Re: 5/16 Duriel AMPS140, +3 176, +5 184, +8 200
Venita and Ennis93 said:
If the people on the Lantus ISG are going to be collectively advising Jorge to test as much as you seem to be doing
I did not ask him to test as much as we are testing and especially not as much as I, personally, test. Please reread my post. I said
"if you work" a +2
OR out the door and an in the door. That would be three tests in the a.m. including the PS. Then I said at night a +2
OR a before bed....that would be two tests in the pm including the PS. I was not aware there was a limit on how many strips he could use but I'm not suggesting that he test more than 4-5 times/day.
I also said a midcycle test would be fine
when he is off work (
if he works, I don't know the answer to that). That would be a PS, midcycle, PS, midcycle.
The value of a +2 test? Just for education, very valuable
if it's possible to do. The +2 test will give a good idea if it's going to be an inactive cycle, a typical active lantus cycle, or a very active cycle. Let me give you an example. If he had gotten a +2 last night or this morning, it would have likely been similar to or higher than the PS. If it is much higher than the PS, then he can limit his testing. Since she was in mid blue both cycles, he could have just gotten a +6 test and saved some strips.
The +10/+11 tells the caregiver if he/she will be shooting a dropping number.
He doesn't need to get a +2 and or a +10/+11 every cycle. If he's limited to four tests a day and he's not always around midcycle, then mix it up. Get his PSs every cycle and on the days he can, get just a midcycle, another cycle get just a +2, etc.
Since the question was asked and for additional information on why +2 and +10/+11 tests are important, from the Sticky on
Shooting and Handling Low Numbers
This is where the very early cycle spot checks (those +1's, +2's) and those very late cycle spot checks (the +10's, +11's) come into play. Call them the "neglected" spot checks. Everyone gets those +6 spot checks, but there is a reason to collect data in the very early and very late part of the cycle.
Say you get a preshot of 150. Well if you've collected the data on the average time it takes the insulin to start having any effect for your cat and what happens after +12, then you might see that shooting a 150 is actually very safe in your cat. Kitty will be in the 200's before the insulin starts working. You are then using the lag time (aka overlap and carryover) between shooting and effect time to your advantage.
So why the +10's and +11's? Well say you are on day 5 of a dose increase change and your storage shed is now not only full, it is overflowing... and your +10 or +11 was way higher than your preshot. Good way to stay out of trouble cause now you know you would have shot a still dropping number, not a good idea. so what is the plan then?.... keep testing, and not 2 hours later, every 20-30 minutes would be better, so you can catch the minute it turns and do not loose all your overlap. If you miss the rise and cat is way up there BG wise before you shoot, remember the number is just going to continue to rise in those hours before the insulin has a chance to kick in, and you have a roller coaster curve going rather than the flat curve that is ideal.
Also some Lantus and Levemir users notice a dip at the end of the cycle, meaning that their preshot is always a bit lower than their +10 or +11. It is important to know if your cat is one of those because if you are not raising your dose because your PS doesn't seem to call for it, yet your nadir is not so hot... this could be the reason why.
If Jorge can get a PS and midcycle test each cycle, that would be fantastic but his schedule might not allow him to always get a mid cycle. My goal is to help him get Duriel regulated and perhaps in remission and then no one has the expense of 125 test strips a month. If we can't see what is happening some time during the cycle with a spot check, then Duriel could eventually be overdosed.
I also understand there will be days when Duriel starts getting into lower numbers, where Jorge will need to use more strips to keep her safe.
