5/17 Charlie AMPS 140 +9.5 113 PMPS 113 +3 62 +4 43

[charliesmom]

The past few days, Charlie has been doing real well. The other day, Charlie posted a green preshot of 99 in both AM & PM. I shot a fat .25 and Charlie did fine with that. Since I am working now, I am not able to get an am BG test until +8 or +9 in her am cycle (often later). PM cycle is more flexible, but then again, I cannot be waking up each night all throughout the night due to a new demanding job. As her preshots continue to come down, I am wondering how low it is safe for me to shoot. As an example, if she comes back tomorrow with a 70 or 80 preshot should I still shoot that and if so, should I reduce a little like giving less than .25 at some point? We have had some .25 full units and some .25 normal. It's real hard to see the difference. We will buy a magnifying glass ASAP to make this easier as your micro-dosing pictures that you posted are real helpful. Just trying to get some advance guidance as my am preshot time in Amsterdam falls about 3am EST and not sure if many of you are around at that time. Charlie's sheet is updated. Thank you for any input.

 

[rhiannon and shadow (GA)]

Re: 5/17 Charlie AMPS 140

Hi Jill,
no advise from me but bumping you up.....

 

[Sienne and Gabby (GA)]

Re: 5/17 Charlie AMPS 140

Jill --

Have you given any thought to shifting the time of Charlie's shot? It sounds like you get home at around +8 or so. If you moved Charlie's shot earlier, you could get an early test or two which may help you to have a better sense of where Charlie's cycle is going. It may be better given the later nadir with Lev to keep shot time where it is, though. I think if you can get a curve on a day when you're not working it will give you a clearer idea of where Charlie's nadir falls.

With Lev, the dose reduction guidelines are the same as with Lantus -- you reduce based on the nadir and not on the pre-shot numbers. I would try to make sure you've got food available around the time of Charlie's nadir if you're worried about numbers being low. I don't recall if you have an automatic feeder. If not, that may help. The process and idea of "shoot low to stay low" is also the same. You need to be comfortable, though, with the numbers.

 

[charliesmom]

Hi Sienne,

Charlie's AMPS is early morning (7am - 7:30am usually). Since I started my new job, I can't get home before PMPS. My partner can sometimes get home by +10, but not usually sooner (only occasionally). So I'm not sure shifting charlie's shot time would be beneficial.

I guess I need to do a curve again. Good idea. When I look at her data, I'm still not real clear on where her levemir nadir is falling (sometimes I think it's at +5? other times I think it may be +8, etc).

When you say that with levemir "you reduce based on the nadir", what exactly do you mean? I know you reduce if she dips below a certain threshold, but I'm not sure I understand the nadir connection. Please explain.

We do have an auto-feeder, and charlie eats at 4 fixed times throughout the day (AMPS, +6, PMPS, +6). So the food is spaced out and that seems to work, even when we're not around. She has gotten used to it. If there's any reason we should shift the mid-feeding times from +6 to +5 or +8 (or the nadir point), we can do that. Just need to know where to move it to.

Lately, we've been "shooting lower" than ever before, and it seems to have been working the last couple of days. However tonight, I'm not sure if I'm in for a night of testing and being vigilent. What do you think? Should I be concerned? I will test again in 15 mins.

Thanks for your input,
Jill

 

[Sienne and Gabby (GA)]

Dosing with Lantus and Lev are exactly the same. (In fact, the protocol is fully named, "Tight Regulation Protocol for Lantus and Levemir.") So, you reduce the dose when the lowest point in a given cycle is less the 50. You reduce the dose based on the nadir (i.e., lowest point in the cycle) and not on a pre-shot number. Generally, you only give a temporary dose reduction (the BCS - big chicken sh*t dose) for a cycle if the pre-shot number is low or you're uncomfortable shooting a particular number because you may not be able to monitor.

It sounded like someone was home late to grab a test. I didn't know if moving the time earlier so you could get a +1 or +2 would be useful. With Lantus, it can be but for most cats, with Lev, the nadir is later in the cycle. I do think getting a curve will tell you where then nadir falls. It may mean that you'll want to adjust the times when the feeder opens so there's food available closer to nadir.