Question about reducing.

Max has been at 3 units for a while now, had has blood sugars consistently in the 70s at most readings. We've been doing spot checks recently due to ear hematomas in both ears, so last few weeks I don't have a ton of readings. The hematomas have resolved. I think they were related to his seizure behaviors and scratching rather than blood checks. I forgot to cut his nails and they were talons.

I was thinking, even though he hasn't "earned" a reduction, his numbers are great, and I'm wondering if his pancreas is only kicking out what it has to, that if I reduce, his pancreas at this point could make up the difference. Max does get glucose toxicity pretty quick when his numbers get high, but at what point in good numbers do you continue to reduce to check for the possibility of remission?

 

According to the Start Low Go Slow dosing method, you would do a curve, either every 2 hours for 12 hours or every 3 hours for 18 hours. Based upon the results of that, you would decide on the dose.

Just looking at the data you have, I can tell you that it would have you reduce by 0.25u because you have nadirs under 90.

 

I'm trying to keep him closer to TR, although testing has been an issue lately because I was out of town for a while and because of these stupid hematomas that woundn't heal and I'm afraid they'll come back.

Do you think maybe he'll hold his 70s-all-the time as he has been if I reduce. Maybe his pancreas will pick up the slack? Or if I reduce, I'll just send him back up and have to do a roller coaster again. Maybe I should just let it be.

I'll try to do a curve and see where we are at, get some night numbers too maybe.

 

Hard to know what he'll do if you decrease the dose, but the testing is an essential part of TR - a minimum of both preshots and one mid-cycle. So during the time that you can't test, i'd go with the SLGS guidelines to keep him safe. When life returns to normal if you want to go back to TR and can do the testing, then go for it.

His ss does have a lot of 70's in it! He does look tightly regulated right now, but I'd be worried to hold him in this range without more testing. If his hematomas heal, that might reduce his blood sugar, and therefore his dose would need to be decreased to compensate. Infections, inflammation, pain can all increase BGs, and when they resolve the BG can decrease.

That's just my 2 cents worth, though - you know him best.