Re: 6/23 Pepper AMPS 256, +6 28, +6.25 40, +6.5 67, +7.25 87
Good thoughts by Michelle above on frequency on testing. You have to learn how often you have to test Pepper to keep a handle on the numbers. I tested more frequently at first, until I figured out when I needed to test. From the latest test, looks like you are getting around 1.5-2 hours from HC and it wore off. Next time this happens, test 1.5 hours after the last HC and then 2 hours after and that'll narrow it down for you. Although where you are in relation to the nadir also can impact things.
OK - about deductions. First I'm going to quote something Julie/Punkin posted in Tiggy's 5/13 condo:
It's also important to have a strategy for decreasing doses. the tactic i have used if i thought he needed a dose decrease is to drop the dose significantly for one dose to allow the shed to drain some, then return to a slightly decreased dose with the subsequent shot. So if he was at 10u and hitting too low, I would give the next shot at 7u and the following shot come back up to 9 or 9.5, something like that. my husband and i have laughingly named this strategy "Dialing for Doses" because sometimes you are just making the best decision you can make. :lol: it is very important to understand the shed action of the lantus/lev insulins. when you decrease the dose you can still see effects from the original dose for several cycles after the decrease. it seemed to us that doing a significant reduction on that first reduced dose helped to keep the next cycle from dropping too low. In my previous example, if he was getting 10u dose in the morning and hit a 30, and i decreased to 9.5u that evening, i would almost guarantee i'd see a 30 again that pm cycle. that's not enough of a reduction to prevent it.
I agree with the idea of allowing the shed to drain. Although I only did it once, we were at a smaller dose than Pepper, and I often did have an active cycle or two after a reduction. But I also wanted to keep Neko in green more because she bounces more if I don't. After SRT, we started doing a bunch of deductions. At one point it felt like running in front of a freight train going down. I was sometimes doing 2 deductions a week. It was scary the first little while, until I figured out a strategy. I started going down by .5 unit deductions, but we were just under 10 units. I did .5 unit deductions until 3.5 units but in hindsight should have moved to .25 unit deductions around 4/5 units. You'll notice the size of the deductions are the same as what the protocol recommends increasing at that level of units.
The next thing to consider is at what point to reduce. Dr. TImian recommended reductions when we went below 70, which is what I did for the first little while instead of waiting until under 50. It gave me a margin of error. This is off TR protocol (and half way to the SLGS protocol) but if you are reducing fast, just felt a little safer. When the reductions rate slowed down, at around 5 units, we went to waiting to go under 50. The other thing to consider is the numbers you are seeing. If Pepper throws you a number in the 20's, you might reduce a little more than if he is in the 40's. I think of it as the cat telling you what he thinks about that dose. It's OK to be conservative and reduce more, you can always go back up if you need to. You should know within 6-8 cycles if you made the right decision, or he could decide it's time for another reduction. :lol:
Not everyone does reductions right away after SRT. Some cats have had to go up for a while before going down. It's also not all about going down. Sometimes you plateau. In the fall, we were at about the same dose for several months. Sometimes we have to increase to get into good numbers again. It's all about following the life and death of the tumor cells and learning what works for Pepper. Take good notes. You are now doing a science experiment.
Take a look at other acrocat SS's, they might give you some ideas to incorporate into your strategy for Pepper.
