Dosage Change Following Low (Hypo Level)

Woke up to G making gagging sounds and then had diarrhea. (She is fine now with no recurrences of either) Checked bg and got an initial reading of 61 which I recorded on the ss under +6. Since this was mid point of cycle suspect she was possibly lower. Gave her a tablespoon of hills m/d. 20 minutes later she was at 66. In the interim I performed a control test on meter and strips since the 61 was with a fresh vial of testing strips. Control test reflected everything working properly. At +7 she is resting safely at 114. At +10 she is holding at 104.

G is beginning to show response to insulin again after a long course of antibiotics and anti fungal medications prescribed by a new vet. Granted this is also a new vial of insulin.

I was reading an article on glucose curves (I think it was Vetsulin website) and my question is what should my next dose be 5 hours from now given the 61 shown on the current dose. A drop from 550 to 61 is obviously severe. From what I am reading, this is an indication of too large a dose of insulin and I should either be going to half the dose or starting out at 1 again (which I don't think I should).

What thoughts if any ? I want to attempt to get this right this time as there are low reading episodes in G's past where I may not have taken the appropriate action. So alternative thoughts would be appreciated and I thank you in advance.

 

I wouldn't drop the dose in half but a reduction is in order. I suggest you try 4 u if she's over 200 at pre shot time. If that worries you, go to 3.75 u.

 

Thank you. The worrying isn’t what troubles me as I’m used to it. With all her problems I am concerned that I have missed the right dose.

Recognizing there will be a bounce, would it be suggested to hold the 4 U for a number of cycles? I’ve held the 4.5 for the most part due to the other problems that now appear to be clearing. I realize that it was held for an inordinate amount of time. But the other situations were clouding the issues and insulin response.

Still not out of the woods by a long shot.

Thank you again. You’ve been great as always. I’m still trying to understand it all but keep getting other issues thrown in the mix.

 

How long to hold a dose is a judgment call quite often. Some basic guidelines:

• if numbers are high, hold it no longer than 3 - 4 cycles and then increase to avoid glucose toxicity building up
• if you have a lime green you would generally lower the dose next shot time unless you have a lot of data showing lime greens as single "overreactions" to a new dose, etc.
• if nadir numbers are ideal (dark greens to low blues) keep that dose as long as the good nadirs last.

 

Appreciate the help and most importantly your time.

 

UPDATE: AMPS is at 89 - First reading was 79 - Stalling at the moment, but this looks like another no shoot. I may need to go ahead a feed her since she is now apparently dropping again.

 

No shot for sure! That new vial of ProZinc is showing you what it can do! She might end up needing a much larger dose reduction.

 

Thank you @Kris & Teasel for your continued support and willingness to share your wealth of knowledge and experience. I know you and others have been holding my hand for quite some time, but I'm still going to need it from time to time if that is okay with you all.

End of Stall - Still showing 87 so this is going to be a no shoot morning. Feeding her now. Will post numbers during the day as I can but unless too low again tonight (which I doubt based on her history), will be reducing to at least 4 U. Not sure what would justify larger decrease.

For those that have been following her, Cushing's was determined to be unlikely as the ACTH was 6.1 (pre) and 8.1 (post) coupled with normal liver panels.

The growth that formed overnight between her eye and ear is now gone. The new vet inserted a needle, took a sample, performed a culture and determined the correct antibiotic to be using. The skin condition is greatly improving as the sores are now healing and hair is beginning to grow back.

Additionally, the new vet found a fungus and put her on anti fungal medications which are now finished for the time being. 3rd follow up appointment is set for the upcoming Monday.

She still has other issues we cannot determine at the moment, but I am beginning to now have confidence in this new vet. A bit of a drive and expense with toll road involved but I'm finally seeing progress.

 

Wow! G is definitely ready for a decrease huh?

We're here to hold your hand whenever you need...we've all had our hands held in the past, and are glad to pay it forward!

 

I think so. She has spiked over 500 in the past 2 hours which I will enter into spreadsheet when I can. Still will try 4 U for the next few cycles and see how she responds. Thanks for your support @Rachel . Always there when I am flailing.​