Bailey got his wings... June 26, 2014

[Rubytuesday]

Geoff, After reading Jesse Girls post I would defer to her approach.
Yes, the 183 lowest number gives you some cushion to increase, but if you at some point wanted to increase the humalog you don't want to reduce that cushion, at least not in the experimental phase.

Tara

[Geoff]

Fair enough thanks! At one point he was 12.4 (below) which was great 2 hours after eating. Then one assumes the Humalog wears off and he goes up. Will keep with it! Thanks!

22-Nov 10:06pm 12.4 223.2
22-Nov 10:40pm 18.4 331.2
22-Nov 11:17pm 18.6 334.8

[Geoff]

OK, took a BG reading at 7:56pm tonight which was 21.4
Feed him at 8pm, gave him 13 units of protaphane and 1 IU of Humlaog at 8:05pm. Re-tested at 9:11pm and he was 27.3

One would assume he is not getting enough Humlaog. So do I increase by 1/2 IU? I want to take this spike out of his....system?! I am not sure the Humalog is doing anything at all as earlier curves appear markedly similar.

I could try novo rapid from my friend to see if different insulin will make a difference?? I hate to swap to and for though...

Geoff

[Rubytuesday]

Geoff, hang in there!

Not sure which numbers you are comparing these with. I didn't go back and look at old ones as I think he was on different foods and different basal insulin dose and those will all change the comparisons. Honestly my head sometimes spins trying to keep another dog's variables straight in my head so I will just give you some of the foundational knowledge that I work from when trying to treat Ruby.

When evaluating the effect of the humalog I look at the 4 hrs. after the shot was given. A lot of things can affect results. For instance, rate of absorbtion and digestion which may vary from day to day. Then you will also want to start looking at what is happening before the humaog and meal to evaluate how well a humalog dose is doing. Jesse Girl talks about how it is hard to figure out if rises are due to food or just the body rising at the same time food is given. Now, I do think Bailey gets a pretty hefty food rise, but there may be times when the body is rising even before food and then paired with the food rise is what makes it look like the usual humalog dose isn't working. It took me a long time and a lot of testing to be able to differientiate between the two.

I used to go back and forth between R and humalog depending on how much duration I needed, but I found that I couldn't get a handle on things and now that I am sticking to just the Humalog her picture is much clearer to me. I would discourage you at this point to try working with a different insulin.

If I remember correctly I think he may have been jumping higher and it may just be that he needs more, but it can be easy to overshoot with the fast actings. I would rather try to approximate a 1/4 increase even though you would need to do it by eye, as I know you don't have the 1/2 u marked syringes.

While trying to find the right humalog dose I would often set my alarm to wake up during the nadir time just to be sure that number was staying in a good range.

Also whenever calculating a fast acting dose you always need to consider the fasting number. When you get to a point that the fasting numbers are lower you may need to start cutting your humalog dose proportionately.

You might check Craig's thread "Annie getting too smart" as he uses R to correct the food rise.

A lot to consider I know.

Tara

[CraigM]

Originally Posted by Geoff

OK, took a BG reading at 7:56pm tonight which was 21.4
Feed him at 8pm, gave him 13 units of protaphane and 1 IU of Humlaog at 8:05pm. Re-tested at 9:11pm and he was 27.3

One would assume he is not getting enough Humlaog. So do I increase by 1/2 IU? I want to take this spike out of his....system?! I am not sure the Humalog is doing anything at all as earlier curves appear markedly similar.

I could try novo rapid from my friend to see if different insulin will make a difference?? I hate to swap to and for though...

Geoff

His reaction to Humalog isn't what I'd expect either, although I've never used it myself. Before increasing the Humalog, I think I'd do the one unit another time, with follow up test, just to be certain it wasn't a fluke.

Originally Posted by Rubytuesday

When evaluating the effect of the humalog I look at the 4 hrs. after the shot was given. A lot of things can affect results. For instance, rate of absorbtion and digestion which may vary from day to day. Then you will also want to start looking at what is happening before the humaog and meal to evaluate how well a humalog dose is doing.

Again, I don't have personal experience with Humalog, but am wondering about evaluating after four hours. I thought Humalog was suppose to be in-and-out of the system much faster than that? As you know, I use a mix of "R" and "N" and I believe the nadir of the "R" is around three hours in Annie. By four hours there is sometimes a small rise in her BG before the "N" fully kicks-in. (This observation was using Novolin insulin, still trying to get things figured out with the switch to Humulin insulins) Of course, "every dog is different"

[Rubytuesday]

Again, I don't have personal experience with Humalog, but am wondering about evaluating after four hours. I thought Humalog was suppose to be in-and-out of the system much faster than that? As you know, I use a mix of "R" and "N" and I believe the nadir of the "R" is around three hours in Annie. By four hours there is sometimes a small rise in her BG before the "N" fully kicks-in. (This observation was using Novolin insulin, still trying to get things figured out with the switch to Humulin insulins) Of course, "every dog is different"

Sorry if I confused. Yes Humalog is usually out of Ruby's system in about 3- 3.5 hrs. When I monitor up to 4 hrs. what I am looking for is if there is a jump after the humalog runs out. I was thinking this would be a way for Geoff to be reassured that the Humalog is working because he would probably see the uptick in numbers when it was gone.

Hopefully that makes sense.

Tara

[CraigM]

Originally Posted by Rubytuesday

Again, I don't have personal experience with Humalog, but am wondering about evaluating after four hours. I thought Humalog was suppose to be in-and-out of the system much faster than that? As you know, I use a mix of "R" and "N" and I believe the nadir of the "R" is around three hours in Annie. By four hours there is sometimes a small rise in her BG before the "N" fully kicks-in. (This observation was using Novolin insulin, still trying to get things figured out with the switch to Humulin insulins) Of course, "every dog is different"

Sorry if I confused. Yes Humalog is usually out of Ruby's system in about 3- 3.5 hrs. When I monitor up to 4 hrs. what I am looking for is if there is a jump after the humalog runs out. I was thinking this would be a way for Geoff to be reassured that the Humalog is working because he would probably see the uptick in numbers when it was gone.

Hopefully that makes sense.

Tara

OK, perfect sense. Sounds like your duration with Humalog isn't all that much shorter than "R" is in Annie. Again, "every dog is different (edid)"

[Geoff]

OK, thanks all for the support and info. So, to re-cap. I should test Bailey and then inject him with 1IU of Humalog then re-test hourly for 4 hours to monitor the Humlaog? That is, a random time say midday or something? Or, could I not just do a slight increase at meal times to see if it makes the slightest difference? Say tonight, 8pm, 1.25IU of Humalog? Then monitor.

[CraigM]

Originally Posted by Geoff

OK, thanks all for the support and info. So, to re-cap. I should test Bailey and then inject him with 1IU of Humalog then re-test hourly for 4 hours to monitor the Humlaog? That is, a random time say midday or something? Or, could I not just do a slight increase at meal times to see if it makes the slightest difference? Say tonight, 8pm, 1.25IU of Humalog? Then monitor.

Yep. I'd be really interested to see what duration you get.

[Geoff]

So which one should I go for? Since I am not home at midday, how about I increase his dose tonight and test?