7/26 Rachel’s George AMPS 295

[George’s Mom]

Yesterday: Yesterday Thread
@Wendy&Neko

When we give R, we want them to drop less than 100 points over the time R is active, which is typically around 4 hours. Any drop larger than that can cause a bounce. Meaning higher numbers and it defeats the purpose of using R. Last night he dropped a lot more than that, so 1 unit was too big a dose of R.”

Okay. I understand what you’re saying and really did debate giving to him both times. However, it is SO nice to see BLUE!!!! But I agree, it’s too aggressive. He just hasn’t been blue at all since July 8th. Since May 26th, he has only spent 6.5 hours total in the blue. He has been gimping around like a little old man. He’s 17 but he’s been a spry 17 up until the last few months.

Are you planning on continuing to use R? We suggest that people use it only with guidance from experienced users of it. There are many things to learn about when to use it, and more importantly, when not to use it.”

Well, I have 8 syringes remaining of R with 1 unit in each. (Vet sent me home with some from his bottle.) My preference would be to get the Lantus in better shape, but I like the ability to chop off a bounce with the fast acting. So I’d say my answer is maybe??? I know it’s dangerous bc of hypo.

On the spreadsheet, it's better to talk in terms of + hours than the actual clock. With everyone in different times zones with different preshot times, it's just easier that way. So I think (?) last nights R was at +3 and +10? You can modify the spreadsheet cells for those times, to add 1uR to the BG at that time. That way it's easier to see the impact of R on the numbers following the shot. It looks like you did another dose at +6.5 during the AM cycle today? It looks like it did a better job and didn't drop his as much today.”

I am not fully understanding how the +3 or +10 works or the AMPS or PMPS. Normally, he gets his insulin at 8am/8pm CST. So AMPS would be 8am? and +1 would be 9am? +10 would be 6pm? Sorry, I just haven’t fully grasped how it works. Also, Is there an example SS to look at with R added as you mentioned? Not following how to include in my SS.

Yesterday was wacky bc of the Lantus freezing. He got his Lantus at 10am instead of 8am (pharmacy didn’t open until 9am). So I think if I am saying it right, AMPS was at 10am (2 hrs late). I gave him R @4:30pm which would’ve been +6.5, waiting on his nadir before giving. But then I gave him Lantus at 8pm (10 hours after last dose) to get him back on schedule. Again, I know my approach yesterday was a little aggressive (ok maybe a lot) but he hadn’t seen blue in 3 weeks so I wasn’t worrying he would dip down that low given what I saw his body do with the R and knowing his typical Lantus peak/trough.

If you can confirm I am referring to the + system properly, I’ll try to conform to it and stop talking in time. I have not given him any more R since the +6.5 from yesterday (4:30pm 7/25). I am going to see how his bounce is today. And decide there whether to give him R again. I might drop that dose to .5 unless he gets >500 again. And I will not give until after an expected Lantus nadir. Agree?

I know you’re PST, so I will check this message board before giving any R. But I also know you have a million other people you’re helping. >60,000 messages in your profile, WOW! You have helped a TON of people! Also, sorry to hear Neko is a GA now. I dread that day with my George.

 

[George’s Mom]

I gave him .5units of R @ +5. His BS was 366

 

[Wendy&Neko]

I am not fully understanding how the +3 or +10 works or the AMPS or PMPS. Normally, he gets his insulin at 8am/8pm CST. So AMPS would be 8am? and +1 would be 9am? +10 would be 6pm? Sorry, I just haven’t fully grasped how it works. Also, Is there an example SS to look at with R added as you mentioned? Not following how to include in my SS.

Neko's spreadsheet has some examples of R use, more so in the latter half of 2015 than in 2016. Other examples include Howie's spreadsheet, starting end of December 2020, Darcy's SS starting 2/13/2020. There are others but that should give you enough examples of what the spreadsheet looks like.

AMPS is the time you gave the AM shot, the + hours are the number of hours after that. And yes, your examples of +times compared to your situation are correct. Typically we start by giving R at preshot time (AMPS or PMPS), then possibly at +6 if needed. Not on a "as needed" basis.

 

[George’s Mom]

Okay. I may try doing .5 with his Lantus and will follow these other SS to do so. Thank you!