Where are we now?

So the dose reduction from 2.75 to 0.85 seems to have cured the 500s. I'll have more data tomorrow to know how she's doing later in the cycle, but the +3-4 readings look like she's getting a bit of a drop off this dose. But where are we now? I gather that both the too-little and too-much insulin theories are supported by this data?

Unless I get something remarkable tomorrow, I'm not sure I want to continue with Levemir. I know no one thinks Lantus is any more likely to help, but if I'm starting all over from scratch at a too-low dose, I'd rather move to Lantus with the promise of getting back to where we were (400s very rare, drops into the 100s). It seems futile to repeat the exact same dose increases with Levemir and hope something is different this time. She's never had anything close to a good dose on Levemir all up and down the scale.

As for more diagnostics, I'm still torn about it. The vet wants to do an ultrasound first to look for pancreatitis and the suggestion of Cushings/acro. The blood tests for Cushings/acro are also a possibility. (She says she'd send them to U. of Tennessee, but everyone here seemed to say U. of Michigan was the only game in town. Should I be concerned the tests are the right ones?) But all of this feels like a shot in the dark to me, and I don't see it changing much of what we would do. I'd always rather have more information than less, but I'm not sure this information is worth the cost (dollars, time, and stress for Celle). Plus, I can't shake the hope that the problem is the Levemir. It seems to me the easiest and cheapest thing to try first.

Here's her Lantus spreadsheet: https://docs.google.com/spreadsheet/pub ... utput=html

 

Melissa,

The link to the Lantus spreadsheet does not work. Can you fix?

Lana

 

Does this work now?

https://docs.google.com/spreadsheet...yldGtoZXdBd0sxSzV1cFZxak9FallEQmc&output=html

 

The data on Lantus is very spotty. The BGs certainly had more greens at 4U, but doses were also all over the place.

If you return to Lantus, be more consistent/methodical with dose increases/decreases.

 

Yes, I'll do dose adjustments differently with Lantus the second time. We've come a long way since then. We were intentionally alternating doses since we didn't feel like we could reliably measure quarter units, especially with two of us doing the shooting.

I do think the +6 reading today was interesting. She's not all that flat even on the much reduced dose. The 0.85 does look significantly better to me than 2.75. Is that not correct, i.e., both just mean "too little insulin"? I'm still not getting it obviously. I'd be inclined to either reduce again to 0.5 or stay with 0.85 longer to see if the preshots can go down further. So I'm planning to start Lantus at 0.5. It's the only thing I can think to do that doesn't leave me completely discouraged.

Another thing that was different between Lantus and Levemir is that on our initial rise to 5 units we held each dose for a whole week. I'm inclined to think that 3 days is just too little time for Celle to settle into the dose, so we just kept exacerbating the rebound cycle once it started. So I'd like to hold the Lantus doses for at least 5 days, but that will be hard if we're starting way too low. Any thoughts on how to adjust the Tilly protocol given this history?

 

You don't need to do an expensive u/s for pancreatitis; blood test - fPLI test is all that's needed. 0 - 3.5 result is normal; above that number may indicate pancreatitis.

I believe the only place that does the IGF-1 test for acromegaly is at MSU and I know that IAA test was being done at U of Guelph in Canada. I don't know of other locations doing these tests in N.America but maybe others know.


IAA Test
IGF-1 (Acro) Test

I am not sure about your suspecting insulin resistance as you are stating you are getting better results after lowering the insulin dose. Usually when one is still getting high 300s at doses of 8u or 9u BID, resistance is suspected but not at .85 or even a 2.75u dose. You may want to see if you are needing a higher dose be spending a great deal on money on tests.