What is going on?

Discussion in 'Lantus / Levemir / Biosimilars' started by TMR, May 16, 2013.

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  1. TMR

    TMR Member

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    Mar 2, 2013
    For the last 3 days, Midnight's blood sugar has been much lower in the morning than in the evening. Do you think I should go down to 0.5 units? Most days I am asleep or away an hour after each dose so I can't retest after a skipped dose.
     
  2. Blue

    Blue Well-Known Member

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    Dec 28, 2009
    I have probably asked/ mentioned before but it's difficult to know what's happening because you have no tests at all after the pm shots. In order to know how the dose is workiing, you need to test before you go to sleep..... something around +3 or +4 are going to be very telling. What if you had tested at +3 on 5/14? The pmps was 511 and you dosed 0.75u, but how much of an effect did it have on the cat later on? If you got a 59 by morning, I would guess that your cat hypo'd overnite. It's very important to get that before-bed test as many cats drop lower at nite time, and if you had tested on 5/14 and saw a number in the 100s already, I would have said to feed that cat some HC food before a hypo.

    Even with seeing no pm numbers, I'd say most definitely to drop to a 0.5u dose and see how it goes.

    Gayle
     
  3. TMR

    TMR Member

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    Mar 2, 2013
    I work 3 nights a week from 7 pm to 730 am. So on those nights I cannot test after the pm dose because I am not home. I can try to do it some nights when I am off. This is something new--to have readings below 200 3 or 4 mornings in a row. Also, because of my work schedule, I get very little sleep. If I am working that night, I sleep from about 11 or 12 to 2 or 3 pm before work--so I can't get the midcycle reading. If I am coming home from work in the morning, I sleep from about 8 or 9 to noon or 1 pm, so if I hold the morning dose, I am not awake to retest in an hour or so. It is just kind of complicated. I am doing a lot for my cat, but I am not home or awake (and due to very little sleep, I am not going to get up in the middle of the night or sacrifice the few hours of sleep I get during the day) enough to do as much testing as most people are telling me to do. And I am going to be away for a week at the end of the month. The cat sitter probably won't test at all, so I just need to feel comfortable with the dose before I leave. That is why, with the skipped doses in the morning the last couple days, I wonder if I should decrease to 0.5 units. And also, if I am fortunate enough to get a cat sitter to come over twice a day to feed and shoot Midnight, and wipe up about 10 puddles of stool off the basement floor every day, I will be grateful for that. I am sure he/she will not be able to test preshot, retest a few hours later, test midcycle, etc.
     
  4. Blue

    Blue Well-Known Member

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    Dec 28, 2009
    That's OK if you don't get mid cycle tests, but if you can get some before bed tests, that would be great.

    So, if you see a pattern where the pm shots of 0.75u end up with a too low amps number, that tells you that the dose is too high. Dropping down to 0.5u will give you more peace of mind and also give you less worry about a sitter not testing. Also, if the number seems low at ps, instead of delaying, you can shoot a reduced dose instead.
    Remember that if you shoot 1 hour late in the am, your pm shot needs to be 1 hour later, but if you are shooting at the usual time in the pm, then you are shooting at +11, an early shot, so it's like a dose increase.

    I'd say go with the 0.5u and see how that works.... maybe you will get more balanced numbers
     
  5. TMR

    TMR Member

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    Mar 2, 2013
    The timing of the shots is already off a little anyway. When I go to work, she gets it around 6:20 pm. Then if I get out of work on time at 7:30 am, she gets the morning dose around 7:45 am. So that is about 13 1/2 hours. Then if I work again that night, she would get the pm dose again around 6:20 pm, so that is only 11-ish hours. The point is that I try to get as close to 7 am and 7 pm as possible. I am trying!!!!
     
  6. TMR

    TMR Member

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    Mar 2, 2013
    Also, I thought I was supposed to retest in an hour after eating, if I held a dose--and then give the shot if it was above 200. If I give the morning shot at 8 am and then as you are saying, give the evening shot at 8 pm, then the next morning it should be at 8 am? That would just complicate things even more!! Oy vay!!
     
  7. nckitties3

    nckitties3 Well-Known Member

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    Jan 12, 2013
    I have no advice, just want to say I'm very sorry you are having to try to do this with your schedule, I can only imagine how difficult that is. :YMHUG:

    With my Lucian, with his crazy numbers and bounces, it is the only time in my life that I am grateful that I am not working. I could not care for him if I was.

    You and your baby are in my thoughts. Wishing you the best. cat_pet_icon
     
  8. Blue

    Blue Well-Known Member

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    Dec 28, 2009
    Exactly, the shots need to be as close to 12/12 as you can so if they are 13/11, that has to do and can be worked out.

    What do you mean about having to wait until the number is above 200? You can still give a shot at the normal time for a lower number, and you can even give a reduced dose instead of waiting..... I think if you drop down to the 0.5u, you will see more level numbers.
     
  9. TMR

    TMR Member

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    Mar 2, 2013
    If I am giving 0.5 units twice a day and Midnight's blood sugar is less than 200, are you saying I should give her 0.25 unit?
     
  10. Blue

    Blue Well-Known Member

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    Dec 28, 2009
    Possibly. Giving a partial shot is many times better than skipping because by the time it's the next shot time, the cat's gone 24hrs with no shot and the number will be high again.

    Your goal is to get numbers that are between about 40 and 120, so if you get a 199 and skip that shot, she's guaranteed to be high by the next shot.

    Try to think of a no shot number that is more reasonable. Maybe a 150 would be better.

    Another thing you can do is start a new post in maybe the Health forum and ask about schedules that are not on a 12/12 schedule. I know there are others who have had 12 hour work days and they have set up routines to adjust for the shots on a 12/11 schedule.... they may be able to give you some good suggestions.

    Has anyone told you about the drop method for fine tuning doses?
    Take a used syringe and fill it with water to the 0.5u mark.
    With the needle pointing upward, twist the plunger until you see a drop at the end of the needle; flick it off.
    Repeat the twist and flick until you have no more water in the syringe.
    You should be able to get 4 drops out of a 0.5u measure, so that means you can reduce any dose by 1 drop.
    if you twist off 1 drop, you now have a 0.375u dose in the syringe.
    if you twist off 2 drops, you have your 0.25u dose.
    Then 3 drops off, you have a 0.125u dose.

    So, if you try to go with a 0.5u dose for am and pm shots, but you are finding that you are higher on the one cycle than the other, you can twist off 1 drop for the 11 hr cycle just to try, then give the full 0.5u for the 13 hr cycle.
     
  11. TMR

    TMR Member

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    Mar 2, 2013
    I have not heard of that. Interesting!
     
  12. Blue

    Blue Well-Known Member

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    Dec 28, 2009
    It's a better way of making your dose a fat or skinny one.
    There are diagrams that people use to 'eyeball' it, and others use calipers to measure, but I still think the drop method is consistent to what YOUR drop size may be.
     
  13. BJM

    BJM Well-Known Member

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    Oct 6, 2010
    When you have to skip shots often due to low pre-shots, reducing the dose makes sense so you can shoot twice a day.

    Also, you might experiment with the carb levels, maybe see if a slightly higher level overnight prevents too low of a drop by morning.

    When you have a fairly consistent 11/13 timing requirement, it may make sense to slightly fatten the dose up for the longer period; and skinny it for the shorter period.

    It may be helpful to note custom 11/13 dosing in your signature block so others know it isn't standard..
     
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