3/2 Chino|AMPS=364|PMPS=356|0.25 units Novolin R

[Adrian and Chino]

Yesterday...

No observable response to 0.1 units Novolin R yesterday. This morning, I gave 0.25 units. It's the 8th cycle on 6.5 units of Lantus. His BG has been creeping back up and we didn't see blue last night. If we don't see blue tonight, either, then I'll take him up to 7 units tomorrow morning - even if I have to wait a few days to try R again. My main goal with R is to get him under 300 for at least part of the daytime cycle.

 

[Adrian and Chino]

+1 = 397

 

[Doodles & Karen]

Hope you see some downward movement today. How's he doing with the HyperT meds?

 

[Adrian and Chino]

He still hasn't figured out that there are pills in the "treats" he gets with breakfast and dinner He doesn't seem quite as ravenous as he used to be, and he's spending more time outside of the kitchen. We have an appointment tomorrow morning for followup labs to see where he is in regards to T4. I'm going to ask for an SDMA as well since hyperthyroid can mask kidney problems that are later apparent when it's treated.

 

[Doodles & Karen]

He still hasn't figured out that there are pills in the "treats" he gets with breakfast and dinner

That's awesome, makes it so much easier. Good luck with the follow up BW.

 

[Adrian and Chino]

AMPS=364
[6.5 unit Lantus, 0.25 unit Novolin R]
+1=397
+2=379

 

[Adrian and Chino]

AMPS=364
[6.5 unit Lantus, 0.25 unit Novolin R]
+1=397
+2=379
+3=343
+4=327

Hourly checks are difficult during busy workdays... I've been up to 10 minutes off for each one, between calls and meetings and tasks/processes I can't easily stop in the middle of and resume later >_<. So I might wait until the weekend to try 0.5 units. I like the 70 mg/dL drop I've seen in the first 4 hours, but I don't know if it's enough to get him below 300 before the PM cycle.

 

[Doodles & Karen]

I like the 70 mg/dL drop I've seen in the first 4 hours

That's a nice R cycle. Much more than that and you could trigger another bounce. Hopefully he'll continue to trend down today and good luck with the increase if he needs one.

 

[Wendy&Neko]

Good data gathering today. Chino seems to be following the more classic R cycle with what looks like an onset at R+2. Again, it will be interesting to see what happens later.

When you do your next R trial, keep in mind that people usually build an R scale. Sandy has great examples in Black Kitty's SS. Basically you modify the amount of R, based on the value at the time of the shot and the timing of the shot. Mine was pretty simple - 0.5U above 300, 0.25U below (when she was at higher doses) and I always shot in the back half of the cycle or up to +1, never later. My R scale changed when Neko's Lev dose was smaller. Today you got data on a pink start and it was an OK amount of movement.

I agree on your plan for the increase. He does seem "stuck".

 

[Adrian and Chino]

Good data gathering today. Chino seems to be following the more classic R cycle with what looks like an onset at R+2. Again, it will be interesting to see what happens later.

When you do your next R trial, keep in mind that people usually build an R scale. Sandy has great examples in Black Kitty's SS. Basically you modify the amount of R, based on the value at the time of the shot and the timing of the shot. Mine was pretty simple - 0.5U above 300, 0.25U below (when she was at higher doses) and I always shot in the back half of the cycle or up to +1, never later. My R scale changed when Neko's Lev dose was smaller. Today you got data on a pink start and it was an OK amount of movement.

I agree on your plan for the increase. He does seem "stuck".

Thank you. This kind of feedback is invaluable to me. Having only seen it in action twice with Chino, I'm not at a point yet where I can start to formulate a sliding scale, but I'm definitely keeping an eye out for patterns that will help to determine the best regimen. Should I be aiming for the R to peak right around the Lantus onset? When I'm looking at the effect, should I be looking at the difference between AMPS and peak (~37 mg/dL), or the difference between the food spike and the peak (~70 mg/dL)? Am I overthinking this?

 

[Wendy&Neko]

You might want the the R peak a bit before the Lantus onset. Think of trying to time things so that you limit big drops where at all possible. My Neko used to sometimes have a big drop at her Levemir nadir, so I tried to make sure the R action was mostly out of the way before than happened.

Am I overthinking this?

Probably for this early in the game. Start with trying to figure out the R onset, nadir and duration.

 

[Sandy and Black Kitty]

What I like about today's AM cycle is that he stayed and flat. Only a 91 mg/dL difference between the highest and lowest readings = No counter regulatory backlash. Nice

Since his counter regulatory system does not discriminate between a food influenced or non food influenced number, I consider the difference between the highest and lowest values.

The challenge is to try and gently bring down the entire range at a pace that does not allow glucose toxicity to set in and at the same time does not trigger bounces. No easy task since cycle touchstones (onset, nadir, duration) can be moving targets.

Something important to keep in mind when evaluating the overall R action on a cycle is that there is no way to tell what the cycle may have looked like without R.

Since Chino has not reached a Lantus dose that will do most of the heavy lifting in terms of BG control he will likely need further Lantus increases. R can also help mitigate any NDW while going up the dosing ladder

The day will come when you will instinctively know how much R to shoot and when to shoot it.


Keep in mind as important as it is to know when to shoot R, it's equally as important to know when not to use it.

 

[Adrian and Chino]

Since Chino has not reached a Lantus dose that will do most of the heavy lifting in terms of BG control he will likely need further Lantus increases. R can also help mitigate any NDW while going up the dosing ladder

This is good to know. To avoid mistaking the effects of Novolin R for the effects of a new dose, how many cycles should I wait after increasing his Lantus before I try giving R again?

Do you ever use R to compensate for full or partial fur shots (anti-jinx), or to keep the BG under control until the next cycle after skipping a dose because the AMPS/PMPS was too low and still dropping?

 

[Wendy&Neko]

Do you ever use R to compensate for full or partial fur shots (anti-jinx),

Yes, I had lot of opportunities to use R after a skipped or missed shot. It would help keep the lid on the BG rises. There were also times when she would get a partial dose due to going under anesthesia.

or to keep the BG under control until the next cycle after skipping a dose because the AMPS/PMPS was too low and still dropping?

That never happened. It's fine to shoot a dropping preshot number - it's a great way to take advantage of the overlap. I would never shoot under 50, but if I waited 15-20 minutes, she would always come up above 50 so I could shoot.

 

[Sandy and Black Kitty]

To avoid mistaking the effects of Novolin R for the effects of a new dose, how many cycles should I wait after increasing his Lantus before I try giving R again?

it is dependent on the numbers. A Lantus increase will not likely show action on the first cycle (if you were on a fast track that might be a different story). So if you wake up to serious ugliness tomorrow you could consider 0.25R with the AM Lantus dose. It is very much a shot by shot call particularly since you are in the learning stage. In any case, in the same way you dont want the R nadir to coincide with the L nadir during any given cycle, you want to avoid giving R either as a bounce is breaking or as a new L dose starts showing action. The combined downward pull would likely trigger a nasty bounce.

Do you ever use R to compensate for full or partial fur shots (anti-jinx), or to keep the BG under control until the next cycle after skipping a dose because the AMPS/PMPS was too low and still dropping?

Absolutely!!! I had plenty of fur shots happen and many skipped shots. Due to BK having 2 episodes of DKA still visible in the rear view mirror, I was using R well before the IAA dx

BK was the first FDMB kitty to be tested for IAA . The result was 84%, which is considered extreme insulin resistance. All of us here, including the gurus back in the day of the FDMB 'class of 2008-2009', didn't really know what we were dealing with.
We were flying by the seat of our pants (which resulted in a lot of holding our collective breath as well as collective nail biting along the way).
One thing we did know and that was always front of mind is that IAA can change on a dime. Therefore I never hesitated to stall or skip or shoot a BCS. Knowing that I knew how to use R and always had it on hand made all the difference. I knew with R in the fridge I could cover any mishaps and/or missteps.