3/18 Guinness|+5 288|+9 339|PMPS 444|+3 389|+6 389

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Re: 4/18 Guinness AMPS 326 Dose increase?

Bumping up for some other eyes to see and give suggestion on dose.

Note your subject line has the wrong date.
 
Re: 3/18 Guinness AMPS 326|+2.5 273|+4 317 Dose Increase at

Thank you for bumping up my post and the FYI regarding the date. Still not sure what's going on with him, although his numbers seem generally lower than a few cycles ago. I'm just wondering if I should hold this dose or bump up slightly. Looking for some guidance.
 
Re: 3/18 Guinness AMPS 326|+2.5 273|+4 317|+5 288 Incr??

Looking for clarification or thoughts regarding bumping his dose this PM. His numbers are slightly reduced these last couple of cycles, but still in the 300 range. Should I bump to 2.25u or stay at 2.0?
 
Re: 3/18 Guinness AMPS 326|+2.5 273|+4 317|+5 288 Incr??

Hi guys .. sorry I can't answer your question .. I know you are wanting an answer before pmps tonight .. hopefully some more experienced eyes can catch this and help you out ...
 
Re: 3/18 Guinness AMPS 326|+2.5 273|+4 317|+5 288 Incr??

Every time you tinker with Guinness' dose, the wait time starts over. You need to hold a dose for a full 6 cycles. So far:
  • 4/14 AM - 1.75u
  • 4/14 PM - 2.0+ This was more than a 0.25u increase
  • 4/16 PM - 2.0u
  • 4/17 AM - 2.0+
So, in 5 days, you've changed the dose 4 times. I'd stick with this dose for another 3 cycles
 
Re: 3/18 Guinness AMPS 326|+2.5 273|+4 317|+5 288 Incr??

i don't know either, but am just stoppin by to say have a good day, linda! you too, guinness!
 
Re: 3/18 Guinness AMPS 326|+2.5 273|+4 317|+5 288 Incr??

Sienne, I guess I've been fixated on this that you told me a few days ago...
4/14
"Beth (Blue) is correct. With nadirs over 300 you can be more aggressive with dosing. You can raise the dose as quickly as every 4 cycles and you can increase by as much as 0.5u."


I understood a cycle = "1 cycle is 1 shot & the subsequent 12 hours." I asked this question a few days back and got that answer, not from you, but someone else. Looking at my spreadsheet, he has been at 2+(and this plus is just a hair over 2u, consistently, except on 4/16 pm's shot when I was away from the house) for 8 cycles counting this morning's shot. Am I not understanding what a cycle is? Is a cycle 12 hours or 24? Are you saying because his 4/16 pm shot was a hair less than the fat 2.0, it starts him over on 4/17 am?

"Every time you tinker with Guinness' dose, the wait time starts over. You need to hold a dose for a full 6 cycles. So far:"

* 4/14 AM - 1.75u
* 4/14 PM - 2.0+ This was more than a 0.25u increase
* 4/15 AM - 2.0+
* 4/15 PM - 2.0+
* 4/16 PM - 2.0+ 4th cycle at 2.0+
* 4/16 PM - 2.0u This was based on the blue number I got the day before and being away from the house most of the evening
* 4/17 AM - 2.0+
* 4/17 PM - 2.0+
* 4/18 AM Today
* 4/19 AM - 2.0 +
* 4/19 PM - 2.0 +
* 4/20 AM - 2.0 + 6th cycle at a consistent 2.0+?

I'm not trying to be difficult, I'm just trying to understand the logic behind the information that I am getting. I will hold his dose the 6 cycles instead of the 4 suggested earlier and keep to the 2.0+ (I'm very anal about this shot being the exact same size every time, unless I have a reason to change it). Thanks for the information, I'll stick to the protocol. I'm just getting nervous about his numbers staying so high for so long. I do see him gradually coming down though, which I know is ideal.

Again, thanks for your help and checking in on us.
 
Re: 3/18 Guinness AMPS 326|+2.5 273|+4 317|+5 288 Sienne?

The issue is that the nadirs are not consistently over 300. When the nadir is below 300, you have to wait 6 cycles.
 
Re: 3/18 Guinness AMPS 326|+2.5 273|+4 317|+5 288 Sienne?

One more question, do you see a consistent nadir with him, because I'm having trouble seeing that and feel his numbers are confusing. (ie, last nights +4 at 285 and +5.5 377). Would you suggest I get some other test numbers that I don't have like +7, etc? Ok, maybe that's 2 questions.
 
Re: 3/18 Guinness AMPS 326|+2.5 273|+4 317|+5 288 Incr??

linda and guinness said:
Sienne, I guess I've been fixated on this that you told me a few days ago...
4/14
"Beth (Blue) is correct. With nadirs over 300 you can be more aggressive with dosing. You can raise the dose as quickly as every 4 cycles and you can increase by as much as 0.5u."


Indeed that Phase Two section is kinda tricky. At the time of your question you were still above 300. Later on that same thread we discussed when you dropped out of the 300's you would need to change the strategy again.

Blue said:
The caution using that section of the protocol is if Guinness drops down out of the 300's, then you will need to lower the dose increases back to 0.25 and hold them longer.

It is a lot of information coming at you with a moving target like changing BG's that are improving with dose.
 
Re: 3/18 Guinness|+5 288|+9 339|PMPS 444

This one isn't improving with dose. PMPS 444.

Any help with my question regarding a consistent nadir. I just don't see one and really don't see any trend in his data. I was hoping more trained eyes could give me some thoughts about when they thought his nadir was.
 
Re: 3/18 Guinness|+5 288|+9 339|PMPS 444

linda and guinness said:
This one isn't improving with dose. PMPS 444.

Any help with my question regarding a consistent nadir. I just don't see one and really don't see any trend in his data. I was hoping more trained eyes could give me some thoughts about when they thought his nadir was.

It looks to me he is nadiring between 2-4.

His avg. AM preshot has gone from 407 to 359
His avg. PM preshot has gone from 344 to 361

Overall you are seeing a shift down in his numbers. :smile:

The nadir will continue to move around as the dose gets closer to the correct amount, it is not going to always be in the same time frame every time. Even Attie doesn't give me a consistent late nadir, every once in while he throws me a +4 low.
 
Re: 3/18 Guinness|+5 288|+9 339|PMPS 444

Linda, I've been reading your condo all day long with interest!!! Man, I feel your pain. It is so confusing when there's no consistency in the numbers. And the high numbers are scary!! I sure hope Guinness has a breakthrough soon so you can relax a little. I don't know about you, but I feel my blood pressure will never be the same again after all this nailbite_smile
 
Re: 3/18 Guinness|+5 288|+9 339|PMPS 444

Try to find a way to dose as consistently as possible, time-wise and dose-wise: sliding scales don't work. Don't skip shots. Fluctuations are very common in this phase before BGs start to stabilize under consistent dosing: a typical curve of cat over the first 1.5 months on Lantus can be seen here.

http://www.tillydiabetes.net/images/Lan ... _Graph.jpg


I too was like both of you when I started out on the Lantus journey. Many times I needed to actually break away from the boards as I got so darn frustrated with what I thought was conflicting advice. Then one night as I was surfing and learning, guess I have to learn it my way, I tripped across this graph. And suddenly all the information sunk in as I could literally see how this was supposed to work and what it will look like.

I hope it helps you two as much as it did me. I ended up actually printing it out and came to realize that unlike other insulins that peak and nadir quickly...

Lantus sort of does a downshift and make all those high numbers of the peaks go away. It takes about the same amount of time as regular insulin to establish 'regulation,' but it eliminates for the long-term those high numbers.
 
Re: 3/18 Guinness|+5 288|+9 339|PMPS 444

Thank you Blue's bean for the information and graph. I'm trying to be very consistent in shot amount and time (I actually cancelled tickets to something on Saturday so I could be here to shoot him at 4:30pm, much to my husband's dismay). As you can see by my spreadsheet I shoot and feed like clockwork, very rarely am I more than 5 minutes early or late with food or shot.

The graph is really interesting and I need to know what happens over that amount of time because last time we were at the insulin buffet he was diagnosised and OTJ in just a little over a month. So I'm not sure how the long dance goes.

Also, thank you so much for taking the time to average out my AM/PM shots, that was very nice and analytical of you. Maybe I should be graphing his progress or averages, that might make me feel a little better.

Patty, thanks for watching our progress today. You are witnessing a control freak freaking out because she doesn't have any control and SHE REALLY WANTS CONTROL! She was hoping some dosing advisor would give her some direction that would ease her panic of not being in control, but no dice. I do feel better, but wish his PM number wasn't so high or at least wish I had some idea what got us here again and what is going on with him.

Thanks for the support all!
 
Re: 3/18 Guinness|+5 288|+9 339|PMPS 444

Hello Linda,

I hope you get some of the answers you are looking for. I hope one of the dosing experts comment on your increase soon!! I agree with you about .25 but I'm all kinds of confused about a nadir myself so please don't listen to me! These ladies will take great care of you!
 
Re: 3/18 Guinness|+5 288|+9 339|PMPS 444|+3 389

Back up in the high 300's and really no explanation as to why. I'd understand if I left a cupcake out or something, but geez, he was actually looking like he was decreasing.
 
Re: 3/18 Guinness|+5 288|+9 339|PMPS 444|+3 389

Back up in the high 300's and really no explanation as to why. I'd understand if I left a cupcake out or something, but geez, he was actually looking like he was decreasing.
 
Re: 3/18 Guinness|+5 288|+9 339|PMPS 444|+3 389

Linda, yep, its official...we're twins. I drive my family crazy because I need to be in control of everything. To this day, I still try to tell my daughter how to dress (and I'm still usually right!!). I've had such a hard time with this because, no matter how hard I've tried, I haven't yet succeeded in making my hairy baby feel better. When he acts so totally different from his usual self, like sleeping all the time (the kind where you can barely wake him up), it scares the crap out of me. Because I work at home, he and I have been best buds since the day my daughter and I brought him home from the rescue agency 10 years ago. He used to follow me around the house, sit in the bathroom when I brushed my teeth and put on my make-up, slept at the foot of my bed, and slept in his little bed on a table next to my desk when I was working. He doesn't do any of these things anymore. He usually just finds a closet or a corner in the back bedroom to sleep. Everyone once in a while I see a spark of the old Champ, usually in the mornings, where he wants to play and he will stay awake for a few hours, but by 11 a.m., its nighty night. I see that Guinness' numbers are even higher than Champ's and I know how it makes you feel. The first two weeks of visiting this board, I cried ALL the time, I was just so worried. At the end of last week was when I finally had my breakthrough...I finally realized that I'm doing the very best I can to make him well. If he doesn't get well, it's not because I didn't try because I'm putting everything I've got into this. And I know you are too with Guinness. And I truly believe our kitties know this. At Champ's initial vet visit, all the blood work for other problems came back negative. He was perfect except for the high blood sugar. Just yesterday, I felt a lump on his side, but I don't know if its like a cyst in the skin or if it's fixed to the muscle underneath. I'm going to feel it every day and see if it grows or changes in any way. I'm going to have to take him to the vet for a follow-up one of these days soon so I'll mention it to the vet and see what she thinks. I'm thinking there's probably nothing else wrong with Guinness...he might have just dipped his toes in the diabetes waters last time and this time decided to jump in the deep end. The little pooh!! I'm going to make myself be patient, even if it kills me. I'm going to throw logic out the window (that will be sooo hard!!), play by the rules, and hope Champ responds sooner rather than later. Good luck with your journey, too. I love Guinness' "Oooh, is that a camera?" look in his picture!! I know this is long, but sometimes it feels really good to talk to someone with the same type of personality cuz I know you'll relate.
 
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