Dosing Advise for Maggie

Looks like incoming bounce to me. That 102 to 202 in that time period is faster rise than we'd usually expect after nadir.

I don't see a PMPS?

 

456 pmps. I gave him 3 units

 

Maggie is 155 amps. I have him 0.5

 

Ok let's see how he does!

 

is it correct to give him 0.5 ? he is 263 @+3. he ate lunch after that and will not eat anything after +9 or +10. i will check again @+6 and +9

 

was not look like 0.5 is enough for him. should we increase a little bit more as the proposal below ?

Original plan
Below 100 - skip
100-149 range: will try 0.25U
150-174 range: will try 0.5U
174-199 range: will try 0.75-1U
Above 200: will try full dose

Proposal plan
Below 100 - skip
100-149 range: will try 0.5U
150-174 range: will try 0.75U
174-199 range: will try 1.25U
Above 200: will try full dose

 

I would stick with current plan for now. Because he's bouncing again today I think; the problem is if he doesn't bounce, I don't know how far 0.5U will drop him, so trying to be safe. Our goal here is to walk the line between keeping a bounce down if he bounces, but avoiding hypo if he doesn't bounce.

 

I'm confused . I thought … If nadir starts to trend up, that's how we know it's not enough insulin ?

Can you tell me which date that he's bounce and which date that he's not getting enough insulin from his sheet so i can see the different ?

 

Let me see if I can explain this differently...

Your normal dose (currently 3U) is based on nadir when he is not bouncing (7/8, 7/9) OR when he is clearing a bounce (7/7 AMPS, 7/11 AMPS). When nadirs are green like he saw on 7/8 and 7/9, we hold the dose a little longer (5-7 days).

The sliding scale does usually increase by the same amount as the normal dose. So if you increase to 3.25U, chances are the sliding scale would increase by 0.25U as well. Depends on how he is reacting to the sliding scale doses.

Again, the issue with these low preshots is when giving the shot, we do not know if he will bounce. Look at 5/14, 5/17, 5/20. Those are cycles he did not bounce and went hypo, or much lower than we want him. Nearly all of the other low preshot cycles he has bounced.

Our goal is to give at least some insulin so that:

• If he bounces, the insulin helps keep him from getting too high
• If he does not bounce, the insulin dose does not make him go hypo

Our goal is NOT to have him hit a low nadir every cycle. His bounces are not predictable and it's a recipe for trouble trying to overwhelm a bounce with more insulin.

 

do you consider the cycle is 12 hrs between amps and pmps and not the whole 24 hrs ? also does the PMPS included in the 12 hrs AM cycles or does it count as 12 hrs PM cycle. Most of his PMPS is really high this is why i thought not enough insulin to last him 12 hrs

 

A cycle is the 12 hours following a shot. So the AM cycle starts with the AM shot, and lasts until the PM shot. Then the PM shot starts the PM cycle.

His PMPS is usually high because he bounces form daytime (AM cycle) lows. Unfortunately there's nothing you can do about that but wait for his body to stop bouncing so much.

 

hi FrostD,

i don't think 7/11 and 7/13 bounce or clear from the bounce. he was not high in the PM cycle the night before. His afternoon on 7/11 and 7/13 keep raising even before the PMPS and at PMPS. Should this consider not enough insulin ?

 

If you still want to follow the Modified ProZinc Method - where reductions are under 50 and the target nadir is 50-100 - then yes increase by 0.25U. if SLGS, you would hold the 3U. I still would keep the sliding scale as-is if you decide to increase. You can choose to increase the sliding scale by 0.25U each but know that comes with a good risk of very low BGs and possible hypos if he doesn't bounce.

 

I’ m not sure which method to use and i’m ok tto keep him at 3 but i am saying every time he’s under 150 and giving him 0.5 does not seem to be enough for him since he’s diabetic for a while not newly diagnosed. Also he’s not bounce or break the bounce on those with 0.5 unit. Would you please take a look at his data again and see if you see what’s i am seeing here? I think 1 unit should be ok for him since i am able to monitor him every 2-3 hrs here or 1 hr if needed

 

He does bounce from those low numbers nearly every time. That blue to pink in a few hours is a bounce.

You hold the syringe. You know the risk if he doesn't bounce and you give him a full dose, it's your choice what you want to shoot in those lower numbers. You can take the risk of shooting a higher dose to hold down a bounce, just know that also comes with the risk of hypo if by chance he doesn't bounce.

 

Thank you Frostd