By 'a break' and 'lay off the testing' you mean an hour to a few hours without testing, right?
Yes. If the numbers are obviously headed up and you aren’t giving R, if you are past nadir and aren’t giving R, etc, then look at your data and see when you might need to test again. It could be a couple hours or even much longer if you didn’t give R and you know the numbers aren’t going to come back down.
Being flexible with R doesn't mean being flexible with testing, right? You still have to test.
Look at a lot of SSs and you’ll see there is flexibility in testing depending on what the BG is. Once I was comfortable with Gracie’s patterns and then her patterns with R, I was able to be flexible in both. It’s a challenge when you are new to figure out the patterns but if you study his SS and determine his onset, nadir, and duration for both insulins, that should help you with testing and shooting R.
Also, it looks like Crystal's insulin increases were faster and by larger increments than Maxi's. Why is that?
Under the TR protocol, you can raise the dose every four cycles if nadirs are over 300. Once the dose gets over 5u, we often suggest increasing by 10%. Suki was also home with Crystal and so she could test enough to know how low a dose was taking her and when it was safe to increase.
It seems that our definitions of 'rest' and 'break' are different.
When I say “break”, I’m usually referring to testing and when I say “rest”, I mean get some sleep. One thing I read was that for people that must get up at night (e.g. new mothers), getting 1.5 hours of interrupted sleep is important. I couldn’t always do this with Gracie but it was my goal especially in the last couple years even if that meant I fed her higher LC food so I could go longer between tests. But I knew her and her cycles. That’s really important.
I thought I had to wait until at least 4 hours after Lantus before giving R because Lantus's nadir is usually at or is meant to be at +6. So if he doesn't get R at his Lantus time, sometimes I check at +4, but I always check at +6 and give R if his number falls within the range. As you said, the meter tells me what to do. But I have to follow the +4 minimum and not less than 2 hours before the next Lantus shot for R, don't I?
I haven’t read through all your condos so I don’t know what Sandy or Wendy has told you but I trust what they say. You might ask them because they may have a specific plan for Maxie and I don’t want to mess that up.
But, very generally speaking, there isn’t a “rule” that you can’t shoot R within 4 hours of Lantus. The critical thing is not to overlap nadirs. For instance, as an example, if you give Lantus at AMPS, you see the BG going up still by +3 and you know he onsets at +2, why not stop the skyrocket? Again, I’m speaking generally to address your question but it’s important to check with Wendy and Sandy in case they have a specific plan.
and not a criticism at all (FD is a daily learning process), I would raise the dose to 8.75u provided you can monitor with at least a +2 and/or before bed test in the evening. Yes, he possibly saw some green last night but if he did, it was likely the R.
Always get a second test each cycle. My only comment is that the +2 doesn't always work with all cats, just most on Lantus. Neko could have a higher +2 and still have an active cycle, because she had a late onset on Lantus, then Levemir, and also with R. With all cats, you need to Know Thy Cat. With acrocats, and higher doses, it's that doubled. Maxi looks more like an average +2 onset kind of guy so the +2 should work for him.
