Re: Regulating Bailey
Hi Geoff, I had some questions.
Date Time mmol mg/l comments
18-Nov 8:19am 23.8 Fasting (Started Humalog) 0.5 IU 428.4
18-Nov 9:06am 29.2 525.6
18-Nov 11:12am 28.3 509.4
18-Nov 12:06pm 22.4 403.2
18-Nov 1:06pm 21.5 387
18-Nov 2:03pm 17.9 322.2
18-Nov 4:00pm 16.7 300.6
18-Nov 6:04pm 14.2 255.6
18-Nov 7:43pm 13.5 243
18-Nov 10:00pm 18.7 336.6
When did Bailey get his evening meal and was the humalog dose given with the meal?
19-Nov 4:19pm 15.7 282.6 Raised to 1 IU
19-Nov 6:12pm 16.8 302.4
19-Nov 7:56pm 15.6 Fasting 280.8
19-Nov 10:04pm 21.7 390.6
Here it look as though you gave the 4:19 humalog as a correction, but without food. Did he get any Humalog with the meal?
20-Nov 8:20pm 25.8 464.4
20-Nov 10:26pm 20.4 367.2
22-Nov 10:06pm 12.4 223.2
22-Nov 10:40pm 18.4 331.2
22-Nov 11:17pm 18.6 334.8
23-Nov 6:22pm 10.2 183.6
23-Nov 10:31pm 19.8 356.4
25-Nov 8:12am 16.8 Fasting 302.4
25-Nov 11:41am 30.8 554.4I wonder if this is one of those times when he went longer then 12 hours past his last injection and that is also reflected in this high number
25-Nov 1:01pm 22.8 410.4
25-Nov 2:03pm 21 378
25-Nov 4:15pm 12.8 230.4
25-Nov 6:15pm 12.6 226.8
25-Nov 8:07pm 11.3 Fasting 203.4
25-Nov 10:08pm 18.3 329.4
25-Nov 11:17pm 23.4 421.2
Assuming the humalog was given with the meal it looks like the food rise is out lasting it
26-Nov 7:09pm 18.8 Fasting Fed at 8pm 338.4
26-Nov 9:09pm 27.3 491.4
26-Nov 10:27pm 29.6 so going up not coming down!I see this with Ruby as the food rise can last as long as 6 hrs. with her so once the humalog wears off she starts to go back up again.
Don't get discouraged, I see the humalog working. I think you are just working with an insulin that you haven't gotten familiar with yet. I think the humalog is working for about 3 hrs. and when it is gone the food rise is still there so the bgs start to climb again.
There are a lot of approaches you can take to help with this depending on how much flexibility you have in your schedule.....which I know isn't a lot.
*You could increase the humalog, but I would go slowly and do small increases if you choose this route. What you don't want to run into is having a big disparity between when the humalog is working and when it wears out. For instance, you don't want to drive him down to a 90 to have him jump back up to a 300 as soon as the humalog wears out.
* You could increase the protophane to bring the fastings down just a bit more. It looks like his lowest number was the 183 which leaves you a nice cushion. I would only increase by 1/4 and I wouldn't change anything else until that change was evaluated say in 5 days. The nice thing about his trend is his nadir is happening at his fasting so it is more convenient to catch lows.
* the approach I am favoring now and which is working for my dog is giving the basal insulin 2hrs early. It takes a little time to go to work, can then clear some of her mid 200 fasting and then is more powerful when the food rise kicks in. I do still have to incorporate the fast acting with her meal but I am using less so I am not getting as much of the zig zag numbers mentioned above. There are three points at which I might give humalog: around 3pm to correct if her insulin is running out, with her meal if the 3pm humalog wasn't needed, after the 3pm humalog runs out to counter the remaing food rise. This last humalog dosing is trickier because it is dependant on how her food was absorbed and how potent the basal insulin is then, which remember was given early. Luckily Ruby's belly starts to grumble when her bgs are on the rise, so I can test and see based on how far past that last humalog dose and what the numbers are, what I should give her.
* another approach you may consider is feeding Bailey once daily. I switched to it for multiple reasons and it isn't without it's own kinks to work out. What I like about it is that the hoops this disease makes me jump through I only have to jump through once a day. I do the approach listed above at night when I am ordinarily home anyway and during the day she gets a reduced dose. Right now we are trying to see if I can give her a snack that she won't regurge (megaesophagus) so that I can increase her daytime dose to give her enough duration. In this case the food rise is a good thing as it doesn't take much food to get a good rise. With Bailey you could probably just give him a couple of biscuits laced with syrup and be good.
Hope I haven't thoroughly confused you!
Tara
Hi Geoff, I had some questions.
Date Time mmol mg/l comments
18-Nov 8:19am 23.8 Fasting (Started Humalog) 0.5 IU 428.4
18-Nov 9:06am 29.2 525.6
18-Nov 11:12am 28.3 509.4
18-Nov 12:06pm 22.4 403.2
18-Nov 1:06pm 21.5 387
18-Nov 2:03pm 17.9 322.2
18-Nov 4:00pm 16.7 300.6
18-Nov 6:04pm 14.2 255.6
18-Nov 7:43pm 13.5 243
18-Nov 10:00pm 18.7 336.6
When did Bailey get his evening meal and was the humalog dose given with the meal?
19-Nov 4:19pm 15.7 282.6 Raised to 1 IU
19-Nov 6:12pm 16.8 302.4
19-Nov 7:56pm 15.6 Fasting 280.8
19-Nov 10:04pm 21.7 390.6
Here it look as though you gave the 4:19 humalog as a correction, but without food. Did he get any Humalog with the meal?
20-Nov 8:20pm 25.8 464.4
20-Nov 10:26pm 20.4 367.2
22-Nov 10:06pm 12.4 223.2
22-Nov 10:40pm 18.4 331.2
22-Nov 11:17pm 18.6 334.8
23-Nov 6:22pm 10.2 183.6
23-Nov 10:31pm 19.8 356.4
25-Nov 8:12am 16.8 Fasting 302.4
25-Nov 11:41am 30.8 554.4I wonder if this is one of those times when he went longer then 12 hours past his last injection and that is also reflected in this high number
25-Nov 1:01pm 22.8 410.4
25-Nov 2:03pm 21 378
25-Nov 4:15pm 12.8 230.4
25-Nov 6:15pm 12.6 226.8
25-Nov 8:07pm 11.3 Fasting 203.4
25-Nov 10:08pm 18.3 329.4
25-Nov 11:17pm 23.4 421.2
Assuming the humalog was given with the meal it looks like the food rise is out lasting it
26-Nov 7:09pm 18.8 Fasting Fed at 8pm 338.4
26-Nov 9:09pm 27.3 491.4
26-Nov 10:27pm 29.6 so going up not coming down!I see this with Ruby as the food rise can last as long as 6 hrs. with her so once the humalog wears off she starts to go back up again.
Don't get discouraged, I see the humalog working. I think you are just working with an insulin that you haven't gotten familiar with yet. I think the humalog is working for about 3 hrs. and when it is gone the food rise is still there so the bgs start to climb again.
There are a lot of approaches you can take to help with this depending on how much flexibility you have in your schedule.....which I know isn't a lot.
*You could increase the humalog, but I would go slowly and do small increases if you choose this route. What you don't want to run into is having a big disparity between when the humalog is working and when it wears out. For instance, you don't want to drive him down to a 90 to have him jump back up to a 300 as soon as the humalog wears out.
* You could increase the protophane to bring the fastings down just a bit more. It looks like his lowest number was the 183 which leaves you a nice cushion. I would only increase by 1/4 and I wouldn't change anything else until that change was evaluated say in 5 days. The nice thing about his trend is his nadir is happening at his fasting so it is more convenient to catch lows.
* the approach I am favoring now and which is working for my dog is giving the basal insulin 2hrs early. It takes a little time to go to work, can then clear some of her mid 200 fasting and then is more powerful when the food rise kicks in. I do still have to incorporate the fast acting with her meal but I am using less so I am not getting as much of the zig zag numbers mentioned above. There are three points at which I might give humalog: around 3pm to correct if her insulin is running out, with her meal if the 3pm humalog wasn't needed, after the 3pm humalog runs out to counter the remaing food rise. This last humalog dosing is trickier because it is dependant on how her food was absorbed and how potent the basal insulin is then, which remember was given early. Luckily Ruby's belly starts to grumble when her bgs are on the rise, so I can test and see based on how far past that last humalog dose and what the numbers are, what I should give her.
* another approach you may consider is feeding Bailey once daily. I switched to it for multiple reasons and it isn't without it's own kinks to work out. What I like about it is that the hoops this disease makes me jump through I only have to jump through once a day. I do the approach listed above at night when I am ordinarily home anyway and during the day she gets a reduced dose. Right now we are trying to see if I can give her a snack that she won't regurge (megaesophagus) so that I can increase her daytime dose to give her enough duration. In this case the food rise is a good thing as it doesn't take much food to get a good rise. With Bailey you could probably just give him a couple of biscuits laced with syrup and be good.
Hope I haven't thoroughly confused you!
Tara
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