Strange curve patterns showing up

[Papa Stark]

Twice during this past week (9/28 and 9/30), Snow's day numbers have been kind of... odd. Specifically, his PMPS read has been almost even with his mid-cycle/nadir read.

After a scare last week (9/25) when it was *lower*, managed to get across to the rest of Snow's loving subjects that we were being too aggressive and it was time to reboot - vet had started us at 2u and bignums made us think we should move up to 2.5 - we were mistaken. We went back down to 1u and have been having better luck, but this is a headscratcher.

9/28
AMPS 399 1u
+6 179
PMPS 184 1u (this time, I didn't catch the oddity until after giving him his PM shot, thus the full overnight curve to make sure he was okay. Lovely bounce at 3AM )

9/30
AMPS 384 1u
+7 228
PMPS 235 1u (this time, I reasoned that,despite the odd curve shape, his number was high enough that skipping the shot was not a good move)


I've been searching around the web, looking at what the various graph shapes could indicate. I've seen dose too high, bounce, insulin resistance... none of the graphs look like this. On thinking about it, the only thing I can come up with is maybe his feeding schedule needs to be adjusted a bit (it's currently 2/3 at shot time + 1/3 at +2 for day feeding) or maybe he's not being fed enough, but I'm not sure enough to act on the theory without asking folks who might have a better idea.

 

[BJM]

Remember to consider the +/- 20% range around the test; this range gets wider as the numbers increase. If the ranges for 2 different tests overlap, the numbers may be considered the same. (The high estimate of the low number is greater than the low estimate of the high number)

AMPS 288 -> 230.4 - 345.6
PMPS 329 -> 263.2 - 394.8

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[BJM]

With a full week on 1.0 units of ProZinc, and nadirs above 150 mg/dL, you could slightly increase the dose to 1.25 units.
We eyeball this, as no OTC diabetes syringes measure 0.25 of 0.75 increments.

However,
If you use a conversion chart, you can use U-100 syringes with U-40 insulin.

U-100 has 100 units per mL.
U-40 has 40 units per mL. It is 40% the concentration of U-100.
Because ProZinc is a U-40 insulin, it has a concentration 40% of a U-100 insulin. If you multiply the U-100 syringe marks by 0.4, you get how much U+40 insulin the syringe would be measuring.
Mark * 0.4 = U-40 amount
0.5 * 0.4 = 0.2 units
1.0 * 0.4 = 0.4 units
1.5 * 0.4 = 0.6 units
2.0 * 0.4 = 0.8 units
2.5 * 0.4 = 1.0 units

 

[Papa Stark]

Blah, even with 100U I won't be able to get 1.25 even.

I was looking at his numbers considering a dose increase like you said, but I was too worried about those weird "static" days.

In a related question: once you've drawn prozinc into a syringe, how long is it good for (if it remains in the fridge)? Grandma's eyes aren't what they used to be, so if I can pre-load a couple of days' worth at a time, it might save her some squinting.

 

[Sue and Oliver (GA)]

Hard to know. I think the one higher nadir is just an odd cycle. You don't want to get hooked up wondering about one cycle or one number - just keep watching the big picture.

If you are nervous about increasing by .25, you could give a fat one unit to see if his nadirs drop a little. (He has a ways to drop - above 50 is okay.) A fat dose is when you draw up more than one unit and let out drops until it is just a little more than one. If you want, you can mark a sample syringe filled with water dyed with food coloring at that amount with a marker or tape. Then it would be pretty consistent.

Or you might increase on a day you know you will be around so you can see exactly what it does. If need be, you can steer the numbers up with food.

They suggest not prefilling syringes. I don't think it would hurt once or twice, but I don't know that I would do it consistently. If you do it for her, remind her to roll it gently before injecting.

 

[Critter Mom]

... Grandma's eyes aren't what they used to be, so if I can pre-load a couple of days' worth at a time, it might save her some squinting.

I use a jeweller's loupe with an integral LED light to help read the syringe (20x magnification). You can pick them up for reasonable prices on ebay.

 

[Papa Stark]

... Grandma's eyes aren't what they used to be, so if I can pre-load a couple of days' worth at a time, it might save her some squinting.

I use a jeweller's loupe with an integral LED light to help read the syringe (20x magnification). You can pick them up for reasonable prices on ebay.

Oh, I've already got several, from back when I used to do surface-mount work. I've given her three for various things. She uses it once or twice before either forgetting about or losing it.

So I'll start him on the 1.25 dose come tomorrow morning, which means I need some rack. Thanks, everyone.