May 17 Charlie

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charliesmom

charliesmom

Member Since 2012
The past few days, Charlie has been doing real well. The other day, Charlie posted a green preshot of 99 in both AM & PM. I shot a fat .25 and Charlie did fine with that. Since I am working now, I am not able to get an am BG test until +8 or +9 in her am cycle (often later). PM cycle is more flexible, but then again, I cannot be waking up each night all throughout the night due to a new demanding job. As her preshots continue to come down, I am wondering how low it is safe for me to shoot. As an example, if she comes back tomorrow with a 70 or 80 preshot should I still shoot that and if so, should I reduce a little like giving less than .25 at some point? We have had some .25 full units and some .25 normal. It's real hard to see the difference. We will buy a magnifying glass ASAP to make this easier as your micro-dosing pictures that you posted are real helpful. Just trying to get some advance guidance as my am preshot time in Amsterdam falls about 3am EST and not sure if many of you are around at that time. Charlie's sheet is updated. Thank you for any input.
 
Good to hear that Charlie is doing well.

Being on lev his nadir might actually be around the +8 or 9 mark- Sneakers is closer to +10 so I wouldn't worry about it that much- if you can get one on your version of the weekend that would be great. How low is she at the +8/9 that you do get? If you can't get an absolute nadir go off the BG's you can get and work from there.

Since Charlies numbers have been in the green do you want to start doing the drop method to see how she does? But those are some pretty good numbers and the dose seems to be working so weaning off slowly may be the way to go. You might find she's had enough of the shots :lol: .

I love the comment- 40th birthday and still diabetic- I'll be 40 this year and, yep, mine is still diabetic, so I can totally relate.
 
She is doing great!

That is a good question - about what to shoot on a lower PS. You have the data that tells you she is fine shooting on a 99. I'd say that is "good" data down to the low 90s. Below that you want to be able to be around to test or reduce slightly until you have data that shows what dose is good. She may be fine getting .25u on a 75 - but hopefully she will do that on the weekend so you can test her!

Many, many people shoot on low numbers - with the data to show it is safe and predictable. I am not one on them (I'm a bit nervous even though I have been working from home for three years now). So I reduce a bit, but still test. I don't want to cause a low number (below 40) and rebound bounce.

Ideally, you keep shooting your regular dose and testing and if she drops below 40 (protocol) or 50 (my opinion) you reduce. Just make the reductions very small. This is micro dosing/drop territory. I wouldn't reduce more than .1u - and probably only .05u, which is 20% of .25u.

If you are unsure, won't be home to test, it is always safe to reduce the dose or, if very low, skip the shot. A token amount of insulin is usually better (in this case approx. half the dose or .1u) so you don't end up with a higher number 12 hours later.

I have seen .05u drop beau from 150 to 39, but I don't think he could have had a serious hypo because there is no duration with a dose that low. It did, however, cause a rebound bounce. I ended up setting a no not shot (below) number. For him it was 150. For Cami it was 130, can't remember if I had one for Jeddie. Looks like, at this point, if you had one for Charlie it would be below 100. It just depends on how she reacts and what you are comfortable doing.
 
One day, I will be real happy when Charlie decides she has had enough of the shots. Hopefully I wont have to add another comment to Charlie's sheet when it's my 50th birthday. :lol:
By then I won't be laughing. I'll be crying though, and I'll be seriously tired and grumpy. @-)

This testing during the night and not sleeping is really starting to get to me. Very tired, and that's not great when you're starting a new job with info overload.

I am actually not sure when Charlie's nadir on levemir is. People previously told me +8 or +9, but sometimes I think maybe she is a double dipper, with one of her nadirs a bit earlier (+5?) and sometimes later (+8ish?). This makes it a bit hard to manage, so lately I've felt uncomfortable going to bed for the whole night and I end up testing at different moments when I wake up during the night. That's getting pretty tiring though.

What is the "drop method" and how do you "wean off slowly" when you are already shooting a very small amount (.25)? Honestly, I don't think I can see the difference on the syringe between .25 and .20, let alone measure out that difference, and since my partner shoots as well, that's another challenge (consistency).

Tonight Charlie seems to be lower quite early in the cycle. Not sure if that means I'm in for another rocky evening? Thoughts?
 
Yes, she did earn a reduction tonight.

The micro dosing photos that I linked IS the drop method: you get micro doses by using the drop method. All I can say is that it takes practice and a good eye and/or magnifier. Originally I practiced twisting off drops from .5u to get increments of .1u and eyeballed half of one of those drops to get .05u. That gives you 4 dose below .25y (.2u, .15u, .1u, .05u). For now just work on getting something half way between 0 and .25u. You will be at .125u - or there about).

I learned from that to eyeball the doses in relationship to the syringe markings and the flange on the plunger stopper. If I have the top of that flange resting on the bottom of the zero line, that is about .15u. Consistency is more important than accuracy - doesn't matter if what you call .15u is really .17u as long as you are consistent. And that also means you have to look at the syringe carefully to see that the zero line is printed right at zero and when fully closed the flange sits right at the top edge of it (top always referring to needle pointing up).

I don't think you need to get up and test at night unless you are worried and/or got a low test before you went to bed. If bedtime for you is 3-5 hrs after her shot just test right before you go to sleep. I hardly ever got up to test. It was just too hard for me.

As for worrying about consistency between the two of you shooting, you can draw doses of lev and leave them lying flat in the fridge for up to a week. You can't do this with lantus (if anyone is reading who uses lantus). I pre-drew doses for Beau (who was headed OTJ) of .05u when I was going to be gone for 9 days and they did not get used so I used them after I got back - up to 3 weeks after I drew them and they were ok.
 
Thank you for sharing those micro-dosing photos. They are a good refresher. I've printed them out and went and bought a magnifying glass over the weekend. This morning I also checked the syringes to make sure the ones we are using are consistent with one another (with a small amount of space before the first line).

From the pictures, it turns out we have actually been shooting .15

Tonight, Charlie seems to be dipping early in the cycle on the .15

So my question is, would you advise for us to reduce to .10 for the morning? Charlie's sheet is up to date. I caught her at 47 and gave LC plus maple syrup, since it's almost midnight here and I can't be up all night waiting for her to drop further. I will test her again one more time in 30 minutes and then HOPEFULLY go to bed.

Thanks for your help in advance.
Jill
 
If you keep having low nadirs- and early ones at that- I would think going down to .1u would be a good idea.

Looking at the SS Charlie is seriously looking into OTJ. She still reacts to low numbers though so I would expect a bounce within the next 3-4 cycles and if she does keep the .1u dose until she clears out of it.
 
Sorry - didn't see this until now - must be 6pm your time on Weds.

She is flirting with a dose reduction. But one low could be a "fluke" and she ate less or exercised more last night. Also, as Heather pointed out, she may bounce from the 47. I know you shot whatever you thought was best this morning (don't see the number/dose yet on the SS).

My rule of thumb is to see is the PS following the low number is still low (In Charlie's case, I think that would be below 125 or 130 maybe) in which case I would take the reduction. However, if she bounced and is in the upper 100s or low 200s, shoot the old dose (.15u) and take the reduction the next time she is below 130. usually, the PS following the low is higher, but the next one is low so it is a matter of stalling one cycle to wait for the low part of the swing to reduce.

It looks to me like she was low during the day yesterday and just riding out a nice string of "normal" numbers. In retrospect, you probably could have reduced on that 94 with the assumption that she was in the 40s during the day.

Remember, the 40s are safe. Not a number you want to aim for because there is no wiggler room if she drops farther, but still safe.

Looking really good, Jill!
 
Hi guys,

Didn't get that last message until now. Any thoughts on Charlie's #'s and progress? Hold on the .10 while she settles on this new dose?

Jill
 
Yeah, I would keep holding this dose for another two days or so. If she doesn't come down you could go back to .15u.

Can't tell where those 300s came from - unless she dropped lower from the 95....
 
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