? 9April2020/Maxi/PMPS320/Increase Lantus?/What About R?

bambinaki

Member Since 2010
Last thread: http://www.felinediabetes.com/FDMB/threads/7april2020-maxi-amps346-increase-r.228014/#post-2554309

Hello-

Maxi has been on 7 units of Lantus for 6 cycles. I just gave him 7 units, so he's starting his 7th cycle at this dose.

Beginning this time yesterday, we tried 24 hours / 2 cycles without R.

Should I increase to 7.5 units of Lantus tomorrow morning?

What about R (tonight, tomorrow, beyond)? It doesn't seem to have much of an effect.

Thank you.


@Sandy and Black Kitty @Wendy&Neko @Olive & Paula
 
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You could have gone to 7.5 U of Lantus tonight, but now it will be tomorrow morning. You can do R if you want tonight. No R tomorrow morning - you don't give the same cycle as the L increase.
 
You could have gone to 7.5 U of Lantus tonight, but now it will be tomorrow morning. You can do R if you want tonight. No R tomorrow morning - you don't give the same cycle as the L increase.

What do you think about increasing Lantus more frequently than every 6 cycles and forgoing R?
 
What do you think about increasing Lantus more frequently than every 6 cycles and forgoing R?
That's riskier if cabergoline starts to work. If caber starts lowering the dose, you just have to just stop the R. If you are doing just Lantus, you have more of a large depot to worry about.
 
That's riskier if cabergoline starts to work. If caber starts lowering the dose, you just have to just stop the R. If you are doing just Lantus, you have more of a large depot to worry about.


OK.

Do you think I should continue with R?
 


OK

Is this the schedule you recommend?

Give R at AMPS (9:30AM) (per scale)
Test at R+4 (1:30PM)
Test at AMPS+6 (3:30PM) and give R (per scale)
Test at R+4 (7:30PM)
Give R at PMPS (9:30PM) (per scale)
Test at R+4 (1:30AM)
Test at PMPS+6 (3:30AM) and give R (per scale)
Test at R+4 (7:30AM)
 
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Could you please provide a program to follow re. R and Lantus and dose increases (frequency and amounts)?

Thank you
 
What about R (tonight, tomorrow, beyond)? It doesn't seem to have much of an effect.

I think you can try increasing R -

PS 350 or higher, 1.75u R
PS 300 - 349, 1.5u R
PS 275 - 299, 0.75u R

If +6 is greater than 350, 1.25u R


Could you please provide a program to follow re. R and Lantus and dose increases (frequency and amounts)?

Thank you

For the time being continue to follow TR guidelines and increase L after completing 6 consecutive cycles at a given dose. You can tweak your R doses as needed, the numbers will be your guide.
OK

Is this the schedule you recommend?

Give R at AMPS (9:30AM) (per scale)
Test at R+4 (1:30PM)
Test at AMPS+6 (3:30PM) and give R (per scale)
Test at R+4 (7:30PM)
Give R at PMPS (9:30PM) (per scale)
Test at R+4 (1:30AM)
Test at PMPS+6 (3:30AM) and give R (per scale)
Test at R+4 (7:30AM)
regarding testing, test in a manner that, when you step back and look at your ss from a distance there are no wide open spaces of empty cells.
are you testing regularly for the presence of ketones?

btw-your +6 cells have no color. are you able to add the appropriate colors to those numbers?

You have probably heard FD referred to as the "Sugar Dance" . It is a dance, one that can and often does vary from day to day. One day might be the Cha-Cha, the next day might be a Tango. The thing to keep in mind is that, in all cases, the cat is leading the dance.
Acro adds another dimension to the dance; its a stranger that cuts in and wants to lead.
Your best defense is to get to know the stranger.
 
I think you can try increasing R -

PS 350 or higher, 1.75u R
PS 300 - 349, 1.5u R
PS 275 - 299, 0.75u R

If +6 is greater than 350, 1.25u R




For the time being continue to follow TR guidelines and increase L after completing 6 consecutive cycles at a given dose. You can tweak your R doses as needed, the numbers will be your guide.

regarding testing, test in a manner that, when you step back and look at your ss from a distance there are no wide open spaces of empty cells.
are you testing regularly for the presence of ketones?

btw-your +6 cells have no color. are you able to add the appropriate colors to those numbers?

You have probably heard FD referred to as the "Sugar Dance" . It is a dance, one that can and often does vary from day to day. One day might be the Cha-Cha, the next day might be a Tango. The thing to keep in mind is that, in all cases, the cat is leading the dance.
Acro adds another dimension to the dance; its a stranger that cuts in and wants to lead.
Your best defense is to get to know the stranger.


Thank you, Sandy.

Since the aimed glucose level is a lot lower than 275, why give R only when higher than 275?

By 'tweak the R doses as needed' do you mean to follow the new R scale you have given me, or something more/else?

I have been doing my best to test per recommendations, which have varied and included a +2, a +6, an R+4. Now the recommendation is to change it up every day and night to fill up open spaces on the spreadsheet, right? Other than that, there are no 'rules'?

On the spreadsheet, where I add anything more than the glucose number / wherever I add the R dose, the color disappears. I don't know how to add color.

No, I haven't been testing for ketones. (I tried before but the colors on the strip never matched the ones on the box.) Maxi hasn't been vomiting or losing weight, and so treatment is what I'm already doing, isn't it? I will try to test tomorrow.

I appreciate the metaphors; they are poetic. Of essential help is your instruction on concrete actions for me to take. What I can grasp is that his glucose is too high, and I give him medicine to lower it. I'm glad to get the new R scale from you as it gives me something concrete to act on. It would be great if you could give me a more specific testing schedule, even if it changes from day to day. Do I need to continue to get up twice every night to test? In another thread, you mentioned burnout. Burnout isn't an option (if burnout means giving up), but I am exhausted (one 24-hour break didn't relieve me), and I would welcome a testing schedule that allowed me to sleep through the night, or that allowed me to get up once instead of twice. Is that possible? (Poor Maxi is tired of it, too, but remains an excellent patient.)

Thanks again.

Happy Easter!
 
On the spreadsheet, where I add anything more than the glucose number / wherever I add the R dose, the color disappears. I don't know how to add color.
Hi Karen,

The spreadsheet is formatted automatically. So when a number is entered, it automatically fills with the corresponding colour. When something other than a number is entered on the spreadsheet, it doesn't know what to do so it leaves the cell white. When you want to manually put a colour in the cell on the spread sheet, there is a little paint can at the top of the screen.

upload_2020-4-12_11-22-15.png

upload_2020-4-12_11-22-52.png
The middle icon is the paint can. Move your cursor to the cell you want to fill with a colour, click on the paint can and choose the colour you want.
 

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It's good to have specific test times to see how the R is doing. For example, get at least a +4 when you shoot R, especially if you are trying a new R scale and want to see the impact of that R. For the rest of the tests, you are seeing how the Lantus part of the cycle plays out, so it's not as important to test at the same time all the time.
Since the aimed glucose level is a lot lower than 275, why give R only when higher than 275?
The job of R is to lower the blood sugar so that it is a good number for the Lantus to work with. If the number is already a decent number, you don't need to lower it more. Remember, you are working with the Lantus action, and the R action layered on top of that. You have to consider the cumulative effect.
 
Hi Karen,

The spreadsheet is formatted automatically. So when a number is entered, it automatically fills with the corresponding colour. When something other than a number is entered on the spreadsheet, it doesn't know what to do so it leaves the cell white. When you want to manually put a colour in the cell on the spread sheet, there is a little paint can at the top of the screen.

View attachment 52620
View attachment 52621 The middle icon is the paint can. Move your cursor to the cell you want to fill with a colour, click on the paint can and choose the colour you want.

Thank you very much, Judy! Got it.
 
It's good to have specific test times to see how the R is doing. For example, get at least a +4 when you shoot R, especially if you are trying a new R scale and want to see the impact of that R. For the rest of the tests, you are seeing how the Lantus part of the cycle plays out, so it's not as important to test at the same time all the time.

The job of R is to lower the blood sugar so that it is a good number for the Lantus to work with. If the number is already a decent number, you don't need to lower it more. Remember, you are working with the Lantus action, and the R action layered on top of that. You have to consider the cumulative effect.


Thanks, Wendy.

I'll try to always get an R+4 test.

200s are decent? Isn't the goal below 100?

Hasn't it been long enough for the cumulative effect to kick in? The layers of Lantus and R have not brought his numbers into a healthy range. Am I waiting for more accumulation to bring the numbers down? How long?

His AM+6 was just 274, so I didn't give him R because per the scale I should give R only if 275 or above. Is that a line not to be crossed? It seems to me that giving R at 274 would be a good idea since it's only a point away.

I just tested his ketones. I didn't put the strip in his urine stream; I caught some urine in a bowl and dipped the stick in. It shows "trace" ketones as far as I can tell. Photo attached. What should I do?

Thanks again.
 

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