Re: 3/5 TomtheCat AMPS ~226 no shot +12.75 ~206 no shot
Sienne and Gabby said:
I'm not entirely sure I understand how you've been dosing. At the risk of telling you what you already know (and for the newbies and lurkers), Lev (and Lantus) dose should be held constant for the first 5 - 7 days (barring anything that requires a dose reduction like the 33 yesterday). In addition, doses with long-acting insulin are not based on a sliding scale. All things being equal, when a dose is changed, that dose is held for at least 3 days. I think you may have been over dose with Tom due to having been increasing your dose every day. The rationale for slow increases and holding doses is to not miss what is a "good" dose.
As far as this morning, I don't think this is a dropping number. When you factor in meter variance, your +12 (it's not an AMPS since you didn't shoot) and your +12.75 are pretty much the same number. Tom earned a dose reduction. I'd shoot.
Sienne, you are right on all counts. Btw, I shot a 1.5 at +14, and yes, I am acutely aware there are several handy books nearby that can and should be sharply tossed at too-frequent dose changers. I'm practiced at throwing them myself, now and then, and my first reaction to most newbie charts is "stop changing the ##%#* dose all the time!" So I am not doing what I tell others to do, and your comments are well received.
Since I have a second -- while they are sanding the new wood floor downstairs -- I'll try to explain. There is method to my madness -- which is not to say the method justifies it fully, or that it is ultimately defensible; but I'm not just confusing the insulin syringe with cable tv remote for on-demand entertainment, where I think I can "order" the blood glucose level I want, right now, by dialing in a different amount of insulin. Nor am I giving way to jitters. I said above, my first reaction to newbie charts is "stop changing the dose!"; but my second is, "stop
tolerating high numbers" if it is in your power to change them -- diabetes is a disease of deficient insulin. Your cat doesn't know how to give itself the right amount, nor can the cat tell its bean that relief is available with right-dosing. So, part of my approach has to do with my experience with Tom and my ability to read him; and part is that while I don't view red / high pink PS numbers with quite the same alarm as a +8 ~33 gets, I look at them somewhat along those lines. As Steve (of Steve and Jock) posted recently in Think Tank, hypos are horrible, but statistically more cats are irretrievably harmed by persistent high numbers. Tilly says first get the cat into a safe zone bg-wise, and then build on the data by consistency -- you can't manage the bg if you never get control. Personally, I find tolerance for week-on-week of pinks and reds (just look at some of the charts around), and attempts to "wish the bg down" by giving a lower dose than the numbers would suggest, beyond baffling. The fear of hypos is rational, but less so if avoidance entails remaining in the trap of the equally if not more deadly fact of hyperglycemia.
Anyway, I did something I dared to do only because I know Tom: I raised in quick steps until I found the "too much" level. I do NOT recommend it to others because, hey, "too much" is risky and yes, the strategy is flawed because there are not enough days at various dose levels to provide a reliable frame of reference. That's why I am saying it's not defensible. But I believe I was able to cut out days and days of risky red and pink because I am pretty confident with him. Today, by waiting to give the shot, which might have also appeared bizarre, I bought a bit of insurance: I grudgingly exchanged some precious "shed" for data I wanted... Because he just came out of remission, I had to see what would happen. Was I seeing the shed effect-- as was almost certainly the case -- or, since Tom was so new to injections again, was it some other hormonal process that would advise even a lower dose than the 1.25 I was planning? With the schedule I have today, I couldn't take the chance, small as it was, that he might drop into sub-35 even on 1.25u.
... thanks again for your comments, and please don't stop taking an interest in Tom's progress
Ilkka
