Oscar -Low BG, not sure what dosage to do??

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Renee2602

Renee2602

Member Since 2024
Oscar is 11, Melbourne Australia AEST and has an inoperable pituitary brain tumour and he is in palliative care on high dose steroids - 7.5mg morning and night (15mg daily). He is also on cabergoline every 48hrs, in his 3rd week now.

Started on 7units of toujeo pen day and night (12 hourly) on Friday 21st PM. His urine samples started returning negative and 1+ and 2+, much lower than his usual 4+. He usually urinates quite a lot and every 3-4 hours, drinks a lot, very hungry - Monday night he went 10 hrs without urinating and slept through. He does seem less thirsty. We went to the vet, got bloods and Libre sensor attached, came home and the Libre calibrated at 5.30pm, he ate dinner at 6pm and usually gets insulin at 7.30pm but the Libre was saying he was going between 5-6 mmol/L so we did not give insulin - vet had closed and won't open before his next AM shot. Libre then started saying he was in low 4's mmol/L. His usual specialist and local vet are away until Friday. He is rising to out of normal range now, I'm unsure how much insulin to give for AM dose?

I know Libre can take a few hours to get accurate, but we skipped a dose also based on his negative and 2+ urine strips. Wee at 8pm was 2+. It is 3.30am here now.

We do not do manual testing with a glucometer as he is in palliative care and we are limiting the amount of stress and injections he has to have, his brain tumour does mean he is more sensitive and stressed out by these things.

Do i need to fast him before checking his libre 2 hours before his insulin is due?

I do not know how to update the spreadsheet manually with Libre data so a rough timeline of glucose:

25/6:

6.30pm - 6.5
8pm - 4.9
8.30 pm - 4.5
9pm - 4.8
10 pm - 4.3 (he did go as low as 4 at this time but I was constantly looking at the sensor)
11.21pm - 6.7
11.30pm = 7.7

26/6:
1.11am - 8.7
1.30am - 9.3
1.36am - 9.9
3am - 13.1
3.30 am - 12.3

current - 12 mmol/L, just eaten food.


https://docs.google.com/spreadsheet...41YVIvwAJVc5kyPgVZuuM6FeotXSRJ#gid=1303057560
 
Renee --
Would it be possible for you to give one of our members, Bhooma, permission to transfer your data to our spreadsheet template? I suspect that where every you got the template, "borrowed" ours. The spreadsheet we use will automatically convert your numbers from mmol/L, to the format that's used in the US. There will be a page where you enter "World" data which then automatically converts the input and puts it on a separate page so those of us who are in the US can have a better grasp of the numbers. We really do need to have more recent data. You don't need to include hourly Libre readings though.
@Bandit's Mom

I'm also tagging @Wendy&Neko as she's more familiar with Cabergoline than I am. However, the Libre tends to be inaccurate at lower numbers. You get a false low.
 
Sienne and Gabby (GA) said:
Renee --
Would it be possible for you to give one of our members, Bhooma, permission to transfer your data to our spreadsheet template? I suspect that where every you got the template, "borrowed" ours. The spreadsheet we use will automatically convert your numbers from mmol/L, to the format that's used in the US. There will be a page where you enter "World" data which then automatically converts the input and puts it on a separate page so those of us who are in the US can have a better grasp of the numbers. We really do need to have more recent data. You don't need to include hourly Libre readings though.
@Bandit's Mom

I'm also tagging @Wendy&Neko as she's more familiar with Cabergoline than I am. However, the Libre tends to be inaccurate at lower numbers. You get a false low.
Click to expand...
Sorry about that I thought I had contacted the correct person to transfer my Libre data for me over into a correct spreadsheet. I give permission for anyone to do anything they need. Unfortunately what is in the sheet plus what I detailed in the post is all I have as we had to take a two week break from the Libre sensor, and relied on urine testing which was always always 4+, every 4 hours or so as he would urinate 5-6 times a day. He is sitting at 11.7 mmol/L now.

I am thinking of doing 6 units rather than 7 for his AM in 2 hours.
 
Without current data in a spreadsheet, I'm at a loss at what to suggest. If you could manually enter the data from your first post to the spreadsheet, it would help. Just leave the last few weeks where you have no data blank.

And as I've mentioned before, we have very little experience with Toujeo here. I'm not comfortable giving specifics on dosing.

I do know that cabergoline can start working in a couple weeks, but that's typically with the every day dosing. I'd recommend caution and lowering the dose, just in case cabergoline action is what you are seeing. I usually suggest people reduce if they see something as low as 3.9 (70).
 
Wo
Wendy&Neko said:
Without current data in a spreadsheet, I'm at a loss at what to suggest. If you could manually enter the data from your first post to the spreadsheet, it would help. Just leave the last few weeks where you have no data blank.

And as I've mentioned before, we have very little experience with Toujeo here. I'm not comfortable giving specifics on dosing.

I do know that cabergoline can start working in a couple weeks, but that's typically with the every day dosing. I'd recommend caution and lowering the dose, just in case cabergoline action is what you are seeing. I usually suggest people reduce if they see something as low as 3.9 (70).
Click to expand...
Would that be reducing by 1, so down to 6 units?
I’m having trouble entering data manually at the moment, but he is current 12.9 and hasn’t dipped below 10 since about 2am which was 4 hours ago. I recognise this could also be the monitor working correctly, maybe it was inaccurate before as it had just been placed.
 
Wendy&Neko said:
Entering data on the spreadsheet would let me know how long it's been since you last shot. I have too many questions without an up to date spreadsheet. Maybe start over with a new spreadsheet? How to Create a Spreadsheet
Click to expand...

This is the updated spreadsheet https://docs.google.com/spreadsheets/d/1QZWnEQiy8XyW7zOrO_z-DZjaz9hZAXC3EwnDDH5EapM/edit

so you can see what we have been doing the last two days. I don’t have data for the other days not filled in, aside from urine monitoring. Unsure whether to try going back up to 7 yet?

@Wendy&Neko @Sienne and Gabby (GA)
 
The top of the spreadsheet say you are shooting Toujeo SID, but the spreadsheet shows twice a day. Which is it?

We don't have enough experience in Toujeo here to be able to give a good answer. All I can see is that you skipped a dose a couple nights ago. With Lantus, that would deplete the depot and give you higher numbers for a few days. You'd wait for the depot to rebuild before deciding if the dose is working. But that's Lantus, I don't know the timing on how a skipped dose would impact the numbers with Toujeo. Maybe your vet can help you there?

With him getting Cabergoline now, I'd tend to be patient for a while longer.
 
Here is his updated spreadsheet fit to the FDMB template. He was getting once daily toujeo at the start and now is having twice a day toujeo. It is all based on the lowest marker in Libre data. I understand toujeo is not a common insulin in other countries, but I would still be grateful for any advice. The advice given to me from 3 fill-in vets (his specialist is currently away) has been to give half his dose when those numbers went into low greens, which we did, and so he'd go high again.

https://docs.google.com/spreadsheets/d/1uWV5M6VRZfmsNBZIrFvXwie27JtviT8J9CNmDprrCVk/edit?gid=5#gid=5
 
He's also bouncing now from those greens. He's shown he takes 5-6 cycles to clear the bounce. Hopefully that means he'll clear that tomorrow and you can see if he'll go lower on 5 units.

If he was on Lantus or Levemir, I'd also consider how long it takes to build the depot after the reduced shots. But I don't know that answer for Toujeo. As I said previously, maybe the vet can answer?
 
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