JoJo - I believe Caesar is in Rebound...uh, help please?

Hey Jojo, (and others!).

Caesar has/had an infected tooth, and over the past 10-12 days, his numbers have really been playing games with us. He normally is happy around 10 to 13mmol using .5 units Lantus, but since the infection, his numbers started to go up. So, we gradually went up to 1.0 then 1.5 units, but yesterday and today, he's been throwing us almost totally flat curves at 24 - 25 - 24.5 - 25 and today at 32 - 31 - 33 - ++ - ++.

I was not aware that there is a rebound condition with flat curves (but just finished the Wiki on this "new" apparition - the "Flat-Rebound". My jaw is dropping, of course... :shock:

So,

Because I did not know of this type of Rebound (but am of the other "standard" rebound and symptoms), my first instinct when I saw the ++ readings on the meter (<33) was to shoot immediately to try to get these numbers down.

Of course, being a "male", stubborn and argumentative, :evil: and not getting any "concrete answers" (I wanted a Yes/No or other FIRM answer, and not an "I am not sure" or "I don't know), so I went ahead and shot Caesar with another dose of 1.5u, 3 hours before his normal shot time.

Now, of course, I find that I may have just exacerbated the problem. :roll: Duh. we were too busy arguing about everything else to bother giving Karen a shout (Karen & Rambo) - I had her nearby on MSN, but...

What should I do - At his next shot, should I drop all the way down to his "traditional" 0.5u and hold for 2-3 days before bumping up .5u?

Any advice would be helpful.

Thanks,

Bashful Edwin.

 

Jojo has largely been off the Board due to health reasons. Could you attach your spreadsheet? It might also make it easier if you converted your BG numbers since most of the folks here use US readings. It will be the quickest way for people to respond to your post.

 

Hi Edwin,

Jojo isn't around right now, but hopefully I can help.

So you shot 1.5 units at his regular time (what was the PS reading then), and another 1.5 units at +9 (what was the PS reading then)? How long ago was the second shot? You mentioned that you have increased the dose, how many cycles has he been on the 1.5 unit dose?

 

Caesar is a long time diabetic and precedes the days of spreadsheets, so he does not have one.

Ed, could you add the times to that curve? PS, +2, etc., just so we can see when the BGs happened? Thanks.

 

Hi there - I don't have a spreadsheet as we normally do not curve Caesar - It has been like 2 years that we typically have shot between .5 and 1.0 units based on his PS numbers, but for the last 6 months, it has been almost always .5 units.

His numbers generally range between 9 and 14 (162 and 252) which is in both OUR and HIS comfort range.

But this "infection" for the past 10 days has not been fun. As his numbers gradually went up from 15 (270) to about 24 or 26 (432 to 468), we started shooting 1.0 units at that time.

Over the past 2 days, we did not notice his numbers going down - much - so thought to try 1.5u, which we have for the past 4 shots (2 days). Since early this afternoon, his numbers have been above 33 (594).

I am going back into our OneTouch Ultra meter (UltraSmart), so once I get these numbers onto a spreadsheet, I'll post it.

OK, plain spreadsheet at http://spreadsheets.google.com/pub?key=tfN6_VaRcv6Dr9CGTQ_KIFQ&output=html

But we do not remember the insulin doses as we do not normally keep track - BUT the last 2 days has been 1.5units of Lantus.

sorry for the strange numbers, but we have had a lot of "odd" hours over the Christmas Season, and I appreciate that Caesar has suffered for it (some highs and lows), but it has been the last 10 to 12 days that his numbers have been really inconsistent.

IF we have time tomorrow, we will try to do a 1 or 2 hourly curve for 12 hours and see what we are getting.

Also, I think, unless someone advises otherwise, we are going to do his PS shots at .5 units - essentially starting over again in case we are over-dosing at 1.5 units.

IF anyone needs to contact us ASAP, one can text me at XXX-XXX-XXXX - I keep my cell by my bed (on vibrate) J.I.C.

TTFN



Edited by Jill & Alex to remove phone number. If needed, send me a PM, please.

 

Can you please edit out your phone #. There are people who are able to monitor the board who are not members and I would hate to have your phone number spammed. It may be best to ask people to send you a private message and you can sent a phone # that way. However, most of the folks here will discuss care in the forum so everyone can weigh in and offer peer guidance.

Has Caesar been to see the vet to have the infection treated? Infections and inflammations can play havoc with BG levels and it may be challenging to get those levels back under control until the infection is treated. I would also suggest testing for ketones. An infection and not enough insulin could cause problems.

 

Just adding some info here : Caesar has been on a/bs for over a week now. Tested daily for ketones (neg). Is also on pain killers for bad tooth which will be removed as soon as infection has cleared.

Ed- I think starting over at 0.5u may be a bit low after this big increase ... I just worry about ketones. Maybe 0.75 or 1u and reassess from there? And remember that it will take a few cycles to get any rebound out of his system.

 

Welcome Ed.
Good luck with the new dose. I hope his tooth infection problem is resolved soon.

 

in light of this information... i agree with karen. starting over at 0.75u or 1u sounds like a better idea. the Ls like consistency in dosing and adjustments are made according to nadir. get some nadir checks when you can. those are the spot checks that will let you know how well the dose is working...

 

Ahhh, dern-it - we've already given his morning dose. He was 32.5, (585), so at least we got a reading this morning, and not have the device say "too high" LOL.

About 6am, while laying in bed, Caesar began having "some" (very minor, just congested) breathing problems. but he did not appear to be in distress - the sound was not comforting - which kind of solidified our resolve to start at his "normal" dose of .5 - the same dose he has been at for almost two years.

So, we are starting over again right from his "regulated" dose, and will hold there and see what happens.

Do you really think we should give a skinny 1 (or fat .5) - that is the best I can measure with our current syringes - even thought hey do have 1/2 unit markings, they are so close to each other that skinny/fat is the best in-between doses we can give, if lucky.

BTW - I've also changed my spreadsheet so that you can toggle between World/US readings at the bottom left of the chart. I guess I should update my profile with that chart location, eh? It's at: http://spreadsheets.google.com/pub?key=tfN6_VaRcv6Dr9CGTQ_KIFQ&output=html

 

Just as an update. I have updated my Spreadsheet (still located at http://bit.ly/7eIQNc ), and have converted the "World" values to the US Values on the "US" page.

I thought that this spreadsheet was set up so that if one input values on one sheet, the other sheet would show the converted values. At least the one that I had used from the FDMB link said it would, but I don't know how to have it run this query/conversion tool, so I manually calculated the US values and input them into the US page manually.

IF this was Excel, I would know how to link the two sheets together and have the values converted: i.e. - if one input a value on one sheet, it would show up converted automatically on the other sheet.(MS Office instructor in my old days LOL)

Perhaps I will download this and see what I can do with it, then try to import it back up again, eh? Has anyone tried this yet?

Anyways - Back to Caesar. He was high again this afternoon, so we shot a skinny 0.5u of Novalin R, and about 30 minutes later, his numbers started dropping big time. The nadir for R is 4 hours, which coincides pretty close with his PMPS time, so at the PMPS, we gave Caesar a 0.5u of Lantus, as we noted that his numbers started creeping up again.

So, I guess the plan is that if his numbers are high at AMPS -3 (or 6am), then we will do the "VERY" skinny 0.5u of "R" again to start his numbers downwards again for his Lantus "backup" shot at his regular 0900 AMPS shot time.

Wish us luck. Oh, and I'm calling our Vet to get a blood Panel done, as well as sched a dental to get that bloody tooth pulled. We've been giving Caesar AB's for 13 days now, so if the infection is not gone by now, my feeling is that we have to get rid of the source, then try another round of AB 's to see if that will clear this mess up! I really don't think Caesar can stand another 2 weeks of this type of yo-yo numbers...

We just want our Caesar back - he was just fine until this bloody infection came along! nailbite_smile

Whups, I guess I should put the HTML version of my spreadsheet's addy here, eh? and onto my profile too I guess..
[url=http://spreadsheets.google.co...readsheets.google.com/pub?key= ... utput=html[/url]

and why the hell is my siggy not showing up?

 

Good luck getting this new FDMB board figured out. It took me hours to set up my signature and avatar.
I use R sometimes too. I hope you can get that tooth pulled and have your young Ceasar back quickly. So, sending good vet vines and good dental vines.
As far as the spreadsheet, I don't know this for a fact, but I think some people have a row with the non U.S. numbers and below that row is a row that shows the U.S. numbers (maybe calculated automatically?). I live in the U.S. so don't have to deal with that.
Stay warm, and enjoy your day.

 

Honestly, after fightiung with the "world" SS, etc., I just used the regular SS and converted all my numbers to US values (I also edited the headings to include metric values, though!).

Ed- just a reminder to start a new thread (they are called "condos" here) for Caesar each day.