? 31March2020/Maxi/AMPS394/+2:333/+4:295/+6:308/Increase R?

bambinaki

bambinaki

Member Since 2010
Fifth cycle with Lantus, but not with 6.0 units. The partial fur shot yesterday restarts the cycle clock, so today is cycle two. That partial fur shot disrupted the depot, and you are seeing those high numbers as a result. The impacts of fur shots are often worse on subsequent cycles - something I was all too familiar with. :rolleyes:

bambinaki said:
lso, do many caregivers out there go week after week, month after month getting up several times every night for testing?
Click to expand...
That one is easy. You learn their patterns and how they use insulin. With Lantus, if the +2 is quite a bit higher than preshot, like it was last night, then you won't see much action and you generally have a good opportunity for a full night's sleep. Now this rule doesn't work for all cats, just most. It didn't for Neko on Lantus, but I knew for sure if her +4 was higher I could call it a night. And since you did R last night and it was still higher than preshot, I would have gone to bed after the +4.
 
Wendy&Neko said:
Fifth cycle with Lantus, but not with 6.0 units. The partial fur shot yesterday restarts the cycle clock, so today is cycle two. That partial fur shot disrupted the depot, and you are seeing those high numbers as a result. The impacts of fur shots are often worse on subsequent cycles - something I was all too familiar with. :rolleyes:


That one is easy. You learn their patterns and how they use insulin. With Lantus, if the +2 is quite a bit higher than preshot, like it was last night, then you won't see much action and you generally have a good opportunity for a full night's sleep. Now this rule doesn't work for all cats, just most. It didn't for Neko on Lantus, but I knew for sure if her +4 was higher I could call it a night. And since you did R last night and it was still higher than preshot, I would have gone to bed after the +4.
Click to expand...


So I give 6 units of Lantus 4 more times before increasing?

What about increasing R tonight?
 
bambinaki said:
What about increasing R tonight?
Click to expand...
Hi there,

Regarding increasing the R, this is where it gets tricky. The last 2 AM cycles BG ended up going down by approx 100 points over the 4-5 hours or so the R action is in play.

You can continue with incremental R increases just be aware the more you push past 100 points the greater the likelihood of triggering a bounce. ECID
On the flip side if he does bounce you would have the opportunity to use R to try and keep BG reasonable until the bounce subsides.

Last night would have been ideal to try some R at PM+6. I'm sure the opportunity will present itself again.

So time to tweak the scale a bit -

PS 350 or higher, 1.5u R
PS 300 - 349, 1.25u R
PS 275 - 299, 0.5u R
+6 greater than 350- 1u R at +6.


What do you think?
 
Sandy and Black Kitty said:
Hi there,

Regarding increasing the R, this is where it gets tricky. The last 2 AM cycles BG ended up going down by approx 100 points over the 4-5 hours or so the R action is in play.

You can continue with incremental R increases just be aware the more you push past 100 points the greater the likelihood of triggering a bounce. ECID
On the flip side if he does bounce you would have the opportunity to use R to try and keep BG reasonable until the bounce subsides.

Last night would have been ideal to try some R at PM+6. I'm sure the opportunity will present itself again.

So time to tweak the scale a bit -

PS 350 or higher, 1.5u R
PS 300 - 349, 1.25u R
PS 275 - 299, 0.5u R
+6 greater than 350- 1u R at +6.


What do you think?
Click to expand...


Sandy, I really have no idea and am relying on your knowledge and wisdom.

Continuing with incremental R increases and triggering a bounce doesn't sound good.
Continuing the damaging high glucose levels doesn't sound good.

If you advise me to follow the new R scale, that is what I will do.

May I please have a testing schedule?
(E.g., If number is this at +2, no more testing needed; if number is that at +2, test again.)

Thank you very much!
 
Last edited:
bambinaki said:
Sandy, I really have no idea and am relying on your knowledge and wisdom.

Continuing with incremental R increases and triggering a bounce doesn't sound good.
Continuing the damaging high glucose levels doesn't sound good.
Click to expand...
Bounces happen and worst case scenario you ride it out. Then you adjust the R dose accordingly.
What you must be careful of is that you dont inadvertently create and get stuck on the 'R roller coaster' where kitty bounces so you use some R to take the numbers back down to where you would like them to be which triggers another bounce, so you shoot that down with more R...next thing you know you end up caught in an endless loop of creating and then chasing down high numbers. Its a trap to be avoided.

We have no way to know what speed and or amount of decent might trigger a bounce, until you experience it. I think its safe to continue incrementally increasing R while at the same time increasing L as per the TR guidelines until the L is able to handle things on its own. We also need to consider the cabergoline and the potential for it to reduce Maxis insulin needs. You must at this time have your antennae up for signals that the cabergoline is changing things. When you see that happening you simply stop using R and see where the dust settles.


bambinaki said:
If you advise me to follow the new R scale, that is what I will do.
Click to expand...
That is a decision you must feel comfortable with. You can keep using the previous scale and see where things go or try the revised one. In any case I do recommend if you see a +6 of 350 or higher you give 1u R at that time.
bambinaki said:
May I please have a testing schedule?
(E.g., If number is this at +2, no more testing needed; if number is that at +2, test again.)
Click to expand...
Test at +2 always. Onset begins around +2 for most cats. You'll probably see an active cycle if the +2 is the same/similar OR lower than the preshot number. Continue testing until you see the cycle has gone flat or numbers are rising. As time goes on you will get to know Maxis patterns and test accordingly.
 
Thank you, Sandy.

I'm still confused (as usual).

It's safe to continue increasing R and L, but if I want to avoid the bouncing roller coaster trap, then I should stick with the previous scale?

What would you do if Maxi were your cat?

The signals that I look for to see if the cabergoline is working are better glucose numbers, right?
 
The signals cabergoline is working, are better numbers that are not explained just by increasing the insulin dose.

You should be fine with increasing the L per the protocol. For R changes, you want to stick to the guidelines that R drops you no more than 100 points. This latest R scale is by way of an experiment. You may or may not have to go back to the previous one.
 
Wendy&Neko said:
The signals cabergoline is working, are better numbers that are not explained just by increasing the insulin dose.

You should be fine with increasing the L per the protocol. For R changes, you want to stick to the guidelines that R drops you no more than 100 points. This latest R scale is by way of an experiment. You may or may not have to go back to the previous one.
Click to expand...


Do you mean that you advise to stay with the newest, tweaked R scale for now?
 
You must log in or register to reply here.
Back
Top