? Dosing dilemma with Rusty

So, we're having a bit of a dosing dilemma with our guest, Rusty. We had him down to 0.05u and he held normal numbers for a week, with one drop under 50. So, at his Mom's request, we tried him off insulin for a day (she'd like to have him home now, but isn't sure if she can give shots twice a day at the moment). He went back up over 120 in the first 24 hours, so we put him back on 0.05u and made him earn his reductions the usual way. He had his 3rd drop under 50 yesterday so I started him on a trial last night with a PMBG of 81. This morning, he was up to 124. I was a little late with food for them all, so they got food at around +1. I tested him at +3 and he's at 117, so essentially hasn't shown a drop after processing the food.

So, the dilemma I have is that 0.05u appears to be too much insulin, but no insulin at all isn't enough. And I have no way of measuring anything less than 0.05u - that comes out as just one tiny drop as it is! What do I do next? Clearly he isn't quite ready for OTJ yet, but I can't dose him. Do I try once a day dosing or should I give him a day or two to see if his numbers settle better into the normal range?

Rusty's spreadsheet is here https://docs.google.com/spreadsheets/d/1anaJvMOP-G1lu1ZYm_hBKd3j_e9HyvzWaUoffGn9jso/edit?usp=sharing It does only cover a few weeks as his original spreadsheet hadn't been kept up on so was out of date (his Mom had been keeping a paper record, but I don't have that available). The numbers on the first couple of days were similar to the ones that his Mom had been getting, but from then on he started doing a lot better.

 

Are you giving Rusty a snack around +8 to +9 each cycle? And several small meals throughout the day? I'd try giving him a bit more time on the trial before giving up. Getting a little bit of blue at first is not uncommon. Are you testing him with the Relion Confirm as well?

 

He actually free-feeds apart from the 2 hours before shot time. And I do often catch him taking just a couple of mouthfuls of food during the day, so I'm pretty sure he's snacking quite regularly. I can't pull the food between snack times unfortunately because I need Regan to eat as much and as often as she can as she lost weight both after Rosa passed and then again a few weeks later when she started with oral stomatitis, so we're trying to get her to snack frequently too! I am using a Confirm for Rusty, but it's his own one, not the one I used for Rosa which Regan has now inherited so I can make sure the steroids she's on aren't making her diabetic too! It's all action in our house at the moment - Roxi still isn't regulated (and her spreadsheet desperately needs updating - I have all the numbers, but they haven't been input in months) and I've only just got her in the last week to the point where I can occasionally test her without a second person on hand to stop her biting me!

I'll give him another day or so and see if he settles though - thank you for the help.

 

If his numbers do creep up more, another option is to go back on the 0.05 unit dose, but give him slightly higher carb food.

 

I will keep that one as the secondary option at this point I think. Regan can handle more carbs of course, but with Roxi's regulation still a bit up and down, I'm trying to keep her carb intake fairly level so I at least know that isn't a factor in her numbers. But if he really needs it, I can try giving him a +2 snack of a medium carb food in a room on his own and see how that goes for him.

 

Beautiful PMBG Go Rusty