? Urgent dosage advice needed after a low today (45) for Misty

She definitely earned a reduction by going below 50. You need to reduce the dose. I would reduce by one full unit (ten percent of the total dose) and take her down to 10 units and keep a close eye on her because she could start earning more reductions quickly. I see she had SRT a little over 2 months ago You may want to create a custom reduction point of something higher that 50 due to her SRT — if it looks like she’s going to start having a lot of lower BG. She’s not taking any other medication like Cabergoline is she? I know that our moderator and Acromegaly guru, Wendy, will come along to comment as well as soon as she’s available.
 
Suzanne & Darcy said:
She definitely earned a reduction by going below 50. You need to reduce the dose. I would reduce by one full unit (ten percent of the total dose) and take her down to 10 units and keep a close eye on her because she could start earning more reductions quickly. I see she had SRT a little over 2 months ago You may want to create a custom reduction point of something higher that 50 due to her SRT — if it looks like she’s going to start having a lot of lower BG. She’s not taking any other medication like Cabergoline is she? I know that our moderator and Acromegaly guru, Wendy, will come along to comment as well as soon as she’s available.
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Thank you, Suzanne! I held off on Cabergoline (I actually have some) for fear of her having a major drop. I gave 10.5 tonight (before you had responded). She is at 183 +4 on her PM dose. Will be monitoring very closely tonight!!
 
Suzanne & Darcy said:
It looks like maybe the SRT is gradually affecting the BG. I hope that soon you will need to reduce a lot more. :)
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Well back to 300s today. But she did have hi carb foods yesterday. Will stay w 10.5 for a few more doses. Have message in to internist as well. She is showing some stomach upset now w new food but only since I stopped mixing in RC glyco. As soon as she goes 100 percent on a new low carb food this happens! Will backtrack to 75/25 again. Such a science!!!
 
Sorry for the late delay, was out of town.

Looks like she was/is bouncing from that 53 a couple days ago. Bounces can take up to 6 cycles to resolve. Meaning as long as to tomorrow night or maybe the day after.

We generally suggest 1 unit changes (up or down) with a dose over 10 units, so I agree with Suzanne a reduction to 10 units would have been what we would have said. TBD what she decides to do when the bounce is over. Under 10 units, changes are typically by 0.5 units, until they get under 5 units when even smaller changes are suggested. Think about 10% of total dose.

After SRT, CSU suggested to me that I reduce when Neko went under 70, instead of under 50 as per Tight Regulation. That gave me just a bit more margin of error and worked for us. SRT action can come in waves, so you do have to be cautious and take reductions when earned. Once Neko's SRT action seemed to be on pause, I went back to the regular reduction point.
 
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