12-13 Howie AMPS=188 +1=208 +2=227 +3=214 +4=186 +5=172 +6=189 +11=148 PMPS=123 +1=145

No R if he's under 300. At least that was the rule when I got started. Later you might give it at lower BG, but for now I'd hold off.

ETA: Just looked back and I see you got different advice from Sandy yesterday. Ignore me. :)
 
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Just checked your SS and I see that you went ahead and gave it. Be sure to track hourly (maybe even past +4) and be prepared for low numbers... if 0.25 dropped him by about 100 at +3 yesterday he could go pretty low today.
 
Here are the guidelines I was given:
No R if under 300 (until you have more data about how he responds)
No R on the same cycle as a Lantus increase, in case the Lantus increase brings him lower than usual
No R if it's a bounce breaking cycle and he's already dropping on his own

Also, R is always optional. If you can't monitor or aren't prepared to stay up with him, you can skip. It's not like Lantus where you're building a depot and need to keep the dose consistent.
 
Just checked your SS and I see that you went ahead and gave it. Be sure to track hourly (maybe even past +4) and be prepared for low numbers... if 0.25 dropped him by about 100 at +3 yesterday he could go pretty low today.
Yes, that 100 point drop was a shock. Not knowing if that was the R or a bad strip, I should have retested (hindsight!) His PM +3 only dropped him 50 points last night.
 
Here are the guidelines I was given:
No R if under 300 (until you have more data about how he responds)
No R on the same cycle as a Lantus increase, in case the Lantus increase brings him lower than usual
No R if it's a bounce breaking cycle and he's already dropping on his own

Also, R is always optional. If you can't monitor or aren't prepared to stay up with him, you can skip. It's not like Lantus where you're building a depot and need to keep the dose consistent.
I’m lucky he gets dose increases of L tomorrow and Thursday as I have a ton of meetings for work those days!
 
Yes, that 100 point drop was a shock. Not knowing if that was the R or a bad strip, I should have retested (hindsight!) His PM +3 only dropped him 50 points last night.

Did he get R in the evening? I don't see it on the SS.

One of my problems with sorting out the R response is that when Oberon was stuck in the 300s he'd have fluctuations within that range that were sort of random. So the R effect was overlaid on top of that messiness. It meant that sometimes I'd give R and it looked like it didn't do anything, and other times I'd give the same dose and he'd drop 100 points. Eventually we determined that a dose of 1.25 U dropped him about 100 points, so I could give that safely if he was over 300. We later added in other doses for other BGs (1.5 U if over 450; 1 U if between 250 and 300). That's his R scale- it tells me what dose of R I can safely give for a particular preshot BG number. So he might get 1.5 U of R in one cycle, and 1.0 in the next, depending on his BG. Now that the IAA is breaking and he's sliding down the Lantus dosing scale, I'm having to revise the R scale as well, since he's more sensitive to insulin now. Starting over by testing 0.25 U again. Your R scale will likely be different than mine, but this gives you an idea of what to expect. It's a very different approach from the Lantus dosing, where you continually increase the dose until you get to one that's effective (and then drop when reductions are earned).
 
Did he get R in the evening? I don't see it on the SS.

One of my problems with sorting out the R response is that when Oberon was stuck in the 300s he'd have fluctuations within that range that were sort of random. So the R effect was overlaid on top of that messiness. It meant that sometimes I'd give R and it looked like it didn't do anything, and other times I'd give the same dose and he'd drop 100 points. Eventually we determined that a dose of 1.25 U dropped him about 100 points, so I could give that safely if he was over 300. We later added in other doses for other BGs (1.5 U if over 450; 1 U if between 250 and 300). That's his R scale- it tells me what dose of R I can safely give for a particular preshot BG number. So he might get 1.5 U of R in one cycle, and 1.0 in the next, depending on his BG. Now that the IAA is breaking and he's sliding down the Lantus dosing scale, I'm having to revise the R scale as well, since he's more sensitive to insulin now. Starting over by testing 0.25 U again. Your R scale will likely be different than mine, but this gives you an idea of what to expect. It's a very different approach from the Lantus dosing, where you continually increase the dose until you get to one that's effective (and then drop when reductions are earned).
Oops! Thanks for catching that I forgot to enter that he got R last night! I will be very interesting to see how this works with Howie and what his scale will look like. What did you see that led you to know that the antibodies were breaking (vs just the R effects)? Howie lives in yellows and has been increasing his pinks lately.
 
His initial pattern was that he was stuck in the 300s with occasional brief dips lower. Those dips started happening more frequently, then started dipping even lower and lasting longer. Eventually they started going low enough that he earned Lantus reductions (BG below 50, though I'm actually using a modified reduction threshold of 70 because of the IAA). Once that happened, he started getting a reduction about every 6 cycles. He's gone from a high of 10 U to 4.5 U in just over a month. Check out the "BG vs. date-all" tab of my SS to see the whole picture. (Graph labeling is missing... blue is BG, yellow is preshot BG. Red/green are Lantus/R, using the right hand Y axis scale. Orange is ketones, which I've also been monitoring occasionally.)

I'm not sure how much of what happened was specifically because of the R. I started using it right around the time the dips increased in frequency; it could be that the R helped that happen. Once the antibodies started to break, I stopped using it as much; a lot of the time the conditions weren't right (BG too low), and he was doing a fine job of coming down on his own anyways. Right now he seems to be spending more time in the high numbers again in between his dips, and I'm considering using R a bit more often to try to keep him in at least slightly lower numbers. But since his Lantus dose is less than half what it was, the R scale also needs to be redone.
 
The suggestion for Howie is different for R scale to start partly because of his overall numbers (less pink than Oberon was at this point), and also because he's on Levemir. With Levemir being shot at preshot, it's longer until onset and you are also more likely to have lower numbers at preshot as the entire insulin action is later. I liked the idea of R with Levemir for Neko, especially with her L onset not until +5. It was like R kept a lid on things until onset. However, her R onset and nadir were later than normal, so it took some tweaking to get things right. Looks almost like Howie might be sligthly delayed from the usual R+2 onset.

Interesting cycle today, looks like R might have kept a lid on things. Will be interesting to see where he goes the rest of this cycle. Also good to see ketones down a touch.
 
The suggestion for Howie is different for R scale to start partly because of his overall numbers (less pink than Oberon was at this point), and also because he's on Levemir. With Levemir being shot at preshot, it's longer until onset and you are also more likely to have lower numbers at preshot as the entire insulin action is later. I liked the idea of R with Levemir for Neko, especially with her L onset not until +5. It was like R kept a lid on things until onset. However, her R onset and nadir were later than normal, so it took some tweaking to get things right. Looks almost like Howie might be sligthly delayed from the usual R+2 onset.

Interesting cycle today, looks like R might have kept a lid on things. Will be interesting to see where he goes the rest of this cycle. Also good to see ketones down a touch.
It was an interesting day! I’m Christmas baking so haven’t been as vigilant getting stuff posted today. He ended up going down to 172 at +5 and then back up to 189 at +6. I need to give his ears a break this afternoon. I’m curious what his L nadir will be tonight! His diarrhea has not been getting better with the s boulardii. He didn’t eat his mini meals over night that had it and he’s not been very excited to finish his food today. I finally got some organic chicken and poached it. He’s gobbling that up and seems more alert. I’ll have to see what the vet wants to do tomorrow.
 
@Sandy and Black Kitty, @Wendy&Neko
In case you get this before 720pm CST, Howie’s +11 just came in at 148. I do believe this is the lowest he’s ever been! In case his nadir is at PMPS when it normally has been and is lower, I just want to confirm I shouldn’t give him R tonight but should still keep with his 19 units of L? I’m really in unchartered territory! Tomorrow he should begin 20 units of L. My brain is a little moosh right now...is there a reason to hold him at 19 units?
 
@Sandy and Black Kitty, @Wendy&Neko
In case you get this before 720pm CST, Howie’s +11 just came in at 148. I do believe this is the lowest he’s ever been! In case his nadir is at PMPS when it normally has been and is lower, I just want to confirm I shouldn’t give him R tonight but should still keep with his 19 units of L? I’m really in unchartered territory! Tomorrow he should begin 20 units of L. My brain is a little moosh right now...is there a reason to hold him at 19 units?
No R tonight.
 
With low blues, you consider holding this dose a couple cycles longer. Lovely day. :cool::cool:

Typically HC is reserved for under 50, some people use MC to steer the numbers/prevent fast drops. But ECID on how carb sensitive each kitty is. I presume you have the supples?
 
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With low blues, you consider holding this dose a couple cycles longer. Lovely day. :cool::cool:

Typically HC is reserved for under 50, some people use MC to steer the numbers/prevent fast drops. But ECID on how carb sensitive each kitty is. I presume you have the supples?
Yep? Have MC and HC food. I’m afraid the vet is going to recommend metronidazole for his diarrhea tomorrow. I can tell he’s lost weight. How will that impact his BG (if you know)?
 
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Howie on my lap not wanting to get up from his nap. Such a life!
 

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