? Need help understanding Elmo's post hypo nadir....

[Beth 73]

Hypo event Sunday night, October 30. Reduced vetsulin to 0.5 Oct 31st pm. Nadirs remain in triple digits compared to double digits before hypo(and on 1.0 unit vetsulin). Having never gone thru this I am wondering if these elevated Nadirs indicate anything? Should I stay at 0.5 or go up to .75? Confused and don't really know even what to ask. Checked at + 5 instead of +4 today to see if nadir had shifted. Do elevated Nadirs indicate anything or am I making a big deal out of not so much ?

 

[Marlena]

Beth, Vetsulin is such a difficult insulin.
Generally speaking if you had hypo you will see the numbers go up after that and may be higher due to bounce which is a protective mechanism. If you see the numbers going higher after a big drop you should not increase the dose of insulin. You need to wait 2-3 days for the bounce to clear and see if the numbers come down.
Looking at Elmo's SS I can tell he was in hypo many times recently so sticking to lower doses and observing what's appearing next is warranted.
Marlena

 

[Beth 73]

Thank you for ur insight. Wednesday was his third day and I was confused as to what to expect post bouncing now that it is Saturday and 3 days since BGs evened out. Wasn't sure what triple digit Nadirs indicated and if there was cause to change what I was doing. Going to stay the course because certainly don't want to experience hypo again .

 

[MrWorfMen's Mom]

Beth, I think you could take Elmo up to 0.75u. The hypo occurred on 1u and you decreased first to 0.75u but if memory serves, I suggested 0.5u the next night because we didn't know if Elmo was bouncing and you needed some rest after that scare. I was looking at Elmo's SS earlier today and while his numbers are decent, they could be a tad lower. We usually make dose changes in 1/4u increments and you did 0.75u for one cycle with no problem. I just didn't want you to have another sleepless night. I think you've given the 0.5u a good run and any bouncing should be cleared by now.

If you decide to increase, I'd do the dose increase tomorrow morning rather than on the night cycle tonight. With the time change tonight, if you just do a 13 hour cycle, he'll probably be a little higher at AMPS tomorrow anyway.

ETA - No problem posting here in Health but we'd like to keep postings specific to Vetsulin users in the Vetsulin forum unless they are of an urgent/emergency nature so the community can benefit from each other's experiences.

 

[Beth 73]

Beth, I think you could take Elmo up to 0.75u. The hypo occurred on 1u and you decreased first to 0.75u but if memory serves, I suggested 0.5u the next night because we didn't know if Elmo was bouncing and you needed some rest after that scare. I was looking at Elmo's SS earlier today and while his numbers are decent, they could be a tad lower. We usually make dose changes in 1/4u increments and you did 0.75u for one cycle with no problem. I just didn't want you to have another sleepless night. I think you've given the 0.5u a good run and any bouncing should be cleared by now.

If you decide to increase, I'd do the dose increase tomorrow morning rather than on the night cycle tonight. With the time change tonight, if you just do a 13 hour cycle, he'll probably be a little higher at AMPS tomorrow anyway.

ETA - No problem posting here in Health but we'd like to keep postings specific to Vetsulin users in the Vetsulin forum unless they are of an urgent/emergency nature so the community can benefit from each other's experiences. [/QUOTE

 

[Beth 73]

Thank u for checking on us, Linda. I posted on vetsulin forum but after 4 hours started to get anxious as we newbies r prone to do so posted on Health as well. His elevated +4s concerned me. Could u suggest a good syringe for me to be able to accurately draw a .75 dose. I can eyeball for now but would rather be as accurate as possible?

 

[MrWorfMen's Mom]

Not a problem Beth. The Vetsulin forum was not active for a long time but we've found more and more people using Vetsulin lately and are trying to re-establish that community. I totally understand you thinking it best to post on Health for some assistance. Weekends are often less active and while we try to get to everyone in a timely fashion, it can be slower on weekends unless it's a 911 call.

Elmo's numbers are quite good. They could be a bit lower but he is in good shape and under renal threshold (spilling glucose into urine and risk of kidney damage) so technically you could just keep him where he is and he'd be just fine. It's really up to you whether you want to get him a little lower or not. If you want to aim for remission which is by no means a guarantee for anyone but nevertheless a possibility, then trying to get him a bit lower would be the way to go.

As for syringes, I take it you don't have 0.5u markings on your syringes which must be a real nightmare when trying for 1/4u increments. A lot of folks order them online from ADW. There are several different varieties HERE.

You want the ones with 1/2 unit markings. Most of us use the 3/10cc, 31G, 5/16" (8mm) needle. There are BD, Ulticare, Vetsulin and the Carepoint which seem to be the least expensive.
Carepoint single box: https://www.adwdiabetes.com/product/carepoint-vet-u-100-pet-syringe-31g-half-unit_16367.htm
Carepoint case of five: https://www.adwdiabetes.com/product/carepoint-vet-u100-syringe-31g-half-unit_16368.htm

I don't use u40 syringes so can't tell you which are the best ones but if you do a general search (not any particular forum) for syringes, I'm sure you'll find some threads about syringe preferences from other members.