? 16April2020/Maxi/AMPS493/Increase Lantus & R

Today is the 4th cycle on 7.75 units. Last time it took Maxi until the 6th cycle at a new dose before showing his blues. Time for patience on the L. And the size of L increase would be based on the nadirs you see before then. Meaning, I can't guess ahead of time.
 
Wendy&Neko said:
Today is the 4th cycle on 7.75 units. Last time it took Maxi until the 6th cycle at a new dose before showing his blues. Time for patience on the L. And the size of L increase would be based on the nadirs you see before then. Meaning, I can't guess ahead of time.
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Thank you, Wendy.

I just don't want Maxi to go through another cycle at a dose that is less than it should be. I.e., I don't know if you'll be able to let me know by tomorrow PM, so that's why I'm asking now.
There are ranges on which you make your recommendations, so instead of being on pins and needles, waiting until the last minute, and possibly missing another cycle at the dose that would be recommended, I was hoping you could give me those ranges.
 
The guidelines, per TR, are if you get no nadirs below 200, to increase after six cycles. If you see blue, you can hold 6-10 cycles. I tend to shorter if high blue, longer if low blue. The reason we had you hold longer last time was you were seeing quite a bit of mid blue, and uncertainty over the cabergoline effect. When cabergoline kicks in, it can make very fast changes to dose requirements. So, my comments on dosing are somewhat on the cautious side.
 
Wendy&Neko said:
The guidelines, per TR, are if you get no nadirs below 200, to increase after six cycles. If you see blue, you can hold 6-10 cycles. I tend to shorter if high blue, longer if low blue. The reason we had you hold longer last time was you were seeing quite a bit of mid blue, and uncertainty over the cabergoline effect. When cabergoline kicks in, it can make very fast changes to dose requirements. So, my comments on dosing are somewhat on the cautious side.
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Thank you, Wendy.

So if I see no blue by the end of tomorrow's AM cycle, should I increase Lantus by .5 or .25 (to 8.25 or 8 unit)?

And no further tweaking of the R scale?
 
bambinaki said:
Thank you, Wendy.

So if I see no blue by the end of tomorrow's AM cycle, should I increase Lantus by .5 or .25 (to 8.25 or 8 unit)?

And no further tweaking of the R scale?
Click to expand...
When the dose gets to be over about 5u, we do the increase by approximately 10% so, for the time being and until we start seeing some changes that warrant reconsideration, you want to do increases by 0.5u. “If” the dose gets up to 10u bid, dose increases will likely be 1u. But we will look at that closer when and if that time comes.

Regarding the R scale, it would be really helpful to have it as a tab on his SS. I’ll make a tab for you and then if you can put the current scale on the tab, that would be super helpful so anyone with R experience who is helping can quickly access that without having to look back through condos to see what it is. So....I’m sorry to put you off right now on that question but I don’t know what your current R scale is.
 
Marje and Gracie said:
When the dose gets to be over about 5u, we do the increase by approximately 10% so, for the time being and until we start seeing some changes that warrant reconsideration, you want to do increases by 0.5u. “If” the dose gets up to 10u bid, dose increases will likely be 1u. But we will look at that closer when and if that time comes.

Regarding the R scale, it would be really helpful to have it as a tab on his SS. I’ll make a tab for you and then if you can put the current scale on the tab, that would be super helpful so anyone with R experience who is helping can quickly access that without having to look back through condos to see what it is. So....I’m sorry to put you off right now on that question but I don’t know what your current R scale is.
Click to expand...

Thank you, Marje.
I'll post the R question in a new thread.
 
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