11/27 Beau - amps/315, +9/377, pmps/344, +3/230

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alicia.1771

alicia.1771

Member Since 2011
Previous post 11/26/11 - http://felinediabetes.com/FDMB/viewtopic.php?f=9&t=57345

Beau did really well last night. He had a slow and steady drop from 241 @pmps to 118 @+5.5. He probably went lower but I couldn't get up and test until @+8.5 at which time he was already coming up to 229.

amps - 315 - continued with 1.75u
+ 3 - 315
+5.5 - 322
+9 - 377
pmps - 344 - increased back to 2.0u per board suggestion
+2 - 291
+3.25 - 230

I'm very happy with his amps. It seems if the drop is slow and steady he doesn't bounce as high. I guess we will see by the rest of his morning numbers since on his last blue nadir he continued to rise after am shot.

I wasn't sure whether to continue with the reduced dose of 1.75 or back up to 2.0 since I kind of increased his dose during a bounce. I went with the reduced dose and will let him settle into 1.75 for a few days unless his numbers tell me otherwise.

I'm going to give his ears a little rest today so don't want to test so frequently. What are the important + hours to test for a mini curve on Lantus?
 
Re: 11/27 Beau - amps/315 - what hours to test?

ok, now you want to hold the 1.75u as a dose no matter how high he goes, unless he drops below 50, for at least 6 shots in a row. changing doses can give wonky numbers, so hold hold hold!

he may bounce from those pretty blues last night. i check about every 3 hours or so, but i'm not sure what's best for Beau because he seems to go lowest at the end of the cycle. perhaps some one else can advise you on that.
 
Re: 11/27 Beau - amps/315 - what hours to test?

it was the 2u dose that caused the breakthrough - last night's cycle was running on shed action from the previous cycle's 2 unit dose. Since 1.75 units wasn't enough and 2 units caused a breakthrough, I would stay with 2 units and see what that dose can do.

For today, I would probably get a +3 to get an idea of whether he is going to stay high this cycle (bouncing) or maybe see some more action. Then depending on what the +3 is, you can decide what other tests would be helpful.
 
Re: 11/27 Beau - amps/315 - what hours to test?

i don't want you to be confused - libby has a ton more experience than me, so if she says change the dose, then change the dose. :-D
 
Re: 11/27 Beau - amps/315, +3/315

+3 - 315

He's holding steady so far :)

Thanks for commenting on the dosage. I want to see how his numbers are today since 1.75 did bring him down from 322 @pmps to 122 @+5 on 11/24, which was the 6th cycle on that dose. However, I went ahead and increased his dose to 2.0 the next morning because he was > 260 for the 5 cycles prior to that and I was becoming impatient of his high flat numbers :oops:
 
Re: 11/27 Beau - amps/315, +3/315

I'm not sure you got the gist of Libby's note.
Libby & Lucy said:
it was the 2u dose that caused the breakthrough - last night's cycle was running on shed action from the previous cycle's 2 unit dose. Since 1.75 units wasn't enough and 2 units caused a breakthrough, I would stay with 2 units and see what that dose can do.
Click to expand...
This is a little complicated so bear with me. Lantus is a depot-type of medication. We refer to the insulin depot as a "shed." There is a sticky note that describes this in more detail. What this means is that there is a reservoir of Lantus that remains in the system. Whenever you change a dose it has an effect on the shed. However, the effect is rarely immediate. Often, you see the effect a cycle or two later.

What Libby was indicating is that it was not the 1.75u that caused the blue numbers last evening. Rather, it was the effect of the 2.0u that you shot in the morning.

Think of it as though you were steering an ocean liner. You may turn the ship but it takes a while for the course to change. This is in contrast to a power boat where when you turn the wheel, the effect is immediate.
 
Re: 11/27 Beau - amps/315, +3/315

Hi Sienna,

Thanks for going over the shed with me. My concern is that on the 6th cycle of 1.75 Beau dropped to 122 at +5 and maybe lower but I went to bed. According to protocol I should have held the dose for another 3 days but I didn't and instead increased it to 2.0 the next morning. If you look at his SS he was high and flat for 3 cycles on 2.0 and finally started to come down at the end of the 3rd cycle. I guess this could be interpreted as either his bounce is clearing since it was the lowest he has been in months and/or the 2.0 dose is taking effect. I don't mind going back up to 2.0 if that will help him maintain the breakthrough. But it seems that would be ignoring the good nadir on 1.75 unless we consider it to be an out of norm drop??? confused_cat

I think I need clarification on when to increase a dose. The protocol says:
Increasing the dose:
Hold the dose for 3 - 5 days (6 - 10 consecutive cycles) if nadirs are less than 200 before increasing the dose.
After 3 days (6 consecutive cycles)... if nadirs are greater than 200, but less than 300 increase the dose by 0.25 unit.
After 3 days (6 consecutive cycles)... if nadirs are greater than 300 increase the dose by 0.5 unit.
Click to expand...

If within the 3 days on a new dose the nadir reached the required nadir only once (our case was 122 on the 6th cycle of 1.75), does it call for a dose adjustment or hold the dose? Or does the nadir has to reach the required # for all 6 cycles? I think this is where I got confused...
 
Re: 11/27 Beau - amps/315, +9/377 - what to shoot tonight?

+9 - 377

Slowly rising throughout the day. Most likely a mild bounce from last night's blues. Not bad considering he usually goes into the 400's and stay there for a while after some good numbers.

Didn't hear back from anyone regarding my question on dose increase protocol. Any long-term Lantus user can chime in a bit? PM shot is coming up in 2 hours and I'm not sure whether to go with 1.75 or 2.0. This week work will be crazy so I won't be able to stay up really late or get up in the middle of the night so I'd rather be safe, but at the same time I don't want to loose the momentum either... :?
 
Re: 11/27 Beau - amps/315, +9/377 - what to shoot tonight?

just realized beau's pic is up!!

hi, Beau!

and bumping your post for better eyes...
 
Re: 11/27 Beau - amps/315, +9/377 - what to shoot tonight?

I agree with Libby and Sienne...I would go back to 2.0u.

The numbers you saw on 1.75u are history, whether or not you increased prematurely doesn't matter now. The nadir you use for evaluating for dose increases is the lowest nadir you saw....it does not need to be maintained for all of the cycles.

Remember you are aiming for Beau to spend as much time as possible in the 50-120 range.
 
pmps - 344
+2 - 291
+3.25 - 230

Thanks everyone on the dose advise! Dose increased back to 2.0u on pm shot. So far so good.
 
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