7/27 Rachel’s George AMPS 400; PMPS 400

[George’s Mom]

Yesterday’s thread link

@Wendy&Neko I am giving George the Humilin R because his #s are still very high. I’m thinking it’s time to increase the Lantus to 5.5 and maintain the Humilin R at .5 or 1 unit? I am not sure what I am doing here. I know not to give him R when it could coincide with the Lantus nadir. But seems like his R nadir might be 3 hours after giving? I gave him 1 unit @ +6 of the time of Lantus administration. His #s are still not dipping down into the 200s. .5 unit of R didnt seem to phase him much so I bumped back to 1 unit.

I think I’m not following protocol super well. I’m open to making changes, but wanting to drop his #s out of the 300 and 400s and am thinking I will use R regularly.

Thoughts?

 

[Wendy&Neko]

Yes you can increase the Lantus to 5.5 units tomorrow morning. TR says to hold doses 6-10 cycles with a blue nadir, and it was just a high one. Tonight is cycle six after the frozen shot (equivalent to a fur shot).

With R, we do not give it the same cycle as an L (Lantus) increase. Some cats react strongly to an L insulin increase. You are trying to avoid steep drops which cause bounces. Remember, you don't want him dropping more than 100 points in the 4 hours after giving R.

I'm still having a hard time figuring out when you are giving R. Did you give it at L preshot this morning? Or two hours before hand? We strongly suggest giving it the same time as giving L. And it looks like another 1 unit of R at +6.5? If so, please add "1uR@6.5" into the +6 AM cell for today. And the AM shot details should either go in the units cell with the L dose, or at the PM+10 of the previous cycle, if that's when you gave it. I like to see when R was given visually on the spreadsheet, so I can see how he's responding in the hours after getting it. Otherwise I find it really hard to see what's happening.

R nadir is typically 2-3 hours after the R shot. So you'd avoid giving it a couple hours before his Lantus nadir time.

I would start with giving R at consistent times, so you can figure out the patterns. That means at preshot times, and possible around +6 each cycle, as long as he's over 300.

Typically we'd build an R scale, that tells you how much R to give based on the R preshot value. So it might be something like 0.5 units R if over 300, 0.75 units if over 400. That is just an example. Until I see on the SS when the RR was given and it's effect, I can't suggest actual numbers.

 

[George’s Mom]

Yes you can increase the Lantus to 5.5 units tomorrow morning. TR says to hold doses 6-10 cycles with a blue nadir, and it was just a high one. Tonight is cycle six after the frozen shot (equivalent to a fur shot).

With R, we do not give it the same cycle as an L (Lantus) increase. Some cats react strongly to an L insulin increase. You are trying to avoid steep drops which cause bounces. Remember, you don't want him dropping more than 100 points in the 4 hours after giving R.

I'm still having a hard time figuring out when you are giving R. Did you give it at L preshot this morning? Or two hours before hand? We strongly suggest giving it the same time as giving L. And it looks like another 1 unit of R at +6.5? If so, please add "1uR@6.5" into the +6 AM cell for today. And the AM shot details should either go in the units cell with the L dose, or at the PM+10 of the previous cycle, if that's when you gave it. I like to see when R was given visually on the spreadsheet, so I can see how he's responding in the hours after getting it. Otherwise I find it really hard to see what's happening.

R nadir is typically 2-3 hours after the R shot. So you'd avoid giving it a couple hours before his Lantus nadir time.

I would start with giving R at consistent times, so you can figure out the patterns. That means at preshot times, and possible around +6 each cycle, as long as he's over 300.

Typically we'd build an R scale, that tells you how much R to give based on the R preshot value. So it might be something like 0.5 units R if over 300, 0.75 units if over 400. That is just an example. Until I see on the SS when the RR was given and it's effect, I can't suggest actual numbers.

Okay, take a look at how I updated it and let me know if I am doing what you’re asking. I’m not 100% that I’m doing it right, but I want to make it clear / easy for you to see so if I’m not, just let me know!

I gave him 1u R tonight @+5 because he was still >400 so not thinking his Lantus nadir would drop lower than 300. Hopefully that’s fine. All of his R shots have been given at times avoiding Lantus nadir.

I am going to plan to give him 5.5 Lantus for AM shot. Then depending on his #s, I will give him .5-1u R at +6.

Thank you again for all your help!

 

[Wendy&Neko]

Yes, the SS is easier now, thanks. The AMPS this morning I think you can take out the R information there?

 

[George’s Mom]

Yes, the SS is easier now, thanks. The AMPS this morning I think you can take out the R information there?

Done! This morning he was 464… So I gave him both 5.5L and .5 R at AMPS. I’m going to keep close eye on his #s and may give him .5-1 u R @ +6 if he’s still >300. He really bounced at PMPS +10. That’s what I see with him typically is as soon as he hits a decent nadir, he doesn’t just gradually bounce. It’s a steep increase. Maybe this is what you were saying about steep drop = steep increase? I was doing R shots at +10 trying to lop off the top of the peak. Idk what I am doing though.

Edit: I just reread your message above and sounds like the .5R @ AMPS was maybe not my best choice. Steep decrease = steep bounce. Shoot. I ask for your patience as I am learning but so much to take in. It has sunk in to my thick skull now. I am going to keep close watch of him. And will probably give R and +6 to help with a bounce.