7/25 Harley: AMPS=132, +6=113....couple o' questions...

[Sherry and Harley]

Happy Sunday Funday!

So, tonight we will be at our 10th cycle on the .75u dose. Except for her wacky first day, she's been hanging in the 100s (mostly mid- to low 100s barring the random green #). How long do we stay with a dose if we aren't seeing a lot of movement (familiar question, Libby? Haha). I'm fine to stay here, if that's what's called for, just wasn't sure about the protocol for situations like this. Would the next step be a 'fat' shot? Or just stay put? If we stay put, does this mean it's as good as it's going to get? Yes, I'm super happy she seems to be regulated at decent numbers, but still hoping for the day when I'm not sticking her with needles.

Also, haha...I have to keep qualifying these next questions with 'I'm a behavior analyst, thus very data driven'. I have graphed Harley's data...I know I'm a dork, but it's really easier to see what's happening if you can look at it visually. Let me preface these questions with, yes, I know that a +1 jump is probable due to the food, it's the inconsistencies that I'm asking about. So, what I'm seeing is that she almost always has a big jump in the evening at +1 (this is where the graphs come in handy...it's super clear). And IF there is a jump at all at AM +1, it's generally small. Her data are strikingly better for the AM cycle than the PM cycle, which I am attributing to the higher +1 number. The recent PM numbers are relatively flat except for the +1 increase. Why would this be?

I created another spreadsheet today to look at when she's eating to see if I could identify a pattern. The only thing that I can see is the she eats a small amount later in the AM cycle...generally her last PM snack is at +5 or +6, but her last snack in the AM cycle is at +8 or +9. Could that be it? I'm going to make a change in the auto feeder to test this, but thought some of you might have an idea. Should I be feeding her the 2-3 small meals at +1-3, rather than across the entire day? Or, is it typical that one cycle would be so different? Can you tell me why?

You're probably thinking...geez, she's really over-thinking this! :roll: I can't help it, I analyze behavioral data for a living. If there is something simple that I can change to help her on her road to recovery, I want to do it! ;-) All-in-all, she's doing great! I'm not complaining...just wondering if I can tweak things so she can be going even better!

Thanks for listening to my craziness!! And feel free to tell me to stop being so nutty and relax. This is just how my brain works and I want her to be better. If you're interested in looking at her charts/feeding schedule, just click on the tabs in her SS: AM Chart, PM Chart, and Food.

Hope you are all having a fantastic day!!

s

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[Sienne and Gabby (GA)]

Except for her wacky first day, she's been hanging in the 100s (mostly mid- to low 100s barring the random green #). How long do we stay with a dose if we aren't seeing a lot of movement

With nadirs in the below 200 range, a dose is held for 3 - 5 days. You could fatten the dose or increase as much as 0.25u. I think the bigger question is how much you're around during the day to monitor.

she almost always has a big jump in the evening at +1 (this is where the graphs come in handy...it's super clear). And IF there is a jump at all at AM +1, it's generally small. Her data are strikingly better for the AM cycle than the PM cycle, which I am attributing to the higher +1 number. The recent PM numbers are relatively flat except for the +1 increase. Why would this be?

Part of what I see is that Harley's AMPS numbers are generally higher than her PMPS - at least on this dose. AM numbers tend to be higher due to "dawn phenomenon." This involves the release of cortisol which is the body's preparation for the stress of the day and it causes a rise in BG levels. It may also be related to your last question about food. If Harley's pancreas is producing endogenous insulin, feeding at +8 or +9 may cause her pancreas to switch on in response to the food. As a result, the PMPS numbers are a bit lower. If the last meal during the evening cycle is earlier, the endogenous insulin has time to dissipate. If you want to use use your feeder overnight, you could provide a snack later in the cycle and see if it has the desired effect on the AMPS numbers.

The other point to consider is measurement error. You will give yourself a headache if you focus on individual numbers. You need to remember there is inherent variance in every BG test you get. Meters have anywhere from 10 - 20% variance due to standard error of measurement. As a result, there's probably more overlap in your numbers than you are immediately seeing on a graph.