1/25 Weezer AMPS 258, PMPS 274, dose increase for AM?

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Linda for Weezer

Linda for Weezer

Member Since 2011
All is well in Weezer World.

Prayers for any in need of healing, strength and comfort today.

Yesterday’s Condo

Recap of yesterday
AMPS 349 shot 14u Lantus & .25u R
+3 369
+ 4 325
+5 303
+6 359
+7 335
+8 317
+9 281
+10 342
PMPS 240 shot 14u Lantus
+2 251
+4 202
+6 166
+7 164
+10 184

Another blue night last night. That makes 3 of the last 4 nights with a good amount of blue. Her daily average for the past 6 days has been yellow. Happy beans here!

I promise I won’t test Weezer every hour for the rest of her life. But since I have been using R I have been trying to see how she reacts to it. I am developing ideas and questions and need some feedback. Our current R scale is to give .25 if she is between 300 – 350 and to give .5 if she is above 350. It appears that her R nadir is at +9. Given that, I don’t feel comfortable shooting R later than about +5 in any given cycle. Because of IAA it takes longer for the R to kick in and to clear. It looks like the R given at AM +2 on 1/22 may have had a second effect in the PM cycle on the next day (1/23), when she dropped to 151, 39 hours after the injection. I’m speculating that the antibodies that bound up some of the R when administered were dying off and releasing the R back. Does this make sense? A concern I have is that if DH had been available all day on the 23rd for monitoring, he would have given her .25 R at +3 because she was at 300. If he had done that the lovely blue night that followed might have gone much lower. So far this dose of R has worked well, but I’m wondering if it were lower, would the possibility of a double dip like noted from the dose on 1/22 (if that is what it was) perhaps be lessened? I would greatly appreciate any ideas and discussion.

While I am asking questions, at what point do we start reducing her dose? I don’t want her going down to 50.

Wishing a kitty day for all, plenty of purrs, play, sunny spots and lots of love.
 
Re: 11/25 Weezer AMPS 258 R Questions

Linda, I don't know anything about R but I just wanted to stop by and tell you that you are doing a great job with Weezer. All the blues are fabulous! I know that there will be people stopping by soon to give you good advice. You are an incredible bean and Weezer is so lucky to have you!
 
Re: 11/25 Weezer AMPS 258 R Questions

No answers for you here but lots of encouragement. You're doing great and so is Weezer, those blues look fantastic!
 
Re: 1/25 Weezer AMPS 258 R Questions

No experience with R, but I know someone who is will be here soon. So great on all those blues!!! You are a great bean and Weezer is doing really well.
 
Re: 1/25 Weezer AMPS 258 R Questions

Weezer is going along just amazing, she is so lucky she has two beans on board that are ready willing and able to do shifts. It really is incredible to watch just how quickly she has improved.
 
Re: 11/25 Weezer AMPS 258 R Questions

Linda for Weezer said:
Our current R scale is to give .25 if she is between 300 – 350 and to give .5 if she is above 350. It appears that her R nadir is at +9. Given that, I don’t feel comfortable shooting R later than about +5 in any given cycle.
Click to expand...
R scales evolve and change as you gather your data on how your kitty reacts. Now that you have a few R cycles-strung together and under your belt, changes based on reactions are definitely appropriate. Go with your instincts.
Linda for Weezer said:
I’m speculating that the antibodies that bound up some of the R when administered were dying off and releasing the R back.
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Could be R - could be Lantus.
Linda for Weezer said:
A concern I have is that if DH had been available all day on the 23rd for monitoring, he would have given her .25 R at +3 because she was at 300. If he had done that the lovely blue night that followed might have gone much lower.
Click to expand...
A valid concern. That's why , when learning about your kittys response to R, you must closely monitor and be prepared for the possibility of a drop.
With IAA, it's very a seat of the pants .
The most important thing about R dosing is to take care to not give it as a bounce is clearing.
Linda for Weezer said:
I’m wondering if it were lower, would the possibility of a double dip like noted from the dose on 1/22 (if that is what it was) perhaps be lessened?
Click to expand...
To me it looks like the R set the stage for your Lantus dose to do show it's action, which is a good thing, By that time shed remodeling from the previous increase was complete.
Linda for Weezer said:
While I am asking questions, at what point do we start reducing her dose? I don’t want her going down to 50.
Click to expand...
IMO the .25uR has worked very well; you can certainly try .01u R and see what the response will be. You can always skip mid cycle R if you see it's not needed,
It may now be time to increase the Lantus, when any upcoming possible bounce clears. It looks like the R along with taking the edge of the bounces has shortened them :-D.
Weezer has had some beautiful cycles and has spent nice big chunks of time in a BG range that is much easier on her organs.
I know how nerve jangling this is. You are doing a fabulous job.
 
Re: 1/25 Weezer AMPS 258 R Questions

Linda:

I don't think you quite have a handle on the way R works. R is a short acting insulin. It's in and out in approximately 4 hours in a cat. The chart that I linked is for humans and a cat's metabolism is about twice as fast. R does not have long acting effects and it has no shed. Technically, it is referred to as a "bolus" insulin and it meant to be used in conjunction with a longer acting insulin, such as Lantus.

What you are seeing is the combined effect of the two types of insulin. When numbers are high, Lantus has more difficulty in bringing those numbers down. This is true regardless of whether the cat has IAA or acro. The R gets the ball rolling downhill so that the Lantus can latch on and exert it's influence over the remainder of the cycle. Think of it maybe as an odd sort of relay race. You put a sprinter at the beginning to get the race off to a powerful start and then the baton is handed off to a marathon runner. Lantus kicks in at approximately +2. So, as the R is petering out at +4, the action of the Lantus is building and then carrying through the rest of the cycle. It is pharmacologically impossible for R to have it's nadir at +9 if you are administering it at your usual shot time and it's effects just do not extend as long as you've described. The IAA does not effect insulin onset, nadir or duration. The antibodies attach to the insulin and, in effect, "lock up" the insulin so it's not available to work at bringing numbers down.
 
Re: 1/25 Weezer AMPS 258 R Questions

I just want to say you are doing an awesome job, Weezer is looking great, and I am learning a TON in you condo lately.

Have a great day!!!
 
Re: 1/25 Weezer AMPS 258 R Questions

Sienne and Gabby said:
Linda:

I don't think you quite have a handle on the way R works. R is a short acting insulin. It's in and out in approximately 4 hours in a cat. The chart that I linked is for humans and a cat's metabolism is about twice as fast. R does not have long acting effects and it has no shed. Technically, it is referred to as a "bolus" insulin and it meant to be used in conjunction with a longer acting insulin, such as Lantus.

What you are seeing is the combined effect of the two types of insulin. When numbers are high, Lantus has more difficulty in bringing those numbers down. This is true regardless of whether the cat has IAA or acro. The R gets the ball rolling downhill so that the Lantus can latch on and exert it's influence over the remainder of the cycle. Think of it maybe as an odd sort of relay race. You put a sprinter at the beginning to get the race off to a powerful start and then the baton is handed off to a marathon runner. Lantus kicks in at approximately +2. So, as the R is petering out at +4, the action of the Lantus is building and then carrying through the rest of the cycle. It is pharmacologically impossible for R to have it's nadir at +9 if you are administering it at your usual shot time and it's effects just do not extend as long as you've described. The IAA does not effect insulin onset, nadir or duration. The antibodies attach to the insulin and, in effect, "lock up" the insulin so it's not available to work at bringing numbers down.
Click to expand...

On 1/8 Sandy wrote this in our condo:
Sandy and Black Kitty said:
We know the evil antibodies bind to the insulin. It's my understanding that the evil antibodies do have a life span, and when they give up the ghost, they also give up the insulin that was bound to them. In this way the antibodies delay the action of insulin, so a normally fast acting insulin like R becomes slower. Likewise for Lantus - it's effects are delayed as well. That's why you can see the effects of R later, sometimes for 2 or 3 cycles, in IAA kitties.
Click to expand...

Trying to tweeze out what is doing what, when, is like tying to take the gelatin out of jello after it's set. But i'm still left wondering if there isn't some tweaking that can be done to our current plan so we have a a better idea of what to expect, and maybe guide her cycles a little better. We really can't test her every hour, day an night.
 
Re: 1/25 Weezer AMPS 258,+3 368,+4 361 R Questions

Linda, because Lantus nadirs around +6, the R may nadir right around the +6.5 Lantus time, so I would get a +6 test at least on this.
 
Re: 1/25 Weezer AMPS 258,+3 368,+4 361 R Questions

Dyana said:
Linda, because Lantus nadirs around +6, the R may nadir right around the +6.5 Lantus time, so I would get a +6 test at least on this.
Click to expand...

Will do!
 
Re: 1/25 Weezer AMPS 258,+3 368,+4 361 R Questions

Wow Linda, no wonder your brains were fried the other day, reading all of this and trying to absorb this information is making my brain hurt!

Wee Wee Weezie looks fantastic these last few days!!! :-D You and the DH are doing an amazing job with her, and Weezer is lucky to have such wonderful beans.
 
Re: 1/25 Weezer AMPS 258,+3 368,+4 361,+6 257 R Questions

I think Sandy and I are saying the same thing but in different ways. However, the duration of R is not what you were describing.

I would also remind you that you need to be careful when giving R. If you give R at +4 in the Lantus cycle, the R is reaching its nadir at around +6. Thus, the Lantus nadir and the R nadir could occur at the same time. While it doesn't look like this is an issue today, it can potentially be an issue. You do not want the nadirs of the two insulins to overlap causing a big drop in numbers.

The reason that you've been urged to test aggressively while you're learning about R is so you have an idea of when the R onset and nadir occur and what kind of duration you're getting. As you get a better feel for how R works with Weezer, you will be able to back off of the testing a bit. If there's anything I can underscore it's that you need a very healthy respect for R. It is an extremely potent type of insulin. We start with micro doses because it's so potent. We want Weezer to be safe at all times.
 
Re: 1/25 Weezer AMPS 258,+3 368,+4 361,+6 257 R Questions

I'm with Tracy - my brain hurts! Hang in there Linda! :YMHUG: No advice here (obviously), just support and cheerleading! SO awesome that you guys have been seeing blues - you are on the right track!
 
Re: 1/25 Weezer AMPS 258,+3 368,+4 361,+6 257,+7 228 R Quest

And I thought I had it bad with Champ!! Whoa, nelly!! Good luck with this R business. I know it's going to be tough for a bit, but you're up to it!! Great job you're doing for your girl!!
 
Re: 1/25 Weezer AMPS 258, PMPS 274

Here's a recap of the day:

AMPS 285 (shot 14 U Lantus)
+3 368
+4 361 (shot .25 U R)
+6 257
+7 228
+8 240
+9 237
PMPS 274 (shot 14 U Lantus)

In the last 5 days, 3 have had stretches of blue at night. I hope tonight will be the same. Today's AM average was the lowest of those 5 days. Yay R! I would like to get some input on tomorrow's AM dose. Tonight was our 12th cycle on 14 U. If we don't get to blue tonight should we go up to 14.5, or are we ready to go to 14.5 whether or not we see blue tonight? Or should we stay where we are a while longer? I shoot at 7:30 EST, so any advice left overnight will be helpful in the morning. I feel incredibly blessed to have so many people sharing their experience and time to help us make these decisions. Thank you isn't enough, but it's all I have.
 
nice. :smile:

I think it is time to try an increase to 14.5 units. Weezer is doing great, but there is room for improvement.

I do have a suggestion for tweaking your R use, now that you have some good data. In the AM cycles, I suggest using R only at AMPS time, not any later than that. Back in the old days (like last week!) when Weezer's bounces were lasting for days, it was easy to get away with shots at different times. Now, though, her bounces aren't even lasting a whole cycle. You don't ever want to give R when a bounce is clearing, and her bounces seem to be clearing in the last 1/2 of the AM cycles. I'm afraid if you give R any later than AMPS, you might run into problems with the R kicking in at the same time a bounce is clearing. Giving it at AMPS should be fine, numbers permitting, because it looks like Weezer tends to rise until at least +3 if you don't give R, and if you do give R it holds her fairly flat.
 
Great job, Linda and DH! Wow, you are doing an amazing job with all of this. I am wondering if you are seeing any difference in Weezer's behavior with the lower numbers. I've been a bit out of touch the past few days so maybe you've commented and I missed it.
Liz
 
Nothing but admiration for you, DH, and Weezer. Linda, you are doing an amazing job! And how lucky you are to have such great help from some terrific beans.
I hope you'll be able to get some sleep tonight.

Ella & Rusty
 
omg brain overladen here - but very interesting reading. I can't help with any of it - but do wish you well with R. Weezer is looking great. I love the blue cycles, and do hope you have one tonight too. Good luck!
 
Like everyone said, you are doing an amazing job with Miss Weezer--Does she know how lucky she is??
Just wanted to say we are all learning lots about R from you & posts tonite-
Please get some sleep though, beans need care too--Hugs & love from us!
 
wow linda - when i look at weezer's ss this week compared to a week ago - amazing. you're doing a fabulous job!

sleep tight tonight! :YMHUG:
 
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