? 03/05 Mowgli AMPS 437, +6 346, +9 379 Dose increase?

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Happy Friday everyone!

Iff we are considering adding an R insulin soon (maybe this weekend?), should we hold off on increasing Mowgli's dose tonight? He's on his 6th cycle on 7.5 units BID.

 

Probably too late, but I would increase the Lantus. More later after dinner.

 

OK, if you are up to giving R a try tomorrow morning, @Lisa & Oberon said she'd be around to sit with you. Start a post at AMPS time, shoot 0.25 units of R at the same time as the Lantus, and test hourly for the first 4 hours. You will be able to eventually reduce that amount testing, but first you have to learn the R onset, nadir and duration. Once you've got that figured, you can ease the hourly testing.

Some basics about R. First, make sure you have a hypo kit with high carb food, just in case. Cats really differ in how much R they need. I've seen a 30 dose Lantus cat never need more than 0.5 units. Make sure you are present of mind and have a good routine if shooting R and L. You never want to mix them up! (it's been done ). Keep them in different parts of the fridge, clearly keep track of when insulin you are dealing with when. I had R in a vial, Levemir in cartridges, in different types of containers in the fridge. If using two vials, put an elastic band around one, or some other way to clearly separate. Some have sticky notes with L and R on them, prepare one syringe, place on the appropriate sticky, then the other. Just find a routine that works for you and your mother.

Your goal is to find a dose of R that lowers the numbers around 100 points during the duration of the R, no more. More than that can cause a bounce and a counter productive spike in numbers. Because you want to reduce the chance of those big drops, we don't use R during the first cycle of an increase, and also don't use it if you think that cycle will be a bounce breaker. Most important, using R is always optional. If not sure, can't monitor, don't use it.

R can sometimes have an effect on the following cycle, because the lower numbers giving L something better to work with. After a while, once you've figured out the characteristics of an R curve, you can lay that on top of L patterns, and figure out when it's safe to give R.

You will eventually be developing an R scale, ie. give a certain amount of R given the R preshot number. Oberon's spreadsheet has an example. Neko's was ridiculously simple, so I didn't document it.

What you see from one R experiment may not look exactly the same for the second experiment. Sometimes it'll look like nothing is happening. You need multiple trials at a dose of R. Have patience. Good luck.

 

Hi Jaime, I'll be around tomorrow morning. Tag me in your post if you decide to do an R trial, and I'll check in hourly to see how it's going.

Something else to know once you develop an R scale is that it may change over time. At one point Oberon needed 2.5 U to get a 100 point drop, but now even 1 U is too much and I'm giving 0.75 U. (He's got IAA so his insulin needs keep shifting as the antibody levels change and/or glucose toxicity develops when he's stuck in high numbers). I've found that when his Lantus dose changes substantially I also need to rethink the R scale.

 

Wendy and Lisa,
Thank you both for offering to help. Interestingly I have been studying Oberon's spreadsheet the last few days and have found it very helpful in understanding the use of R.

We will definitely be very careful with our handling of the two different insulins. We're aware that the employment of this technique comes with additional responsibilities and we take it very seriously.

Linda, look out for our post tomorrow morning after AMPS. Scheduled for 8:00am!

Have a great night!

 

Sounds good! (I'm on EST, so that's 11 am for me.)

 

Good catch on the time difference! 8:00 am PST

 

Since you didn't increase tonight Lantus tonight, you can do it tomorrow night or Sunday. The other times can be R experiments.