Late nadirs

Yvettt

Yvettt

Member
Loka has been diagnosed back in October 2021 and it was a bumpy ride. We are finally starting to see some good results but I do have a question. Her nadirs are quite late in a day , +10 sometimes. Yesterday she was at 5.2 (94) at +12. I spoke with my vet but unfortunately they keep telling me the official guidelines - stick to the same dose (they recommend 2.25) for at least a week - but I don't feel very comfortable to shot when she is so low in the evening.
She is on wet food diet now, she will have 2 meals, one before each shot but she will also graze during the day.
I dropped dose to 1.75 today, after nadir of 4.8 (86) yesterday but I don't know if that is correct. Vet is keep telling me to up a dose and hold it but I don't think it will be safe do it.
Does anybody have any ideas why prozinc is acting for so long, with late nadirs?
 
Hello!

So a few things -
- Is she on a completely low carb wet food diet? This will dictate at what BG you should reduce the dose.

What you are seeing is called bouncing. When the BG drops too low/too fast/lower than they're used to, their liver "panics" and dumps glycogen and hormones into the body. It takes time for them to get used to the lower numbers. So after a fast drop or stretch of low numbers, you'll see her BG skyrockets back up. Now, when the bounce clears it's often a long slide down - hence the late nadirs.

Now the other problem - when you skip or reduce doses plus she is heading into a bounces there is no insulin to offset it, so she goes higher. Then you give the next shot and she drops down hard, then bounce. Repeat.

When you are new we suggest not shooting full dose below 200. But you are no longer new ;) so now what you need to do is gradually lower the number at which you shoot a full dose. Skipping with these green preshots was absolutely the right thing to do to keep her safe.

Here's what I suggest, provided you can stay around to monitor and have hypo kit:
If she is 175 or higher, shoot the full dose and see what happens. Look at your data - the shots where she was in that range and you reduced or skipped, she was high again by morning.

If she is 150-174, try half your normal dose.

If she is 125-149, try 0.5U.

Under that you can try 0.1U if you are comfortable, or skipping is fine too.


Try this for 2 weeks. Tag me after that two weeks, or if you need advice in the meantime :)
 
Hi,

Thank you for your help. She is on a wet food diet only for a few months now.
I think I am a bit afraid to shoot full dose in the evening, when I can see that the nadir was late or numbers are still dropping and she is refusing to eat the whole portion of food - since I cant check on her whole night. She likes to graze so it is almost impossible to get her to eat more than one pouch of food at time (they are 85g). I know they have to eat before the shot but should I wait until I know she ate at least one pouch or is it ok to shoot as long as she ate some?

Luckily I am on a maternity leave and I am at home all the time so I will try to stick to 1.75 even if she is a bit lower than usual and we will see!
 
As long as she ate some it is ok. Congrats on the baby! I've got two little ones at home too, it's a lot to manage
 
Thank you! It is a lot but I am so glad that she got diagnosed while I am still on maternity because I am not sure how I would manage with all of that while working :)

So it has been 2 weeks and I am not sure what is happening, but I think it is a good thing. I have been slowly decreasing dose, every time when it dropped below 90. We are still getting some late nadirs but it is getting better. Within 2 weeks I have decreased dose from 1.75 to 0.25 and she is doing fine! Yesterday, after 0.5 am shot, she went down to 68 so I am not sure if it is still too high? I dropped to 0.25 yesterday evening and she got some good numbers today. She was only 160 in the evening so since half of the dose would be 0.125, I only gave her token dose - I hope that it is ok.

What does it mean? We started with 3 units and now even 0.5 is more than enough. Does it mean that her pancreas is working a bit?
 
Looking good! Nadirs are good, doing the right thing by decreasing. Yes, it would appear pancreas is helping out, hence the reduced need for insulin. Now it's just a waiting game for those AM preshots to come down.
 
Hi Yvette. I was following Loka's SS and very happy to see all those AM green nadirs lately. Can you update his numbers over the past few days?
 
Hi,

I did update all numbers today. Unfortunately something is wrong. She was having nice low numbers but then it started to climb up again. I increased dose to 0.5 but no change. After a few days of higher numbers I realised that her insulin was open for longer than 60 days so I got a new vial - we switch on the 22nd. I have now increased dose to 1 unit but numbers are still high. I am not sure why. She is still eating the same. No ketones in urine, no weight change. She seems fine, not drinking more, but I cant get her bg to drop down. Should I still increase it?
 
Unfortunately without any nighttime data for awhile I can't say for sure. It's a bit odd he would go from the numbers/dose he was at now back up like this, so there is a chance he is going lower at night and bouncing back up.
 
I did some overnight checking and it is still high. I will try to do another check tonight and maybe I will increase dose to 1.5 She started to pee more too :(
 
Yes if no blue tonight, go up to 1.5U.

You can increase by 0.5U every 4-6 cycles until you see blue, then you want to hold 6-8 cycles and only increase by 0.25U. just need to get at least one additional test each cycle, ideally around nadir, to make sure you're not missing any lows.
 
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