1/9 Jenks AMPS 85 +3 66 +5 72 PMPS 230 +7 242

Discussion in 'Lantus / Levemir / Biosimilars' started by AZJenks, Jan 9, 2018.

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  1. AZJenks

    AZJenks Well-Known Member

    Joined:
    Feb 3, 2014
    1/8

    I had a lot to consider last night about what to do this morning. The topic at hand was how to handle Jenks' recent pattern of rebounding late in the afternoon after dipping under 50 early in the cycle after a night of constantly going down from the previous day's rebound. The goal is to stop the early cycle low which will hopefully have the effect of eliminating or moderating the later cycle numbers.

    Options included:

    Giving a half dose in the AM. Here, the thought is that the morning lows are not the result of too much insulin, but rather built-up depot momentum. Burn off the momentum with a depot draining cycle, and hope that Jenks gets back to business on a dose that he's shown he can perform well at just within the last week to ten days or so.

    OR

    Take a quarter unit reduction moving forward. Here, the thought is that repeated trips under 50 indicate he's getting too much insulin. Back off the insulin, stop the trips under 50, stop the bouncing...at least in theory.

    Opinions were evenly mixed in yesterdays condo, leaving me with the executive decision. My gut feeling says we're skirting too little insulin as it is, and this post-vacation magic is on shaky ground as it is, so I'm hesitant to do anything to disturb it. Therefore, I want to play it very conservatively.

    So after much though, I decided to give a half dose of 3.0U this morning with plans to resume and maintain the 6.25U dose moving forward. If these numbers are driven by momentum, hopefully this drains the depot and taps the brakes on the late night/early morning fall, which would then ideally put a stop to the late afternoon rise.

    The risk is that the numbers either blow up in my face today, or he simply picks up and resumes where he left off as if we didn't do a draining cycle at all. In that case, we can move on to a dose reduction, having only lost a couple cycles and some monitoring.

    I don't think there's a right and wrong decision here, so I'm taking the cautious path that ultimately lets me do both if needed.
     
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  2. Stacy & Asia

    Stacy & Asia Well-Known Member

    Joined:
    Oct 2, 2017
    Have you considering getting ahead of those drops and feeding them so you don’t get the neon greens? Some of them maybe can’t be prevented and that would probably spell out for you a reduction is needed, but you might be able to steer with food so he surfs in not so alarming greens.
     
  3. carfurby (GA)

    carfurby (GA) Well-Known Member

    Joined:
    Feb 19, 2012
    Good luck. I hope your plan works and Jenks surfs safely for you.
     
  4. Wendy&Neko

    Wendy&Neko Senior Member Moderator

    Joined:
    Feb 28, 2012
    Good luck with your decision. The 6.5 unit depot was long gone. Those lime greens were all the 6.25 unit depot talking. With larger dose cats (over 5 units), 0.5 unit changes often make more sense than 0.25 unit changes. But looks like the depot drainer might give you a bit more sleep tonight.
     
  5. AZJenks

    AZJenks Well-Known Member

    Joined:
    Feb 3, 2014
    So much for me and my dumb ideas. Look at that PMPS and tell me this plan didn't just blow up in my face?

    Now my concern is that, even if we get him to come down overnight, it's going to be such a significant drop that he's going to rebound and we're going to begin the endless cycle all over again. I really hope I just didn't trigger the end of the post-vacation good cycle stuff. Stupid, stupid, stupid... :banghead:

    I'm not even sure how to interpret what happened. He didn't fall below 50, so I think it's safe to say that is not the root cause of the bounces. And yet PMPS tripled in just half a cycle. So what gives? To me, it says he doesn't have enough gas to make it to the end of the cycle. But I can't square that with it apparently being enough gas to take him under 50 several times in the last two weeks or so.

    What am I missing?
     
  6. Wendy&Neko

    Wendy&Neko Senior Member Moderator

    Joined:
    Feb 28, 2012
    Today wasn't a bounce. You did too large a BCS. I found just taking 1/3 off was better than 1/2. ECID of course. You have to experiment with size of BCS for your cat. Lesson learned. Hopefully he'll get back on track in a couple cycles, but the results of a reduced dose can still be seen a few cycles later. So don't worry if you see higher numbers tonight and tomorrow.
     
  7. Stacy & Asia

    Stacy & Asia Well-Known Member

    Joined:
    Oct 2, 2017
    Not enough tests to say for sure, a couple in the latter half of the cycle will give you a better idea what is happening, but... my best guess is this is a duration issue in the am cycles and tonight could be loss of duration and not a bounce (and he could certainly bounce even if he didn't go below 50). Asia had a pattern for awhile where there was nothing untoward in her cycles, but it seemed after a couple cycles in good numbers, her body would just freak out and bounce (not from lower than usual numbers). It seems for most of the cycles the juice is petering out at the ends of the am cycles, he gets back to business for the pm ones and has good duration there.

    If you could fill in some blanks in the latter half of am cycle and early half of pm cycle, I think you will have a much clearer picture of what's going on and probably more advice what to do about it, but it's hard to just guess. I'm wondering if a lot of the am +9 through pm +4 are blues?
     
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