I double tested yesterday and got 468/526. Don't want to poke her twice every time though.
My impression over the past year is her onset is at +3, but I haven't measured it exactly in a long time.
If IAA is in the mix that could indeed be the case. Since we don’t know my instincts say it’s more the 8.5uL dose finally settled in and showing some action.
this will not always be the case.
Yes but not based on this one event. Gather more data, carefully, one cycle at a time. You will develop a feel for the flow of it.
FWIW under the same circumstances (the absence of the danger of BGs bottoming out) I would not have intervened. It would leave me wondering what would have happened had I not. if it turned out to be a bad call-lesson learned and solid data gathered. For the most part I kept BKs meal schedule steady and worked around it. It was a year before BK had his first taste of HC.
While it's certainly possible the insulin depot has adjusted on the third cycle of the increase to 8.5u Lantus, we also have to consider R was given for the very first time @ +11 instead of @ +10. That hour can make a difference when we're also looking for the onset of Lantus. Since her numbers are so close... well within meter variance... @ Lantus +2 and +3 (@ R +3 and +4), it's hard to tell when the R nadir and Lantus onset overlapped today.
This is her 2nd day at 8.5uL, if that makes any difference.
While it's certainly possible the insulin depot has adjusted on the third cycle of the increase to 8.5u Lantus, we also have to consider R was given for the very first time @ +11 instead of @ +10. That hour can make a difference when we're also looking for the onset of Lantus. Since her numbers are so close... well within meter variance... @ Lantus +2 and +3 (@ R +3 and +4), it's hard to tell when the R nadir and Lantus onset overlapped today.
I very much agree with Sandy. Don't draw any conclusions from any single event... especially when a variable has been changed. You're definitely in data collection mode!
Yes, today is the third cycle @ 8.5u Lantus.
"If" the R given @ +11 this morning overlapped with the Lantus onset, it may have been enough to provide the movement you've seen today.
Possibly, but you can't really ignore what's been going on with the Lantus (the increase and building of the depot) because it's all part of the big picture.
She's been pretty flat today. If her numbers remain flat you may see more movement tonight. Are you prepared to monitor as long as it takes... even if it takes a good part of the cycle? Think about her as well as yourself. Make your decision accordingly.
Lantus is a cumulative insulin. One dose builds upon the next. There is no cumulative aspect to R. R is an in and out insulin. One dose of R does not build upon the next. When the R cycle is done, it's done... gone.
Probably, but again, see how things go.
For what will I be monitoring? Hypoglycemia? Every hour or every 2 hours? I am afraid if I stop R she will bounce back up to black. I have no confidence in the 8.5uL
I think it would be a big coincidence if 8.5u was the first "active" dose of Lantus, after I've been seeing nothing but deterioration for weeks. Because of that I think it is all due to the R. I know that is a guessing game. I thought I could wait and figure that out by skipping R when I increased to 9uL. It's unlikely that 8.5u will take her lower to yellow. My goal is to reduce her numbers ASAP. Do I want to spend time testing 8.5uL on its own when R might be bringing her down 100 points?
I doubt you'd be monitoring for hypoglycemia... although it's always a possibility. If it were me, I'd want to monitor to make sure she didn't take any steep drops... and want to know what she dropped to, but that's just me.
It's entirely up to you as to how you want to proceed... how much risk you want to take. I'm all for aggressiveness. I think that's obvious by looking at Alex's spreadsheets, BUT <---- and that's a big but... safety is and always has been the number one priority with me. Right or wrong, my methods, whether for my own cat or in making suggestions to others is to couple aggressiveness with making time to pull back to accurately assess the effect on the cat. Am I being too conservative in my suggestions? Maybe, but I'd rather be conservative than cause a problem. I can suggest and give you the reasons for my suggestions/advice. However, your cat. You make the decisions.
I'm sorry. I wish I could be as certain as you seem to be. I've rarely (if ever) seen the effects of a full depot after only 3 cycles at a certain dose.
Ah. I previously read the "grabbing onto the R" as explaining the benefits in the first cycle of the R, and then perhaps leaking into the next cycle of L through the lower BG. All those subtle interactions. I do keep rereading the posts but you're right I should link them all together.
