9/21 Jack AMPS 30 no shot

Most Recent Condo

Ok, lots to report
1) A couple of days ago we switched to the ReliOn Micrometer from Walmart. Immediately noticed a HUGE innacuracy in the Walgreen True2Go. While the True2Go is fairly accurate in the <100 range, as you get into higher BG values, it is dramatically under-reporting. When the ReliOn was showing 400, the True2Go was showing 200! We tested on Jack, on ourselves and based on the overwhelming success others have had with the ReliOn, reviews from people using the Relion to manage human diabetes, and our own observations it is our opinion that the True2Go should NOT be used

2) Jacks #s the past 3 days have been...peculiar. We haven't been able to do a good curve the past few evenings, but he's been in the red before his shot and in the morning he's been LOW. We haven't given him an AM shot for 3 days running because his pre-shot number has been in the 30-60 range, and with those #s there isn't a dose that I currently feel safe giving him without being able to stay and watch him carefully. In the mornings, other than being a little bit more urgent about demanding food and not having to be reminded to finish his breakfast he's pretty much acting his usual self. Nothing to indicate that he's hanging out in the danger zone.

2a) Based on his AMPS AMBG the past couple of days, it seems to me that he has earned a reduction for his PMPS--my understanding is that it would be much better to be giving a smaller dose twice a day that resulted in a flatter curve, rather than a larger dose once a day, even if the nadir was staying "safe", right? I'm thinking, take him down to 2.5u this evening and really try to get a good curve from him so we can see what his BG is doing over the night.

2b) Is it possible that he's actually trying to somehow go OTJ already and that his giant # in the evening is the result of his liver producing a spike in reaction to the AM lows? It seems like a very big time lag, but thought I would ask.

le sigh.

Most importantly, can you please work on getting Jack's number up by feeding some HC gravy to him and retest in 15 minutes?
Please post the new BG in your header if you don't mind. we need to get him up0, okay?

It's good to see you again....Jack most definitely earned a dosecrease...with that 48 on 9/19 and now this AMBG=30...I am not sure if you should go down to 2.0u ~~maybe a lower dose would be best at this point. You are quite correct that it is better to shoot the insulin on a 12/12 schedule.

Is it possible for you to post a condo every day for Jack? You see, there are things that we could suggest that would be helpful from day to day. We all post daily and if you can do that, it would be helpful for Jack.

He is getting too much insulin which is driving his numbers dangerously low and then the liver is dumping hormones to raise the BGs to a red ugly number. More later... :razz:

AMPS means AM preshot...if you are not giving a shot it is called AMBG... Morning Blood Glucose.

I would like a dosing expert to take a look at Jacks' SS and tell you what dose to shoot tonight, okay?

When you get a low preshot number there are many different steps you can take. Usually, if you can get a +11 and post the number, we can then discuss your options. Sometimes we can shoot a reduced dose, or we can delay the shot if your scheduling will allow that.
At any rate, it is best to post and have someone help yo with the decision for that particular day.

You're correct in that Jack's liver is panicking by dumping glucose and counterregulatory hormones into his system in response to the low numbers. However, it's not an indication of OTJ -- it's just what happens because Jack's system is not yet used to being in those lower ranges. The bounce is a protective function of his liver.

Jack has definitely earned a dose reduction. All of those numbers below 50 earn a diabetic within the first year of diagnosis a reduction. Further, if you are skipping shots because you don't feel that you're in a safe range to shoot, we need to think about lowering Jack's dose so you can give a shot twice a day. If you aren't shooting BID, you're compounding the problem of bouncing. Not only is Jack responding to the low numbers, by not giving any insulin, the numbers would be high regardless.

I want to take a bit more time with Jack's SS and see if I can round up a few more people to take a look and come up with a dose that you'll be able to shoot twice a day.

You might need a couple of drops of karo to that HC too...I hope you come back to check this....
How is Jack acting?

Please feed HC gravy and a couple of drops of karo and update as soon as you can, okay?

Hi all,

This is Yoshi. Jose is in class right now. This is my first time posting to the board. I am here with Jack until 11:30 am EDT. (and then back at around 1:30 pm).

As you see the recent spot checks, his numbers are going back up - so should I still feed him?
Jack is a little more 'lazy' than usual - hard to tell if it's just him being a lazy cat 1/2 asleep in a comfy spot or if it's something else

I'm probably making the wrong decision by holding out and not feeding him - but his numbers are going up, right? ::sigh:: or maybe it's his liver that's making the numbers go up - and feeding him would stop his liver from reacting?

HI yoshi! :razz:
You will want to make sure that he is not going low again. Can you check in 20 minutes and post the new number?
If he will eat again, a little more LC at that time will be great....but if he is going lower, then HC is in order.

You will definitely need a new dose tonight....will anyone be home to do spot checks this afternoon then?
Can you at least get a +11 and post that number? someone will tell you a good dose for jack at that time, okay?

Hi Pat! Thanks for the reply... I will spot check in 5 minutes, and then give him some LC.
Jose said this morning - if he's under 100 we should be giving him LC in this situation... I was holding off, because I thought it would be good to see what his numbers are doing without food changing them. But I'm guessing the LC I would be giving him now is to help his liver from going into overdrive (?)

When did you feed him, Yoshi? I was assuming you fed after getting the AMBG=30, right?
We always feed the 30s and sometimes we need to give HC...but is numbers are rising now...that is good.
Sometimes they do go down after a slight rise, so we will see what he is in 5 minutes....
Can you post the number then?

He's at 71 right now. I'm pretty sure Jose fed him his normal morning breakfast after his AMBG. So he last ate at about 9 am.

maybe give him some LC for now while you are gone...will you be able to get a +11 tonight and check on the new dose? :razz:

ALWAYS feed low numbers -- especially numbers in the 30s and 40s. You may not want to dump a whole can of food in Jack's bowl if it's around shot time, but you don't want him hanging out in those numbers overly long, either. Often, if you are feeding HC to bump numbers up, they will bobble around a bit as the HC wears off. In this case, if you feed LC, I'd definitely want to see a spot check in 3 - 4 hours to see what Jack's pancreas is doing. In other words, is he producing any endogenous insulin that pulls the numbers down. (I don't think that's the case since he's zooming back up by evening shot time.)

For now, just feed like you usually do. In the future, if you get a number that's low around shot time and aren't sure whether to feed, I'd post. It may also be useful to try to get a PM +11 so you have some idea which way Jack's numbers are heading in the morning.

I'm still mulling over the PM dose. I honestly think you're idea about 2.5u in principle, is on the right track but I think it's going to be too much. It's easier and safer to start lower and work the dose up than having to skip shots. The skipping is playing havoc with the shed. You need a dose you are comfortable shooting (and that's safe) twice a day.

I've been thinking and discussing Jack's SS with a few of the others. What would you think about 1.75u as his new dose? It may be that the dose will need to be raised but for now, it's taking the missed reductions into account and it will, hopefully, not put you in a position where you need to skip a shot due to low numbers.