Here are my thoughts and others might have some as well.
I think you could give it at +8 or +10; giving it at +8 “might” set him up for a better PS although the R will be wearing off by his PS. Giving it at +10 would set him up so the R is wearing off as his L “might” be onsetting but he has some interesting patterns in the past of still being up at +2 or +2.5 even when he was in blue/green. I didn’t go back to his 2015 SS but what do you think his onset was before ....not that it really matters that much now because it can change in the course of a few weeks and until we start seeing some movement on these doses, we won’t know what it is “now”. It was just an observation. But....I also think he’s due an increase to 5.5u 5.25u so that would change the above.
We know now that the meds are not going to drop his BG and it appears they have actually caused it to be higher. If you decide to increase to 5.5u 5.25u tonight, we need to think about when is the best time to give R later in the cycle based on a dose increase tonight. I didn’t give dose increases and R the same cycle but I was just working on the bouncing and not on pulling high, flat numbers down. I’m thinking if you give him another shot of R at +8, then you could increase tonight. While you would think that it will take him some time to fill the depot to 5.5u 5.25u, they don’t always read what they “should” do and with the R in the mix, it might bring him down quite a bit. If you do decide to increase tonight, I might give R at +8 and then see where he is at PMPS. That might be a little more conservative of an approach. If he’s still up there at PMPS, raise the dose and then we will start over with the R tomorrow at AMPS. What do you think? We can always try giving R to him again at +10 once we’ve got the new dose working.
