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Hi Jennifer,

I don't know much about PZI, but I did look at Katie's SS. Was there a reason you thought that the 2 units was too high of does? I saw that her BG#'s started to come down after word (there is often a delayed reaction) and go back up after you brought her dose back down.

Is it possible to do increases in smaller steps? I do not know U40 syringes, but with Lantus I make dose changes in .25 incraments. Perhaps you could post dosing questions on the PZI support page.

Katie, we don't like seeing you in the black brackets, so come on down!!
 
Jennifer
You aren't doing anything wrong. Just stick to the plan and get some mid cycle tests in today. It's the only way to find out what the insulin is actually doing for her. Keep an eye on her during the day and post any strange behavior you notice. There may be a reason beyond the diabetes for her behavior. Do you have what you need to check for ketones?
 
Ketones? No, I don't.
Also, I just got off the phone with the vet, and she thinks Katie vomiting was something else such as eating too fast, not a reaction to the upped dose of insulin. She said the numbers I am getting are well in the range for upping to 2 U twice a day, so I'm going to try that again and see what happens. But I will definitely continue home testing!
 
So, I tested Katie tonight, and her BG was 121!! An hour later, it's at 180. So, she gets an insulin free night. I'm a bit worried though, about when to give her insulin. She was 314 this morning when I gave her the 2 U, and she dropped almost 200 points. I don't want to accidentally make her go hypo. Should I hold off on giving her insulin unless she's above 300? It seems the logical answer to me, but I thought I'd ask.
 
Hi Jennifer!
I feel the need to suggest again that you try as hard as possible to get some tests in between shots. It's awesome that Katie's BG went down from 348 to a PMPS of 121. The big problem though, is that you don't know how low she went in between AMPs and PMPs. Sometime around halfway between the tests, she would have been at nadir, and probably well below 100. The reason that is so, so important is that if you don't know how low she dropped, you don't really know how 2u affected her. She may have been around 50, which is as low as you want her to be, no lower than that. Because you don't know her lowest number, it's impossible to tell if shooting her tonight with any insulin at all would have been okay.

There are a couple of rules of thumb that you need to follow in order to treat her correctly and most important, safely. You need to determine how much insulin it takes to get her to drop to nadir and still be in the "safe" zone. The AMPS and PMPS tests are absolutely required, and you have done those every time and that is a great thing. Not testing, and "shooting blind" are definite no-nos and you have learned that, which is terrrific. But in order to really know what a safe and correct dose is, you have to know what is enough, and what is too much.

Another rule of thumb. You need to be sure that when it comes time to give her a shot, that her BG is "rising" and not falling. The only way to know that is to get a test sometime betwen +6 and +12. If you keep her dose constant, and her BG is actually still falling and not rising, then the insulin will have an even greater effect. Tonight, for instance, if you had tested at say +10, and got a 100, then again at +12 (PMPS) and got that 121, you would have known she was on her way back up, and you could have dosed her. BUT, probably at a reduced dose of 1u maybe. Again, because you really can't tell how much 2u did during the time between pre-shot tests today it's hard to say what a reduced dose would do for her tonight. So you were wise to not shoot, especially with 2u. and especially not knowing if her number was going up.

Here is my advice if you want to keep her dose at 2u. You need to get a test in around 6 hours after her morning shot. You also want to test her at +11 so that when you check her at +12 you will know for sure that her BG is rising. After each test you do tomorrow, fill in her spread sheet or post here. When it's time for her PMPS, post before you shoot. Someone will be here. Is that around 11PM? If so, I'll be online.
You are doing great. And those blue numbers look super, don't they?
Carl
 
The problem is I work 10 hour shifts on Sunday, Monday, and Friday, which is why I wasn't able to do mid-day blood tests yesterday. I will be able to do that on Tuesday, however. I do the tests at 8:30 am/ pm, so that I can check her before I go to work and once I get home. I was very surprised at the 121 last night; I didn't expect a number like that for a while. I will be testing her in an hour to see how she's doing, so I'll add that to the spreadsheet at that time. Thanks so much for the help you've given Katie and me so far! ^^
 
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