5, what type of syringe were you using? Based on that answer, we can help you out with what to shoot from a U100 syringe.

Carl

OK, thanks. It was .5 (well, an eyeballed .5) on a U40 syringe. Most recently a skinny .5, which I was hoping was more like .4, but I don't really know that for sure.

 

[Grayson & Lu]

Re: Josie - VERY late peak or pancreas at work?

Holly -

If you've got one of those fine point sharpie pens - go ahead and mark the half-unit line on the syringes yourself. That way you've got something to work with. Since you're using the U100s, I'd just try to do .2 or a fat .2, which is to the first (hand drawn) 1/2 unit mark. Next time, you may want to grab the ones w/ 1/2 unit markings, but these will work fine for now. The U100s will enable you to see smaller doses as you need to. I don't trust my "eyeballing" much, and still continue to use the U100s on higher doses!

Lu-Ann

 

[Holly and Josie]

Re: Josie - VERY late peak or pancreas at work?

Holly -

If you've got one of those fine point sharpie pens - go ahead and mark the half-unit line on the syringes yourself. That way you've got something to work with. Since you're using the U100s, I'd just try to do .2 or a fat .2, which is to the first (hand drawn) 1/2 unit mark. Next time, you may want to grab the ones w/ 1/2 unit markings, but these will work fine for now. The U100s will enable you to see smaller doses as you need to. I don't trust my "eyeballing" much, and still continue to use the U100s on higher doses!

Lu-Ann

I think I need to go get a fine point sharpie! I tried it with a regular one and I couldn't see what I was doing at all! And of course, a pen doesn't show up. Eyeballing works OK most of the time, but isn't as accurate as I would prefer.

I really want to get the U100's with the half unit markings. Does anyone know what national stores might carry them? My local grocery store and drug store did not, but maybe Wal-mart or someplace like that?

 

[Grayson & Lu]

Re: Josie - VERY late peak or pancreas at work?

Walmart has them. Ask at the Pharmacy window - and be sure to look at them before you buy - not returnable.

Mine are ReliOn 3/10 31 g 8 mm in a white box labelled 81131-0311-78. I also heard Walgreens carries some - but not sure of the brand.

 

[Holly and Josie]

Re: Josie - VERY late peak or pancreas at work?

At +9 she is at 200. The upside is that I don't think I have to worry about her going too low this afternoon. The downside is that's kind of a huge jump between 8+ and a little over 9+.

 

[Holly and Josie]

Re: Josie - VERY late peak or pancreas at work?

Walmart has them. Ask at the Pharmacy window - and be sure to look at them before you buy - not returnable.

Mine are ReliOn 3/10 31 g 8 mm in a white box labelled 81131-0311-78. I also heard Walgreens carries some - but not sure of the brand.

OK, thanks! I'll try Wal-mart!

 

[Holly and Josie]

Re: Josie - should I give shot or wait?

Josie is at 200 at 12.5+.

Here was her cycle today...

AMPS - 244, gave a skinny .50 (on a U40 syringe)
+5 - 120
+6 - 121
+8 - 120
+9 - 202
+12.5 - 200

She had a pretty good curve today, didn't go to low or last too long. However. her numbers haven't moved in 3 hours. So I'm wondering if I should give insulin now or if I should hold off? I'm thinking that I might wait another half hour? To see if it rises? I can tell she's hungry, so I don't think I can wait much longer? Maybe I should feed a bit to see if she comes down or rises? Any help or advice would much appreciated!

 

[Rob & Harley (GA)]

Do you think you can eyeball a .25u?

 

[Holly and Josie]

Do you think you can eyeball a .25u?

I could or would it work to use the new U100 syringes I bought and give a smidge over half on that?

 

[Rob & Harley (GA)]

Oh good on the syringes. I don't have conversion chart in front of me but the doses in the U100 syringes would be .2u, .4u, .6u etc. Get out a magnifying glass and go between the .2u & .4u mark the best you can. Do you see what I'm saying on the conversion chart?

Also I think you stalled this morning a couple of hours, is this the +12 from when you gave her the shot? or when she should have gotten the shot?

 

[Holly and Josie]

Oh good on the syringes. I don't have conversion chart in front of me but the doses in the U100 syringes would be .2u, .4u, .6u etc. Get out a magnifying glass and go between the .2u & .4u mark the best you can. Do you see what I'm saying on the conversion chart?

Also I think you stalled this morning a couple of hours, is this the +12 from when you gave her the shot? or when she should have gotten the shot?

Yeah, it's 13 hours after her last shot.

The conversion chart says to get .2 of U40 insulin draw to .5 on a U100 syringe.

 

[Rob & Harley (GA)]

Thanks, I just wanted to make sure we were talking about the same thing. So yes you would go a smidge above that.

As long as we've stalled this long you might as well test her again and see if anything has changed.

 

[Holly and Josie]

Thanks, I just wanted to make sure we were talking about the same thing. So yes you would go a smidge above that.

As long as we've stalled this long you might as well test her again and see if anything has changed.

Yep, I was going to do that. Be back in a second!

 

[Holly and Josie]

221. So she's either up a tiny bit or it's just the variance of the meter.

 

[Rob & Harley (GA)]

You should be good to shoot, especially since it's a reduced dose.

 

[Holly and Josie]

OK, so I gave the shot. .25. I think. I hope. I ended up using the U40 syringe. I had a bunch of trouble with the U100. It's just so tiny. I am going to have to practice with some water with those. But not with insulin and on my cat! So I chickened out with the U100's. But, maybe it's best the first time I give this low of a dose that I stick with the same syringe, that way if it doesn't work out the way I want, I'll know it's the dose and not that I screwed something up with the syringe.

 

[Rob & Harley (GA)]

That's fine too. I used a magnifyer and a couple of pairs of reading glasses (yes at the same time). :lol:

Practice with the U100's until you are comfortable.

 

[Holly and Josie]

That's fine too. I used a magnifyer and a couple of pairs of reading glasses (yes at the same time). :lol:

Practice with the U100's until you are comfortable.

That's so funny! I don't have either items, however, at least with the U40's if nothing else, I could at least tell that it was less than this morning. With the U100's, I have no experience, so I had nothing to really go on. That's why it made me nervous. But I do want to use the U100's, so practice is in order!

 

[Catannc]

I wouldn't worry about lower numbers after +8 as the insulin should be wearing off and the numbers you see, especially if she's falling are probably her P.

 

[Holly and Josie]

I wouldn't worry about lower numbers after +8 as the insulin should be wearing off and the numbers you see, especially if she's falling are probably her P.

OK, thanks! I thought someone had told me that before and I think it was you! I wasn't too worried about it last night, but today in hindsight I started wondering if maybe I should have been more concerned. Good to know that it was most likely Mr. P!

 

[Catannc]

With those u100's drawing a small dose accurately is hard if you have to keep going back and forth with the plunger. If you draw slightly more than you need you can twist the plunger like a screw and it will slowly move up so you can more easily get a small adjustment. For .25 I would set the plunger just below the .5 line on the syringe where you can just see a slight bit of clear below the black line if you look through it at a light source.

 

[Holly and Josie]

With those u100's drawing a small dose accurately is hard if you have to keep going back and forth with the plunger. If you draw slightly more than you need you can twist the plunger like a screw and it will slowly move up so you can more easily get a small adjustment. For .25 I would set the plunger just below the .5 line on the syringe where you can just see a slight bit of clear below the black line if you look through it at a light source.

Oh, I was a complete mess with the U100's. They are so much smaller and more delicate than the U40's. I bent the first needle. Then, on the second one I pulled the plunger completely out of the syringe. (Luckily, it wasn't upside down at that point.) But yeah, that's exactly what I did, I kept going back in forth. Finally I got frustrated and just decided to use the U40.

OK, so my syringes don't have half unit markings. Just 1 unit markings. But I am trying to visualize what you are saying. So, if there was a half unit marking, I would keep the plunger below that line? Do you mean if the syringe is facing downward? Because when I am adjusting the dosage, the syringe is up in the air and I would think I would go past the .5 line, kind of above it. (If it's up in the air.) Am I making sense? Probably not! ;-)

 

[Grayson & Lu]

When filling the syringe, you should have the bottle upside down and the needle pointed upward. I usually overfill the syringe, then push it back once or twice - ridding it of air bubbles and excess insulin.

 

[Catannc]

Yeah, the half unit ones make it much easier. I adjusted the dose with the needle end up and still in the bottle, so being that the .5 is actually .2 of prozinc a .25 would be just below the .5 line when the needle is pointed up as .25 is larger than .2. The needles do bend easier. I would insert the needle and inject the air with the needle facing down into the bottle, then flip the two over together and hold them both with one hand. Drawing quickly well past the mark you intend to shoot seems to keep the bubbles up top so when you push back they go back into the bottle. twisting the plunger really helps with small adjustments.

 

[Holly and Josie]

When filling the syringe, you should have the bottle upside down and the needle pointed upward. I usually overfill the syringe, then push it back once or twice - ridding it of air bubbles and excess insulin.

Oh, yes, I definitely do it that way!

 

[Holly and Josie]

Yeah, the half unit ones make it much easier. I adjusted the dose with the needle end up and still in the bottle, so being that the .5 is actually .2 of prozinc a .25 would be just below the .5 line when the needle is pointed up as .25 is larger than .2. The needles do bend easier. I would insert the needle and inject the air with the needle facing down into the bottle, then flip the two over together and hold them both with one hand. Drawing quickly well past the mark you intend to shoot seems to keep the bubbles up top so when you push back they go back into the bottle. twisting the plunger really helps with small adjustments.

OK, now I see where I was getting confused. It's the conversion. You would go past the .5 line, because like you said that's really .2 and I was wanting .25. I forgot about the conversion when I was reading your first explanation! Thanks!