? 1/19 Yum 4thR?: 3rd R PMPS+11 621 .25R AMPS 654 8.5L +1 652 +2 480 +3 492+5 400+6 440+9 444+11 389

Yesterday's condo: http://www.felinediabetes.com/FDMB/...mps-468-526-1-505-2-552-3-5-437-6-530.189808/

PMPS+11. 621
shot .25uR and fed a little 0 carb
C'mon Yum!

 

Good luck Yum!! Let us see some lower numbers!

 

Hope you see some movement with R today.

Looking forward to seeing that amps.

Glad you are going to be getting the test for IAA and Acro, knowing if you are dealing with either/or both will be helpful.

 

PMPS+11. 621
shot .25uR
AMPS 654
shot 8.5L

 

PMPS+11. 621
shot .25uR
AMPS 654
shot 8.5L
AMPS+1 652

 

come on Yum, work the R

 

PMPS+11. 621
shot .25uR
AMPS 654
shot 8.5L
AMPS+1 652
AMPS+2 480. won't believe it until I see it again next hour

 

It might be an idea to double check a number when you get a large difference like that, make sure it wasn't a faulty reading (I've had the odd faulty reading occasionally)

Paws crossed he stays out of the black at +3.

What is yums 'usual' onset with Lantus?

 

PMPS+11. 621
shot .25uR
AMPS 654
shot 8.5L
AMPS+1 652
AMPS+2 480.
AMPS+3 492. maybe it's real

 

Looks like it was.

 

I double tested yesterday and got 468/526. Don't want to poke her twice every time though.

My impression over the past year is her onset is at +3, but I haven't measured it exactly in a long time.

 

Guess when they are that high those numbers are within meter variance.

 

Cycle 3 of 8.5uL. Depot likely adjusted. New dose action combined with R action this cycle.

 

PMPS+11. 621
shot .25uR
AMPS 654
shot 8.5L
AMPS+1 652
AMPS+2 480
AMPS+3 492
AMPS+5 400

Woohoo!!! A solid response!!!
Maybe it's the 2nd cycle effect for the R?
She hasn't been responding much to L increases.
I suppose she might bounce, although she's not a big bouncer.
Should I think about late cycle R as extending the duration of L?

I'm thinking .25uR at +11 this evening and tomorrow morning as a possibility? Dynamically adjusted for future measurements of course.

 

If IAA is in the mix that could indeed be the case. Since we don’t know my instincts say it’s more the 8.5uL dose finally settled in and showing some action.
It’s a good idea to pay attention to how many cycles it takes an L increase to show some action. If you can spot a pattern then you might consider avoiding the use of R for that cycle. The R action could combine with the most recent L increase action and result in unexpected lows. Besides hypoglycemia you risk triggering a bounce. This is one of the important “knowing when not to use R” scenarios.

this will not always be the case.

Yes but not based on this one event. Gather more data, carefully, one cycle at a time. You will develop a feel for the flow of it.

Easy does it. See how this cycle plays out.

Beware the siren call

 

PMPS+11. 621
shot .25uR
AMPS 654
shot 8.5L
AMPS+1 652
AMPS+2 480
AMPS+3 492
AMPS+5 400
AMPS+6 440
I wasn't going to check +6, but even though I would love to see pink---I don't want to see a huge bounce. I was thinking of intervening with MC, but it doesn't look necessary.

 

FWIW under the same circumstances (the absence of the danger of BGs bottoming out) I would not have intervened. It would leave me wondering what would have happened had I not. if it turned out to be a bad call-lesson learned and solid data gathered. For the most part I kept BKs meal schedule steady and worked around it. It was a year before BK had his first taste of HC.

 

While it's certainly possible the insulin depot has adjusted on the third cycle of the increase to 8.5u Lantus, we also have to consider R was given for the very first time @ +11 instead of @ +10. That hour can make a difference when we're also looking for the onset of Lantus. Since her numbers are so close... well within meter variance... @ Lantus +2 and +3 (@ R +3 and +4), it's hard to tell when the R nadir and Lantus onset overlapped today.

I very much agree with Sandy. Don't draw any conclusions from any single event... especially when a variable has been changed. You're definitely in data collection mode!

 

This is her 2nd day at 8.5uL, if that makes any difference.
And she's now had evening R at AMPS+10.5 and +10, and one morning R at PMPS+11.

 

PMPS+11. 621
shot .25uR
AMPS 654
shot 8.5L
AMPS+1 652
AMPS+2 480
AMPS+3 492
AMPS+5 400
AMPS+6 440
AMPS+9 444

If I ignored everything else that might have been changing, R at +11 was better than R at +10.5 was better than R at +10.
I am thinking of giving her R at +11 tonight and, if all goes well, again at +11 tomorrow morning. Is that too aggressive?
There is a cumulative aspect to R. Does that stretch beyond 2 cycles? ECID?

I expect to increase her to 9uL on Sunday. I cannot give her R on the cycle with the increase. Correct?

 

Yes, today is the third cycle @ 8.5u Lantus.

"If" the R given @ +11 this morning overlapped with the Lantus onset, it may have been enough to provide the movement you've seen today.

Possibly, but you can't really ignore what's been going on with the Lantus (the increase and building of the depot) because it's all part of the big picture.

She's been pretty flat today. If her numbers remain flat you may see more movement tonight. Are you prepared to monitor as long as it takes... even if it takes a good part of the cycle? Think about her as well as yourself. Make your decision accordingly.

As far as giving R again tomorrow morning...
See how things go. I don't think I would unless Yum is over 500-600 or "if" she bounces from a perceived low tonight. My reasoning: Tomorrow morning will be the 5th cycle of the increased Lantus dose. Chances are, you'll have a better chance of seeing what the 8.5u Lantus can do on it's own. The depot should be in pretty good shape by the 5th consecutive cycle of an increase. Sometimes it's a good idea to skip giving R for a cycle or two just to see where kitty is at without R.

Lantus is a cumulative insulin. One dose builds upon the next. There is no cumulative aspect to R. R is an in and out insulin. One dose of R does not build upon the next. When the R cycle is done, it's done... gone.

When people say they might see action in the cycle following the use of R it's not from the R in the previous cycle. That R is long gone. What they're seeing is the result of the R shot in the previous cycle disrupting the normal flow of events/action of Lantus favorably... which is why we use it. The next cycle is sometimes better than we expected.

Probably, but again, see how things go.
And no, generally, you wouldn't want to give R on an increased Lantus dose.


Just my thoughts. Others may weigh in with different ideas...

 

For what will I be monitoring? Hypoglycemia? Every hour or every 2 hours? I am afraid if I stop R she will bounce back up to black. I have no confidence in the 8.5uL

I think it would be a big coincidence if 8.5u was the first "active" dose of Lantus, after I've been seeing nothing but deterioration for weeks. Because of that I think it is all due to the R. I know that is a guessing game. I thought I could wait and figure that out by skipping R when I increased to 9uL. It's unlikely that 8.5u will take her lower to yellow. My goal is to reduce her numbers ASAP. Do I want to spend time testing 8.5uL on its own when R might be bringing her down 100 points?

Thanks. That is kind of what I was thinking but not so clearly. And this definition suggests that repeating R won't make her go lower and lower awhile I am parked at 8.5uL. The 8.5uL depot is full.

 

She seems a little sleepy. I suppose the lower numbers could cause that. Of course it's winter and the civvies are sleeping too.

 

I doubt you'd be monitoring for hypoglycemia... although it's always a possibility. If it were me, I'd want to monitor to make sure she didn't take any steep drops... and want to know what she dropped to, but that's just me.

It's entirely up to you as to how you want to proceed... how much risk you want to take. I'm all for aggressiveness. I think that's obvious by looking at Alex's spreadsheets, BUT <---- and that's a big but... safety is and always has been the number one priority with me. Right or wrong, my methods, whether for my own cat or in making suggestions to others is to couple aggressiveness with making time to pull back to accurately assess the effect on the cat. Am I being too conservative in my suggestions? Maybe, but I'd rather be conservative than cause a problem. I can suggest and give you the reasons for my suggestions/advice. However, your cat. You make the decisions.

I'm sorry. I wish I could be as certain as you seem to be. I've rarely (if ever) seen the effects of a full depot after only 3 cycles at a certain dose.

 

This made me smile because it brought back so many memories! Oftentimes when I saw Alex sleeping I'd become concerned. I had to remember to look at my other cats. Nine times out of ten they were sleeping, too!

 

Almost PINK!

It might be helpful to make a notebook on info you’ve received about R or at least book mark those condos. Regarding what seems to be a residual effect of R, here’s what I said the other day:

Jill said it in plainer English but the context is the same. And by “longer effects of the L”, that just means the 12 hour duration of L as opposed to a 4 or so duration of R. If the R puts the L at a better place to start with, then the overall curve can lower and you can potentially see a better cycle the next cycle or two.

 

Ah. I previously read the "grabbing onto the R" as explaining the benefits in the first cycle of the R, and then perhaps leaking into the next cycle of L through the lower BG. All those subtle interactions. I do keep rereading the posts but you're right I should link them all together.

 

Wow! AMPS+11 389!!!

 

It’s a PINK!!! Never thought I’d be happy to see one of those for my or any other cat, but in this case, that is a cause for celebration! Go Yum, with your pink dress on!