too little insulin

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Carol & Murphy (GA)

Carol & Murphy (GA)

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I cut down a smidge today due to Murphy's low pmps yesterday - but today he had an early nadir and after +9, he is up in pinks --- so what if 2.25 is a little too high, but a fat 2 (still waiting for the 100 u syringes) is too little?
 
I just ordered the U100 syringes today - I will probably get them next week sometime In the meantime, I do have U40 syringes with the half unit markings
 
Hey Carol. I have a couple of questions.

1) What type of syringes are you using? For most of your doses, it looks like you are using U40 but there were a few that might have been using 0.2 increments (U100 doses) but am not sure. I am going to assume that you are using U40's.
2) I am a little confused regarding meters. Are you using an AlphaTrak or human meter? Your SS is matching a human meter but your signature indicates AlphaTrak SS. I am going to assume that you are using an AlphaTrak meter. You may want to add what kind of meter in your signature.

So with all that said, I got to say that Murphy really tested me tonight. This was a bit of a challenge but that is a good thing because I love challenges and I love Murphy.

Here are my SS observations.
1) Since 10/1, Murphy's AMPS was 70% of the time higher than PMPS. (Total 41 cycles, Murphy's AMPS number was higher than the PMPS number 29 times).
2) Since mid--September, your nadir has been lower when you predominately shot between 1.75 and 2.25. When you were shooting a higher dose (3 units), he seemed to run higher and flatter, even with similar numbers.
3) Murphy, lately, has been pretty sporadic. An example would be on 10/29 & 10/30. Similar high number, same dose but one dropped an additional 100 points. He did this several times so it was hard to land on solid numbers/doses due to his inconsistency. Another example was on 11/1 and 11/3. You gave the same dose (2.25u) but the AMPS were 516/393 respectively and yet the 516 dipped too low and the 393 was a very safe, low cycle. Murphy, your making me crazy! So bottom line Carol, I am so glad that you are sooooo good about testing.

So here are my suggestions in relationship to my observations above (1-3).
1) I would suggest that you move to a 12.5/11.5 schedule. That means that you would go an extra 30 minutes to shoot your PM shot. Example: 5:30am/6pm.
2) The sliding scale was created based on the majority of your dose range of 1.75 - 2.25 units since they have been pretty successful in getting Murphy into the blues here recently. The range of the new sliding scale is from 1.50u - 2.50u. You may find that your sliding scale may need to include additional doses such as 1.25u and 3u. But for now, I did not include those numbers since you have not been shooting those numbers.
3) Since Murphy has been sporadic lately, this sliding scale may be a little conservative. I just want to give you something to start with. Test it out for about 4-5 days and then start "tweaking" it. You will need to continuously study and update your sliding scale based on Murphy's nadir. I will explain how to "maintain" your sliding scale later. I also will not go any lower than 180. That will be up to you if you want to shoot lower which is fine. It is just we don't have any history on that yet.
4) Indicate on your SS your new sliding scale and every time you change it, update it and indicate that on your spreadsheet. If you do go to a 12.5/11.5 schedule, indicate that on your SS too. Draw a color line or something that will draw your attention to indicate these changes. That way, it is easy to figure out what is working and what is not.

Murphy's Sliding Scale
180 - 240 1.50
241 - 300 1.75
301 - 360 2.00
361 - 420 2.25
421 plus 2.50

So, how do you adjust or maintain a sliding scale?
With each pre-shot number, I will dose according to my sliding scale while also reviewing my spreadsheet for a previous, same number and compare. This comparison or continuous cross checking helps to "confirm" your dose. When I am testing a new dose, I usually test at +4. At least for Merlin, that is when he will go low. I typically try out a new dose during the day so I can test throughout the day if needed. If a dose gives me a safe green or even low blue number, I do not change the sliding scale. If the nadir is too high, I may adjust my sliding scale but I usually wait to get a similar number one more time before I change my scale. Once I get the same results, two times (this is why I look at previous numbers and doses), then I change my sliding scale. I also will put something in my comment section indicating that I have a "pending" change as a reminder to change next time. If I get a low, unsafe number, I may change my sliding scale immediately or wait till I get another too low number twice. Regardless, I am always comparing my doses with previous numbers hence, tweaking the sliding scale when needed.

So hope this helps...holler if you have any questions.
 
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thanks a million Cindi - I used the sliding scale this am I guess I used the wrong spread sheet when I set it up - I do use Alphatrak -
I'll work on updating the spreadsheet. I know that Murphy does not have a consistent response to a set dose of insulin so I can only imagine how difficult this was to come up with - I so appreciate it
I see that you came up with 2.5 for anything >421 - I might be a little skittish about that seeing as 2.25 got me so low -but we'll see maybe I'll be brave one day
He has diarrhea today so not sure if that will impact his BG today
thanks again
 
Yep I hear that regarding the 2.5 for 421 plus. However, you gave 2.5 the following recent dates and the numbers were good and I don't think you had to intervene because I didn't see anything in the comment section.

11/3 393 2.25u low 83
11/6 329 2.25u low 169
11/8 446 2.25u low 92
11/9 427 2.25u low 127

So, you have room to go lower according to the numbers above. In mid-September to mid October, you gave 2.25 and 3 units when he had high pre-shot numbers and 2.25/3 units didn't even give you any blue nadirs let alone any greens. The only number I was concerned with was on 11/1 when he gave you a 516, you gave 2.25u and your low number was 66. But this was just one number; one time.

Bottom line, you should be fine because you do such a great job of testing.
 
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Hi Sharon - I'm sleep deprived but not too bad. For the first time since I have had him, he's had diarrhea this morning - cleaning his litter box, he had about 4 big normal stools (normally he has just one a day) and then I saw him have another very soft, smelly stool. He doesn't seem ill though. He thankfully ate a little pumpkin and I also put a bit of psyllium husk for fiber in the pumpkin

How are you? I see Colin is being Colin--is he still on antibiotics or anything from his dental?
 
We are finished with antibiotics. I'm actually fairly happy with him today. He's going down, not much, but considering the last few days when he went up post shot, it's an improvement. I'm wondering if there could be something going on in his mouth though. Maybe some inflammation or something. I can't see in there too well, he won't open wide for me! So if things don't improve I'll take him in for a check.
 
Sharon14 said:
We are finished with antibiotics. I'm actually fairly happy with him today. He's going down, not much, but considering the last few days when he went up post shot, it's an improvement. I'm wondering if there could be something going on in his mouth though. Maybe some inflammation or something. I can't see in there too well, he won't open wide for me! So if things don't improve I'll take him in for a check.
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that sounds like a plan
How many horses do you have, Sharon? do you ride them?
 
I own 5 horses, but board 4 more. I ride one of the ones I board. I used to show in western events and even made a living training for a bit. Right now I'm waiting on the farrier. He's late, as usual...
 
Sharon14 said:
I own 5 horses, but board 4 more. I ride one of the ones I board. I used to show in western events and even made a living training for a bit. Right now I'm waiting on the farrier. He's late, as usual...
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Wow - do your horses know their names? I know nothing about horses, except that they are spectacularly beautiful
 
Sharon14 said:
I own 5 horses, but board 4 more. I ride one of the ones I board. I used to show in western events and even made a living training for a bit. Right now I'm waiting on the farrier. He's late, as usual...
Click to expand...
Wow, Sharon! Do you take care of the stalls yourself?
 
They know them when they want to. They all come running when I call though. It's pretty cool because my pasture is long and hilly. You can hear them before you see them, 'thundering hooves' is a pretty accurate description.
 
Bobbie And Bubba said:
Wow, Sharon! Do you take care of the stalls yourself?
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Yes, although they stay out in the pasture for the most part. The old ones stay in out of the heat of summer with fans and I keep them out of cold rainy weather. They have blankets for real cold(which is seldom) image.jpg
 
Hey Carol. Just checking in. BTW I love the BIG RED Alpha Trak sign. That will get my attention.

So you have a couple of numbers that should be in "pending" status because they did not get your goal of a low blue or high green.

11/11 AM 275 1.75u dropped 100 points & the low was 186 however we will want that lower
11/11 PM 318 2.00u nadir was 320 ugh! What happened Murphy?
11/12 AM 365 2.50u nadir is 299; just running flat today with a 164 drop

So you want to keep an eye out for these numbers (or close to it). If they give you a similar drop the next time, then you will want to move your sliding scale.

There are two ways you can move your sliding scale. One way is to move (increase) the whole scale by 0.20u just like Lisa (@Likameow) recently did. I created the sliding scale more on the conservative side, as a starting point, so we are pretty much sure that some of these numbers are not going to get you to your goal at first time through (but as always, I am hopeful that they do). The other way is to shift numbers independently. You will probably do this once you get a little closer to the right doses.

So let's go for a few more cycles and then see if we need to increase the whole sliding scale or just in a few areas. Sounds like a plan?

Oh one more thing...if you don't mind, can you add one more thing to your spreadsheet? We started this first sliding scale on 11/11. Would you mind inserting a row above that 11/11 and color it? That way, it will tell us that you have started using a sliding scale on 11/11. Then in the comment section, just put "Started Sliding Scale." I also suggest putting the current sliding scale that you are using in the comment section close to where you are currently updating. These additions will help you know what sliding scale you are currently working on and when you started.

You don't have to do it the same as mine but you can check Merlin's SS just to get an idea how I track my updates. You can see my current scale but you will have to scroll up to see my other ones. Every time I update it, I color code the box in the comment. You can also see in my comment section, where I am focusing on a particular number, where I have them in "pending" status. As I move down the spreadsheet and am using the same sliding scale, I just move that sliding scale down the page. You can also check out Lisa and Ben's (Likameow) spreadsheet. She indicates the changes so we can better track the changes.

If you decide to put the sliding scale in the comment section you can state it this way: 180-1.5, 241-1.75, 301-2 ,361-2.25 ,421-2.5 so it can fit in your comment section.
 
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Merlin said:
Hey Carol. Just checking in. BTW I love the BIG RED Alpha Trak sign. That will get my attention.

So you have a couple of numbers that should be in "pending" status because they did not get your goal of a low blue or high green.

11/11 AM 275 1.75u dropped 100 points & the low was 186 however we will want that lower
11/11 PM 318 2.00u nadir was 320 ugh! What happened Murphy?
11/12 AM 365 2.50u nadir is 299; just running flat today with a 164 drop

So you want to keep an eye out for these numbers (or close to it). If they give you a similar drop the next time, then you will want to move your sliding scale.

There are two ways you can move your sliding scale. One way is to move (increase) the whole scale by 0.20u just like Lisa (@Likameow) recently did. I created the sliding scale more on the conservative side, as a starting point, so we are pretty much sure that some of these numbers are not going to get you to your goal at first time through (but as always, I am hopeful that they do). The other way is to shift numbers independently. You will probably do this once you get a little closer to the right doses.

So let's go for a few more cycles and then see if we need to increase the whole sliding scale or just in a few areas. Sounds like a plan?

Oh one more thing...if you don't mind, can you add one more thing to your spreadsheet? We started this first sliding scale on 11/11. Would you mind inserting a row above that 11/11 and color it? That way, it will tell us that you have started using a sliding scale on 11/11. Then in the comment section, just put "Started Sliding Scale." I also suggest putting the current sliding scale that you are using in the comment section close to where you are currently updating. These additions will help you know what sliding scale you are currently working on and when you started.

You don't have to do it the same as mine but you can check Merlin's SS just to get an idea how I track my updates. You can see my current scale but you will have to scroll up to see my other ones. Every time I update it, I color code the box in the comment. You can also see in my comment section, where I am focusing on a particular number, where I have them in "pending" status. As I move down the spreadsheet and am using the same sliding scale, I just move that sliding scale down the page. You can also check out Lisa and Ben's (Likameow) spreadsheet. She indicates the changes so we can better track the changes.

If you decide to put the sliding scale in the comment section you can state it this way: 180-1.5, 241-1.75, 301-2 ,361-2.25 ,421-2.5 so it can fit in your comment section.
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Hi Cindi- thanks again for spending so much time with this
I hopefully fixed the SS ok but I am confused about the pending numbers - I didn't see any on your spreadsheet and I don't really understand the concept here - sorry I am feeling dense about this I'll be checking his pm +5 in a few hours - finger crossed I get at least a yellow
I hope you do get the book "Wesley the Owl" - since you work with them, you're going to love it
 
Hey Carol. Just got back from taking a Swainsons Hawk, Screech Owl, Burrowing Owl and a Great Horned Owl to a Science Cafe Phoenix Library. It was a great event with a mix of adults and little kids. The kids had such good questions.

Your SS looks great!!!! Thank you and I think you will like being able to quickly identify any pattern caused by something you have changed. Regarding the pending doses, I just put something in the comment section that will indicate a number that I am "watching" and I may change. On 11/2 and 11/6, there was a dose that I increased but wasn't sure if I was going to update my sliding scale yet.

I am definitely going to buy "Wesley the Owl" book. Thank you so much for suggesting that.

Isn't tonight's (PM) cycle interesting. Almost same number, same dose as of last night and nadir is almost 150 points difference. Murphy...you are really testing us!
 
I saw that and couldn't wait to see your next test after that green. Great job in trying out that 2.5u too. Well it looks like that number (435 w/ 2.5u dose) is a keeper! So glad that Murphy had a wonderful day. Woo hoo!
 
@Merlin Hi Cindy - take a look at Murphy's spreadsheet - so far, it's working out pretty well
today surprised me - I thought it was going to be a flat day, but then he really dropped between +5 and +6, which I wouldn't have predicted also, his nadir still seems to shift day to day
 
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Hey Carol and Murphy. I saw your +4 yellow just after you posted it today. I can see where you thought he was going to be flat and then he surprised you. I was kind of hoping for maybe a yellow at PMPS too. Darn. I saw that you fed before you got that 216 today at +9. Which food did you give him?

I also see that he is generally running higher at night time ... just an observation.

Are you still shooting every 12 hours? Just asking because Murphy has flipped i.e. only 1 out of 6 AMPS is higher than PMPS in which before he was the opposite. I am seeing some pretty big drops, nice drops by +3 and/or +4 but then jumps up rather rapidly towards the end. The good thing I saw today was he was under 220 for at least six hours.
 
Merlin said:
Hey Carol and Murphy. I saw your +4 yellow just after you posted it today. I can see where you thought he was going to be flat and then he surprised you. I was kind of hoping for maybe a yellow at PMPS too. Darn. I saw that you fed before you got that 216 today at +9. Which food did you give him?

I also see that he is generally running higher at night time ... just an observation.

Are you still shooting every 12 hours? Just asking because Murphy has flipped i.e. only 1 out of 6 AMPS is higher than PMPS in which before he was the opposite. I am seeing some pretty big drops, nice drops by +3 and/or +4 but then jumps up rather rapidly towards the end. The good thing I saw today was he was under 220 for at least six hours.
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Murphy thanks everyone for their good wishes. One thing that is changing is that wet food is now a major component of his diet!!
Cindi -sometimes I have shot 11.5/12.5 - I should mark it - but the last few days I have been shooting 12/12 - mostly because either I over sleep or Murphy is so hungry I haven't had the heart to stall his food. Today he was so hungry between +6 and +7 - I promised him after his +7 test, he could get something to eat so he got ~ 2 Tbls of wet food (so no carbs) I was surprised that his next test was a yellow
 
Yeah so glad to hear that he is enjoying more the wet food. Aww that is so sweet and am so glad he got his snack at +7. Ok - just wondered about the timing of shots. It is funny that he flipped. You could try shooting 30 minutes early at night in hopes you can get to him before he turns red. I wish Merlin was like that. I would rather shoot 30 minutes early at night than 30 minutes later at night.

Are you comfortable with the doses so far?
 
Yes, so far doses seem okay - but I still am not convinced that his reaction is totally predicable to any given dose,
I would love to shoot 30 minutes earlier at night - that means I can either go to bed earlier or I can grab a test that is a little later
 
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