9/05 Butters AMPS 283/+2.5 367/+6 290/+10 297/PMPS 241/+2.5 272/

Discussion in 'Lantus / Levemir / Biosimilars' started by Butters & Lyla, Sep 5, 2020.

  1. Butters & Lyla

    Butters & Lyla Well-Known Member

    Joined:
    May 30, 2020
    Yesterday AM Butters showed me that she cleared her bounce since earning that reduction on 9/02, with a nice cycle of low blues and a brief dip in the lagoon. But throughout the PM cycle her numbers have slowly been climbing. I got a +8: 196. Now this morning she is 283.

    Today is the start of cycle five of 1.5u. I have seen one cycle with a nadir under 100. Could her numbers over the last two cycles be pointing toward a failed reduction? Could 1.75u be too much but 1.5u be too little insulin? How can I tell a failed reduction from a bounce?

    I am asking because I could take action if this is a failed reduction, correct? I wouldn't have to wait for 10 cycles (seeing as I had one cycle with a nadir below 100) to increase.

    Thanks!
    Have a lovely day/evening, all.
     
  2. JaxBenji

    JaxBenji Well-Known Member

    Joined:
    Jul 10, 2020
    You know I have no idea on the dosing ;) BUT I was looking at your SS and that beautiful string of blues all day yesterday :cool: Good luck with whichever way you end up going with your dose! Thanks again for your help this morning!
     
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  3. Butters & Lyla

    Butters & Lyla Well-Known Member

    Joined:
    May 30, 2020
    Ugh, Butters, 367 @+2.5.

    @Sienne and Gabby (GA)
    @Wendy&Neko
    @Sue and Luci @tiffmaxee

    If any of you are on today, would you mind taking a look at Butters' spreadsheet/BG numbers over the last five cycles and giving me your opinion? If it is a failed reduction I would not want to wait any longer than necessary to adjust her dose. Thank you so much. I have read the part of the protocol that addresses failed reductions but am unsure how to interpret it.
     
  4. Sienne and Gabby (GA)

    Sienne and Gabby (GA) Senior Member Moderator

    Joined:
    Dec 28, 2009
    I'd hold the dose for now. I'd like to see what this cycle looks like. I'm thinking this is a bounce.

    Just to check... You hold the dose for 10 cycles if your cat is new to numbers that are under 200. Likewise if most of the nadirs are in the blues and greens (actually, more in the normal range) you hold the dose. Just because you have one nadir that's green, I wouldn't hold the dose for 10 cycles.
     
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  5. Butters & Lyla

    Butters & Lyla Well-Known Member

    Joined:
    May 30, 2020
    I was having problems getting back on the board today. Not sure if it's me or the board.

    I forget that Butters isn't new to numbers under 200 anymore. She has stayed high this cycle. Does this indicate a bounce? And if so, what action do I take based on that? Hold the dose tonight and see what happens? I think it looks like she has been taking 2 - 3 cycles to clear bounces lately. In which case, does it make sense to hold tonight and if nothing changes, go back up to 1.75u in the morning?
     
  6. tiffmaxee

    tiffmaxee Well-Known Member

    Joined:
    Nov 15, 2013
    Yes. The site was down. A bounce can take up to 6 cycles to clear. She’s being stubborn this time. I’d hold. It should clear by morning.
     
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  7. Wendy&Neko

    Wendy&Neko Senior Member Moderator

    Joined:
    Feb 28, 2012
    As for failed reductions, does this post by Jill help? I agree with Sienne, a little early to tell yet.
     
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  8. Butters & Lyla

    Butters & Lyla Well-Known Member

    Joined:
    May 30, 2020
    Thanks so much for your input, Sienne, Elise and Wendy. I really appreciate it. I will continue to hold and do agree that makes sense.

    I think it does. Thank you for finding that! I wonder if I could try to interpret it accurately in the context of Butters' spreadsheet.

    Jill wrote: if you see BG numbers trending upwards after any bounce clears... you'll want to take the dose up

    What I see on the spreadsheet is: Butters cleared a bounce 9/02 PM cycle and earned a reduction. Begin reduced dose 9/03 AM cycle. She also bounces this cycle and the 9/03 PM cycle. Bounce clears 9/04 AM, but her numbers this cycle are overall higher than they were the last time she had good numbers (9/02 PM cycle, prior to reducing).

    Does this example illustrate that Butters' good, non-bounce numbers may be trending upwards? I would need more than this one example to really call it a trend. But do you think I interpreted Jill's statement correctly?
     
  9. Wendy&Neko

    Wendy&Neko Senior Member Moderator

    Joined:
    Feb 28, 2012
    I also would caution against using numbers from just one or two cycles to determine a trend of rising numbers. Butters numbers on 1.5 units aren't hugely different from where they were on 1.75 units. But by now the 1.75 units depot is almost gone, so you'll be seeing what 1.5 can do by itself now. Plus there is the phenomenon that some cats do of going high before they go low (stay tuned for tonight...). Not a good time to increase.
     
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  10. Butters & Lyla

    Butters & Lyla Well-Known Member

    Joined:
    May 30, 2020
    I agree, identifying a trend requires much more data than a couple of cycles' worth. I just wanted to see if I could spot something resembling what Jill meant. Definitely not looking to increase anymore. Thanks! The "high before the low" possibility gives me hope for better numbers to come. :)
     
  11. carfurby (GA)

    carfurby (GA) Well-Known Member

    Joined:
    Feb 19, 2012
    I hope Butters comes down for you tonight.
     
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  12. Butters & Lyla

    Butters & Lyla Well-Known Member

    Joined:
    May 30, 2020
    It looks like she won't be coming down tonight. The waiting game continues.
     
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