5/18 Maxi AMPS 341

[bambinaki]

Last thread: http://www.felinediabetes.com/FDMB/threads/5-17-maxi-amps-360.229704/#post-2572174

Hello-

May I have Lantus dosing advice, please?
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As I understand it, it's against policy to reply in a previous thread, and replies to questions in previous threads should be posted in current threads, so:

Why can you assume it would have been in the 200-300 range?

Most of his +2s and +3s have been.

You can't assume what before bed test time is for other people. They may have different preshot times than you.

That's what I'm saying. When one says to get a +2 test and then another before bed, it's assuming what time +2 and bed times are. Maxi's +2 is 11:30 pm.

Some people adjust their preshot times to be able to get later tests in the cycle.

Having that flexibility would be nice.

 

[Marje and Gracie]

Thank you very much for starting a new condo and moving the questions here. First, I’ll start with the questions you asked me last night.

If I had gotten a +2 or a +3 and it had been in the 200s-300s as we can assume it has been at that time based on the +6 and +7 and then not tested again until the AMPS the night before last, we would not have known it went down to 116.
Wendy responded but I’ll answer as well. As she said, you can’t assume anything. You might want to look at my Gracie’s SS and see that even though I knew her pretty well, she threw me some wicked curve balls. She was on Levemir so she nadired late. One night, I tested her at +5 and she was flat and that was past onset so I grabbed two hours of sleep, got up, tested and she was at 64. I fed her some 13% food. What do you assume happened? Most people would assume that 13% brought her up or at least flattened her out and not worried about it. But I knew my cat so I retested in just 30 mins and she was at 20. Happy as a little clam... no issues.

But your point is valid that if you had not tested at +6 or +7, you wouldn’t have caught the blue. True. That’s why I say let your meter be your guide but there’s also knowing your cat. Another example, maybe he was in the 200s @ +2 that night but if he was, then your meter is telling you he’s dropping and you need to retest.

@Wendy&Neko @Marje and Gracie

What would tonight's dosing advice have been if you had known the night before last 15 minutes after the 116 his number was 118 and last night the +6 was 302?

Maxi's +2 is 'before bed' for most people.

I would have suggested you increase the dose because he didn’t drop into greens on 5/15 pm cycle and he didn’t drop the next night either so he needed more insulin.

Most of his +2s and +3s have been.

Addressed above but in the last two weeks (since 5/1) , you’ve only gotten a +2 two nights and you can’t draw any assumptions from that. PM cycles can differ a lot from AM cycles so it doesn’t matter what his +2 does in the AM. The most relevant data is in the last two weeks as things change and certainly things have changed with him in terms of being sick, eating/not eating, dose, etc.

That's what I'm saying. When one says to get a +2 test and then another before bed, it's assuming what time +2 and bed times are. Maxi's +2 is 11:30 pm.

I understand what you are saying but I have no idea what time you go to bed. Some people are night owls. We have some members that don’t even shoot until 11/11. We also have members that shoot at 6/6 so a +2 is only 8 for them. It’s up to the CG to tell us that they are in bed by +2. We can’t guess that for every member with shot times varying as they do.

I still don’t know if that means you are up then or not. And if you aren’t, you might either want to adjust your shot times as Wendy suggested and if it’s possible or set an alarm and test him so you know if he’s headed up from PMPS or he’s down or the same.

Having said all that, before your vet’s testing advice, you were doing and excellent job of nighttime testing. For each of us, we have to find the balance between when we really need to test and when numbers are up enough that we can sleep. For me with Gracie, i was not able to quit testing if her numbers were dropping at all but other members cats were really predictable so they could.

 

[bambinaki]

Hi @Marje and Gracie

May I have dosing advice, please? Would you please let me know what Maxi's new dose should be, and what the process for dose increasing should be from here?

Thank you

 

[Marje and Gracie]

Hi @Marje and Gracie

May I have dosing advice, please? Would you please let me know what Maxi's new dose should be, and what the process for dose increasing should be from here?

Thank you

I’m sorry. After I posted, I realized I forgot to give you the dosing advice that Wendy and I discussed. She felt you should go up to 9u bid for now. Of course, if you see green today, I’d hold off on that.

If you are doing TR, then when to increase is laid out for you so you should follow that but that doesn’t mean don’t ask questions. We are here to help with all dosing questions. I just wanted to point out that the “process” is the TR protocol since that is what you’ve selected. When/if you get to 10u, then we need to revisit how much you increase by.

Sound good?

 

[bambinaki]

She felt you should go up to 9u bid for now.

To confirm, you think going from 7.75 to 9 is safe?

Should I start R again? If so, with what scale? At what point should that scale change, and change to what?

I am anxious to get rolling because this is month 5 after diagnosis.

Re. TR:

"Many glargine and detemir users in this forum have been successful following a slightly modified version of this Tight Regulation Protocol."
Maxi's dosing has been much modified. This is why I asked about the process.

"If kitty drops below 40 (long term diabetic) or 50 (newly diagnosed diabetic) reduce the dose by 0.25 unit."
So if Maxi's pre-shot number or any number during a cycle is over 50, he still gets his regular dose? Even numbers in 50s and 60s get the regular dose?

"Increase by 0.25 unit after 3 days (6 consecutive cycles) if nadirs are greater than 200, but less than 300.
Increase by 0.5 unit after 3 days (6 consecutive cycles) if nadirs are greater than 300."
Is "nadir" the lowest number in a cycle, no matter when in the cycle it occurs?

"Caregivers whose kitties have "High Dose" conditions may find the need to reduce in whole units or more."
If Maxi and I are lucky enough to get to this point, this reduction info isn't clear.

Thank you

 

[Marje and Gracie]

To confirm, you think going from 7.75 to 9 is safe?

It was Wendy’s suggestion and she is our high-dose guru. But, having said that, before she and I discussed it, I was also thinking pretty much the same dose. And....we wouldn’t suggest a dose that we thought was unsafe. That’s not how we operate here.

Should I start R again? If so, with what scale? At what point should that scale change, and change to what?

Use R under the same conditions you were before and start with the same scale. Adjust as needed. None of us can tell you at what point you should change it or what to because we don’t have crystal balls. Wish we did. Asking specific questions for specific situations is a better approach than asking us to provide an answer for something we can’t predict.

"Many glargine and detemir users in this forum have been successful following a slightly modified version of this Tight Regulation Protocol."

This doesn’t refer to each member doing their own thing. This refers to the Modified TR protocol we use here. It’s modified from the originally written one based on the information we’ve gathered here over the years.

Is "nadir" the lowest number in a cycle, no matter when in the cycle it occurs?

It’s easy for me to give you an answer but then that isn’t teaching you anything with a concept such as onset, nadir, and duration. I will refer you back to the “New to the Group Sticky”. Read through the definitions and then if it isn’t clear, be sure and ask us to explain it. I want you to know this is the same exact approach I try to take with members that have been here for a bit. Spoon-feeding answers on basics of FD after a couple months doesn’t help anyone learn.

"Caregivers whose kitties have "High Dose" conditions may find the need to reduce in whole units or more."

We are definitely able to help you with that when he earns reductions.

Karen.....I hope this doesn’t sound like I’m trying to be hard on you. I’m not. You can ask Rosa.....after a couple months of she and Mimi being here, we were also encouraging her to look through all of the information that is available for you so you can learn where to find it in case there’s no one around to answer the question. If you’ve only read the stickys once, you’ll need to read them over and over. It’s part of the learning process. I believe you are a teacher and, if so, you’ll understand why we want to equip you with the tools to find what you need and, once you’ve found it, then ask the questions for what you do not understand.

Thank you for understanding.

 

[bambinaki]

Thank you