3/6 Panic AMPS 285 +2 220 +4 207

You asked this on 3/4/2020 and got no replies.
Today is looking like it's going to be another green cycle. Will I be able maintain this dose after the 10th cycle mark? After 5 days/10 cycles do I stop counting cycles and just increase when/if numbers start climbing again?
I'm checking a lot of things here, since Elizabeth asked me to look at her condo and comment. Not very familiar with Panic, so I'm asking a lot of questions. Please bear with me.

Elizabeth, how in the world do you go to work, and still get all those tests?

First, I'm going to ask you a couple of questions.
When do you think Panic's nadir is?
When does the insulin onset, or begin working for Panic?
Does Panic have any or much overlap from dose to dose?
Would you tell me when you saw some bounces, and how you identified them?

(I'll let you know if I agree on the bounces)

What brand of insulin syringes do you use? Some syringes are better than others, on being consistently marked on the barrel.
Do you keep a "reference" syringe, with some colored water in it, to measure the dose against the previous dose?
Are you very careful to get all the air bubbles out of the syringe? An air bubble or 2 can make a difference in the dose you are giving. It may not seem like much, but a few air bubbles could be as much as "skinnying" the dose.
 
Thank you Deb. :)

Panic's nadir: +6 though there are times it seems she hits at +5
Onset: +2
Dose overlap: I'll be honest in saying I don't have much experience in this or how to tell
Bounce dates: 2/15, from those greens/blues she wasn't used to | 2/20 - was probably already on her way up at AMPS from that lower night cycle | 2/26, possibly dipped lower in the night | 3/01, due to dipping into the 50s |3/03, possible she dipped too low/fast while I was at work and was on her way up by the time I got home.

Syringes: ReliOn brand
No reference syringe but on her quarter doses (like now) I take an extra few moments to make sure there's "daylight" peeking between the syringe and the line and that the syringe is not touching the line underneath either
I do forget to check for air bubbles most of the time :nailbiting:

EDIT: The testing times haha. Until recently I was working all day Sundays and then 2-3 days a week right after nadir (+6). I also work from home as a freelancer between then. New job, currently only working 4 hours twice a week very early (right after AM shot). Hours will be increasing soon.
 
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Nadirs do move around from cycle to cycle. It looks to me like Panic has even had more like a +4 to +5 nadir a few times lately. When she gets down into the greens, looks like the nadir is a bit earlier on those cycles.

Not sure if you can get a +1 on the days you head off to work. Before you leave. But it might be worth trying that if it's possible.
Also, try for a consistent +2, both AM and PM cycles when you can. That +2 test can be predictive of where the cycle is headed. That way, if you are leaving for work, the +2 is lower than pre-shot, you know to leave some more food outside for Panic to eat as this may be a more active cycle.

+2 about the same as pre-shot, normal cycle, down to the nadir and back up. Easy cycle all around.
+2 higher than pre-shot, signals a bounce. Possible to take a bit of a break from monitoring. A bit of a breather.
+2 lower than pre-shot, means this could be a more active cycle. Monitor more.

Remember the "meter variance", 20% rule. Numbers that are within 20% of each other, are basically the same number. So be sure to take that into account when you are looking at the +2 BG tests.

For example, 3/4 AM cycle from 229 to 148 was outside of meter variance. It was a 35% drop, so that told you to "Pay Attention here, going lower this cycle."

Flat yellows can mean clearing the bounce (usually) For instance on 2/9 PM, 2/16 PM, 2/21 PM, 2/26 PM, There were those string of flat yellows. Says "bounce clearing here."

Dose overlap, how to tell. Well, if the nadirs are really early, at say +3 all the time or +4 most of the time, then it's more likely there is some overlap occurring. BUT I'm not seeing that on Panic's SS either. So I don't think she has much if any overlap occurring.

2/15 AM cycle - up to black (Black = bouncing, High reds and pinks can be bounces also. When the cat is used to lower numbers.)
2/26 AM pre-shot - That Black was a bounce.
3/1 PM cycle - Reds were a bounce (off those low greens as you said)
3/3 AM, continued into the PM cycle (bouncing off those blues from the 3/2 PM cycle) Black was a bounce. I don't think she dropped low on 3/3 AM while you were at work. I think she was still bouncing from the 3/2 PM blues.
3/5 PM cycle High pinks looks like another bounce, but back to yellows by the next AM cycle.

(SO, we pretty much agree when the bounces are happening. You saw the 2/20 which I did not catch)

Looks to me like Panic is clearing those bounces faster and faster.

BUT she still needs a bit more insulin, to get her back in the greens consistently mid-cycle. I'd up the dose to 2U.

So the question to ask yourself, well one of the questions, is "Does the bounce clearing get you back into better numbers? Those greens?" If not, then it's time for an increase.

I'd say no, the bounces clearing have not gotten Panic CONSISTENTLY back into the greens. And that says you have held this dose for enough cycles, and it's time for an increase.

Panic is not new to those green numbers, so holding the dose for more cycles is not helping her get back to those "healing greens".

Panic keeps going from 1 bounce to the next, but I think you have to still count the cycles (6) from the last dose increase and do another increase. Even with Panic heading into another bounce.
 
Thank you SO much, Deb. I learned a lot from your post, I really appreciate you taking the time to help Panic and I out. :)

I upped the dose to 2u last night (sorry I didn't get a chance to reply then, though I did read it!) but went back to 1.75u this morning only because I was away nearly the entire cycle and wasn't comfortable with her being completely on her own for the increase. I'll resume 2u tonight since I have a few days of monitoring. And I'll be sure to write all that down in my remarks section. ;)

Truly, thank you.
 
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