Super bouncing, need advice. Just tested at 34.

Edgar was getting steady at one point, but now seems to be super bouncing all over the place. I just came home to give him his afternoon pill and he seemed fine. On a hunch I thought to test him and his BG on AlphaTrak 2 was 34!!!!!!! I used the testing solution to see if maybe the strip was whack and it was within acceptable range. Fed him high carb food (Old Urinary S/O) mixed with some of his EVO and some Stella and Chewys. At 15 minutes after it was up. (see spreadsheet). But when I look at the numbers, I see he's bouncing like CRAZY lately.

I'm going out of town for two weeks starting on the 14th. Thank goodness I have a vet tech staying with him, but I know the guy isn't going to be as obsessed and on top of it as I am. I want to try and get him more stable, but I don't know if I have enough time to get him there.

My thinking is maybe his Lantus dose is too high right now? And maybe his peaks and valleys are too vastly different, so he's all over the map? God, I don't know. Any thoughts or advice are well appreciated.

 

Your dose may be too high. I say this because you're having to skip shots due to low pre-shots and you got a possible 32. You might try reducing a quarter unit.

 

I think it's too high too. I recently decreased .25 from 2.5 to 2.25, but I'm thinking I should definitely go down to 2. Totally freaked out when I got the 34 reading.

 

Have you picked which protocol you want to follow for Lantus?
Tight Regulation
Start Low, Go Slow

And you're ready to post in the Lantus forum, where you'll get feedback from experienced Lantus users,

 

there's no way I can do the tight regulation w/ my schedule unfortunately, so it's gotta be the low and slow

 

That's fine. Maybe add it to your signature.

Editing your Signature

In the upper right corner of the screen, within the dark blue bar, you will see ID, Inbox, and Alerts

Click on your ID.

On the left, under Settings, Click on Signature.
This is where you will put information that helps us give you feedback.
This is where you paste the link for your spreadsheet, once it is set up.
Add any other text, such as
your name,
cat's name,
date of Dx (diagnosis)
insulin
meter
general location
any other pertinent issues like if there are any food issues, history of DKA, hepatic lipidosis, pancreatitis, allergies, IBD, etc.
Click the Save Changes button at the bottom.

Always click the Save Changes button at the bottom when you have changed anything.

 

Well, he earned himself another reduction down to 2 units from that 34 at the very least!! I notice you've had to skip a couple of AM shots though which might mean he needs reducing a bit more than that so you can give him both shots most days...that might help the bouncing by leveling him out across the 24 hours too. Problem is, I'm not really sure how much to reduce by to level him out so he can have those AM shots - I completely see why you skipped them when you couldn't be home to monitor.

He is fairly bouncy at the moment, but some of that might well be from the skipped shots as well. My concern is that the 2.25 dropped him down to 34 even with the shots you've had to skip. I also wonder if he might have dropped under 68 the night of the 30th...that 92 AMPS on the 1st is fairly low if it was a rising number. And the way he drops from high numbers into green might indicate that he's going low more often than we're aware of on days when you can't monitor him mid-cycle.

Reading back on his spreadsheet, you had some fairly low numbers on 5/21 when you skipped the PM shot - on SLGS that 75 actually earned him a reduction then and that was with his shot being skipped that night! And then a 68 for AMPS on 5/24...again, if that was a rising number then he would have been lower overnight and the 68 itself on SLGS earned him a reduction but then his dose was increased on 5/28 from 2U to 2.5U where it looks as though what he had really needed even before that was a reduction. He earned a reduction on 5/28 with the PMPS of 65, but it looks as though the reduction wasn't given. He went under 90 on 6/26 (again on a skipped shot) and again on 6/27. The problem I'm have working all this out is whether those reduction should be cumulative (or at least partially cumulative) or if it would have been the same reduction earned several times in a row - I would REALLY appreciate some more opinions on that - but either way it looks to me as though he might actually be running those higher numbers from too much insulin rather than not enough.

 

You could reduce by 0.5 units to let the depot drain and see how he does. At most, he might need to be nudged back up 0.25 units.

 

Wow wow wow, April, thank you so much for taking such a detailed look at it!! Looking back on it (and now with way more knowledge and understanding than I had before) I think that yeah, he should have been reduced way prior. I'm definitely bringing it down ASAP.

 

You're very welcome! I have the day off today so had a bit more time to look back on Edgar's spreadsheet in detail than I did the other day when he dropped low at night - if I remember right, we both had to wake up early for work the next day!!

 

oh my yes I do remember. Oy. I passed the heck out that night.

I have a spreadsheet question, too. I would love to "see" his numbers represented graphically. I can process the highs and lows so much better with visual representation. I'm sure there's some sheets formula that would easily turn our numbers into graphs, but I'm not exactly an excel wizard. Any ideas?

 

Let me see what sort of charts I can get running using a copy of Rosa's spreadsheet. I'm better with Excel than Drive sheets, but they are fairly similar - there has to be a chart that will do what you want to see.

 

Ah! I knew you would know something about that. I'm going on a walk with my mom for now but I'll be back later.

 

Enjoy your walk - I'll let you know what I can come up with once you get home.

 

I took the past 2 weeks of glucose tests from am to pm pre-shot, averaged them for each time period*(using the number of tests as the denominator), and plotted them in Excel.
The average dose, including the skipped days in the average was 2 units.
What do you think?

 

oh interesting. I was thinking of plotting all the points to get an idea of the nadirs and such, but that's neat to see. thanks!

 

The curve of the averages suggests that the nadir is around +5 to +6. (drop a line straight down from the lowest part of the estimated curve).

 

that looks about right!!

So say just for my curiosity's sake... If you look at the sheet 3 that I put in there. What if I wanted to make the x-axis a combo of per hour/per day (is that possible?), with the y-axis the BG numbers? Then I could see the highs and lows per day. I mean, it wouldn't be that *useful* per say... but I feel like my brain "gets" lines better than colors.... I also think my brain is just tired and isn't working so well today.

 

You can add 2 columns and put in a formula that may look like '=max(startcell:endcell)' to get the highest in the range and
'=min(startcell:endcell)' to get the lowest in the range.
where:
Startcell:endcell means the range of numbers in the period to be scanned
and you don't include the apostrophes in the formula.
You should get these numbers for the last 14 days

Min Max
244 357
335 380
378 449
257 353
241 328
222 336
89 507
71 251
127 389
209 654
285 296
92 460
199 521
91 460

 

you are clearly the excel wizard that I am not.

 

I work with data, Excel, and SAS (a computer program) all day at the office. I have lots of functions memorized at this point because I've used them so much.

 

BJ....my brain just exploded! LOL

 

It might look like this:
=MIN(E2:Q2)
or
=MAX(E2:Q2)

 

OK, I have to say Google Sheets isn't the most helpful thing to work with - I'd much prefer to use Excel for something like this, but as I don't actually own Excel...the options are limited. However, I did manage to create a scatter chart that would give you a visual on anything that comes up under the lowest y-axis gridline (which I set to 70) and the color coding that Sheets uses automatically for each column of data (you can customize the colors) would let you see at what point in the cycle he'd dropped low.

This is a snapshot save of the one I created from Rosa's spreadsheet. I don't think I could work from it, but if it's something you want to try let me know and I'll talk you through how to create it.

https://docs.google.com/spreadsheets/d/1McO8rTEmUZ5moTm_yQjLRcf_iu_qgjhl5MRB-dT9pj0/pubhtml

 

Interesting effect. Did you plot each time*glucose in that graph as a series?

 

Yeah, with the limitations of the charting tools on Sheets (short of downloading all the developer tools), if I wanted to use date for one axis, BG level for the other and not have it either plot all the zeros where no reading was taken or refuse to do anything except chart AMPS and PMPS, letting it use each possible time point during the day for a series was about the only option that returned anything that could be used at all.

 

Holy crap, you guys. It's like a totally different language! (And I'm supposed to have advanced stats knowledge. Yeah. Not so much.)
Think I'm gonna' stick with the spreadsheet. This is WAY more complicated than I thought it'd be! Oh my gosh.

 

She used date as the X-axis and used each +# column as the Y axis, with different colored dots.

 

Oh, yeah - the only thing that took the time really was figuring out if there was another chart type that would give you something that might have been easier to read. The set up itself of that chart was really very straightforward - I could talk you through it in just a few minutes. Or if you want it adding to your ss and can't figure out how, you could give me edit access for half an hour and I could set it up for you.

 

Yeah. I tried the stock market high-low-close approach, but it still looks too busy to interpret.

 

There's a lot of extra stuff that can be accessed by downloading their dev tools but it's all Java based. Some of those apparently do have the option for multiple x and/or y axis labels. It's something I might download at some point just to see what it can do, but it'll probably take me longer to wander around all that stuff...I tend to get distracted by tools and options that look interesting instead of just getting on with what I'm meant to be looking at!!

 

And I tend to get distracted by shiny things. LOL

 

Nice spreadsheet analysis April

In your circumstances I would drop a half unit and see how he does, safety needs to come first and you can always edge him back up if needs be.