Whats going on with Pelles numbers today?

The last 3 days Pelle has been between 220-250 at amps and pmps on 0,7 unit levemir. But then today Pelles family woke up and tested him at amps and he was 61. Who knows how low he has been during the night. He was kind of cranky, the gave him food and tested again at +1 where he was 95. He was angry and it was difficult for the family to get the test a all. They tried again at +2 to tjek his numbers to see if the could give him his shoot, but it wasen't possible since he was mad. Now at +5 they got a test again and now he is at 106, still with no insulin.

They are giving him and them selves a break now until pmps.

Here is the spreadsheet:


So do you have any idea of whats going on, is the dose to high or what. The family was so happy yesterday because the can relax when he gives you numbers that you expect, and for the third day in a row he did, but now stress is coming back.

Thanks for all your help

Charlotte

 

Well, I'm not real sure about how precise their dosing method is - are they still re-drawing the insulin? So it's possible he got more than .7U last night.

It is also possible that his pancreas is beginning to work so it is holding his BGs lower. That's a good thing, but if that is what's happening, this period can be challenging. Skipping the shot was fine. +5 and still just above 100 is very good. If he has eaten this morning as usual, his pancreas may be working again. We call this stage "sputtering pancreas." Not sure how you will translate that for them!

Sheila did a great job with Beau as he came off Levemir. I will leave the rest for her to offer suggestions because she explains them very well.

 

Thanks Vicky.

The amount of insulin should be the same and he has been eating alle his food.

Pmps is coming up in 30 minutes and I have no idea of what dose to tell them to shoot. My suggestion could be between 125-180 the shoot 0,4 units, between 180-220 0,5 unit, and so on. Could that be ok?

 

A dose less than what he has been at is probably a good idea, yes. He could have had a low overnight, which would mean a dose reduction is needed. Your BG ranges for doses sound OK, although normally Levemir isn't dosed on a sliding scale, but either .4U or .5U is a good step down from .7U and will keep Pelle safe.

I actually hope his BG at PMPS is below 200, as that's a very good sign he is not going to rebound from the overnight low.

 

His pmps umber was 235, so unfortunately a rise. We desided to change the dose to 0,5 unit for a few days so that we can be more sure about him not falling to low. His family really hopes that his pancreas are starting to wake up, so they were a bit disipointed with the 235

 

Please tell Pelle's parents that 235 is very good! An awakening pancreas is not an instant remission. It needs to be coaxed back in to action. He could still have higher BGs at times. I am glad they went with .5U.

Tell them we are also very proud of them for giving you and us the chance to help Pelle. This is very encouraging news that his BGs stayed lower for so long.

 

That 235 is definitely a good number after no shot this am and a possibly very low number overnight. And .5u is a good dose since there is not a big bouncing high number to "shoot down".

When Beau started to go into remission he just sort of stepped down the dosing scale at .1u increments (.5u ---> .4u ---> .3u and so on). I decreased every time he dropped below 40 I think. It might have been 50 (this was over 2 years ago so I would have to look at his SS remember). Of course after each change you need to let the new, lower dose settle, but if there is another low number, reduce by .1u again.

I think making the decrease very small helps to ween the pancreas off the exogenous insulin. If Pelle is going into remission he will probably have days when he doesn't need insulin every 12 hours. I found two things that sort of go against the basic understanding of how these insulins are supposed to work. One was that I could NOT shoot low PS numbers. I could not shoot below 140-150 or he would drop into the 30s. I also shot "as needed" the last couple of weeks. If he was too low at +12, but was 150 by +15, I shot. Then that usually meant I skipped the next shot because I was at work or something.

Take a look at Beau's SS (linked below) for the last weeks of Sept 2007 if you are interested in how his numbers were and what I did in response to them. He actually went without insulin for 6 days while I was out of town because the sitter was too scared to give him any, but he was testing so I got some good data for that week.

 

Thanks Sheila.

I hope that he will go the same way as Beau

Last night his pmps was 236 and at +4 he war 205 and he got 0,5 unit
At amps he was 185 and at +6 he was 164, so not a big different today between amps and +6
I hope that pmps tonight will be lower than amps again. That was what happend with prop when she went in remission, the amps and pmps lowered steb by steb.

 

That is pretty good if his numbers are stabilizing - even at a flat level (not much dip to nadir) and slowing coming down overall. That is what you want.

Let's see what happens as the .5u settles over the next 2-3 days. Paws crossed for lower numbers.

 

He was at 171 at pmps, so yes pretty flat curve. I told them to keep at 0,5 unit since his nadir didnt drop much. But the first day in blue and no stupid numbers after he didnt recieve insulin yesterday morning.
Next test is at +4, that is 11 pm our time, so i hope he is not to low since it is bedtime
But i guess this is a really good sign and couldn have happend without you.
So thanks so much.