8/13 Butters AMPS 144/+3 221/+7 337/PMPS 225/+4 288/+8 264/

Yesterday discussed the possibility of fast tracking an increase for Butters since switching to using calipers. However, she spent quite a bit of time hanging at the beach last night, and decided this morning that she would stay there for now.

Too much blue to fast track the increase. Dose remains 0.75u for today.

I still struggle to measure those doses with the calipers...It takes me a good 15 minutes each time. lol.

Have a lovely day/evening, all!

 

I would hold the dose a bit longer to see how she goes with the depot filling.

 

Nice start today. I hope Butters surfs safely.

 

Hi Lyla, what's the issue with the calipers? Where are you having difficulty?

 

I'm sure you've long gone to bed, but since I didn't take the "fast track" increase, she wouldn't earn an increase under TR until tomorrow morning's cycle at the earliest. So basically, today and tonight's cycle remain at the current dose no matter what. Is that enough time to see how the depot filling goes for her?

 

Yes, per TR you would hold the dose 6 cycles and then increase in increments of 0.25. Unless Butters earns a reduction.

 

Four things, I think, though some may be related:
1) The BD syringes are not very smooth. I find that drawing in and/or expressing insulin from them to achieve that perfectly measured dose is so difficult. And twisting the plunger doesn't do much. I'm hoping this is just practice. But right now, I have to add and remove insulin over and over again.

3) Equipment issue, I think: I am doing this at my kitchen counter, using a little standing lamp that has a 2x magnifying glass built-in and a 10x eye loup I placed on top of that. I have to both slouch over the eye loup/lamp and raise the calipers & syringe high up enough so that they come into focus. Is this normal? Would it be easier if I had a small lightboard and a magnifying glass?

2) I am supposed to measure starting from the position of the plunger when it is pushed all the way in. But I lose that reference point once I draw in the insulin. I find it hard to see where the insulin dose starts in the barrel. I do find it, eventually, and measure down from there.

2) The inside jaws of the calipers are so teeny tiny, and the jaws cross over each other, which makes it more challenging for me to clearly see what I'm doing. This is one of my biggest issues.

Do you think this is mainly an equipment issue on my part? I'm curious what equipment you and others use? I can't do anything about the BDs. Seems they have a monopoly in Canada, or at least at the pharmacies around me.
If not for the lip around the top of the syringes, I could use the outside jaws and they are so much easier to see. But using the outside jaws isn't an option.

Thanks for asking, Sue. Even writing it out helps me think through my process and how I might improve it.

 

For this issue, I usually pull/push the plunger in several times before attempting to get insulin. Maybe 3-5 times. There's supposed to be lubricant inside the barrel. Hopefully all syringes have this (I buy the Relion at Walmart, not expensive syringes by any means)...

I have to run... I'll be back to answer the rest of your questions...or at least offer some more suggestions...

 

Why are the outside jaws a problem?

 

On the BD syringes, there is a lip of plastic all the way around the top of the syringe barrel. The outside jaws cannot fit flush against the syringe barrel because of this lip, only the inside jaws can.

 

Yep it adds time to the routine in the beginning. You'll get sooo fluent with it that you'll be able to look at the dose before measuring and be just about spot on.
Butters, you better show mom the beach/lagoon more frequently or your headed for an increase
Have a good day Lyla

 

When Wendy gets back, she might be able to help you more with using the calipers with those BDs. She should be back soon. But....it always takes some practice and time to where you can draw a dose fairly quickly with calipers. I believe most people end up push/pulling the plunger a bit as well.

I still have my light box that is shown in the video. It’s just sitting in the closet but I’ve been meaning to put it in the Supply Closet on the board. PM me if you are interested. It made a huge difference in the ease of my dosing.

Smart move to hold the dose. While I wouldn’t be surprised if it needs a bit more tweaking, I’d toss our fast-tracking ideas out the window and stick with TR which means if she continues to have blue, you’ll want to hold the dose ten cycles before deciding.

 

Oh Lyla, I wish I could run over and do a show and tell with the calipers!!
My words might not be helpful in the least.
I'll try though! I used strong reading glasses and good lighting above the stovetop!
Then tilt the calipers up a bit so the tip of caliper is directly under the lip of the syringe, and the bottom exactly inside the lower part of caliper shows the exact dose line.
I hope that makes a bit of sense!

 

@Tina Marie and Jan You're familiar with the BD syringes?
Does the insulin dose go right up to the lip of the syringe? This would be a huge help (I think) if I knew I could always measure from directly under the lip of the syringe. It seemed to me like there was a bit of space in the barrel before the insulin starts, if this makes any sense. I am pushing the plunger all the way up and ensuring no air bubbles before I draw the dose. I wonder what I've been seeing.

The day I can do that can't come fast enough. lol.
And there's the threat! I read it to her, and she rewards me with a 337! Thanks Butters.
Have a great day!

 

I thought I'd be able to consider an increase after six cycles, but I went back and re-read the SLGS/TR dosing sticky for the 1500th time and it is six-ten cycles. I should be holding her for the ten (as opposed to the six), as long as I keep seeing a nadir of less than 200, even if this doesn't doesn't happen every cycle?
@Bron and Sheba (GA) is this what you meant as well?

 

Makes complete sense - I see what you mean. But, yes, measure from directly under the very top lip. That top line that looks like zero, actually does hold a tiny bit of insulin. When (thinking optimistically), you get down to a .1 unit dose, that zero line (or just barely under it) would be that .1 dose (oh gee, now I'm going to double and triple check!!)

I'm always wide open to being corrected!!

A way to get no air bubbles, is to always draw a tiny bit more insulin than you need, hold the needle upwards and thump and you can see any bubble go to the top . . . then shoot that bubble out while lining up your exact dose.
Like I said, a show and tell would be easier

 

Yes, if she continues to have blue numbers, you’ll hold ten cycles. This does not apply to SLGS; doses are held one week with SLGS but looks like you are doing TR. And I’ll speak from Bron Yes, that’s what she meant.

She’s using BD from Canada and they are very different than the syringes most of us use(d) in the US. I believe with those BDs that I remember reading they have to put the top caliper on the ledge of the BD as putting it right under the upper lip is really, really hard to do.

 

THANK YOU Marje

 

I'm sorry I wasn't able to get back to you sooner - looks like you've had some suggestions/help today. Hope they've answered your questions

My day went off the rails with zoom meetings and FaceTime with my boss...and on and on it goes...whew!

 

I can 100% relate.
And thank you, but also there is no apology needed. Thank you for asking me about my difficulties this morning. One of the things I adore about this community is that everyone jumps in to offer up advice and support on people's condos.

So yes, I received lots of advice and support and saying "thank you" to everyone for that doesn't feel sufficient, but thank you.