7/9, Stache, amps >400, +7 277, pmps 372, +6 196

Stache

Stache

Member Since 2023
Hello All. I'm recalling Marje's advice from Thursday morning 7/6: "We discussed holding the dose four cycles but since he saw some blue BGs last night, we need to hold it longer."

I assume that was too big of a drop at that point? Anyway, I got into the blues again at pmps +6 this morning. Anyone who's up on this, feel free to comment. Maybe Marje will beat you to it.

I'm just stickin' to the program at this point, waiting for further direction. I'm not the best reader. So far for me, TR & SLGS differ only in degree. If I'm wrong, enlighten me!
 
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Stache said:
Hello All. I'm recalling Marje's advice from Thursday morning 7/6: "We discussed holding the dose four cycles but since he saw some blue BGs last night, we need to hold it longer."

I assume that was too big of a drop at that point? Anyway, I got into the blues again at pmps +6 this morning. Anyone who's up on this, feel free to comment. Maybe Marje will beat you to it.

I'm just stickin' to the program at this point, waiting for further direction. I'm not the best reader. So far for me, TR & SLGS differ only in degree. If I'm wrong, enlighten me!
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They actually differ quite a bit and while we are certainly here to help and answer questions, it is incumbent upon each member to read and ask specific, appropriate questions about the method of regulation.

So my question would be, in reading TR and looking at his SS, what do you think would be the next step? Of course, we will let you know for certain but I’d like to see what you might think.
 
Alright, I'll quote from the following location to make sure I understand the statements:

Lantus / Levemir / Biosimilars > Dosing Methods: Start Low, Go Slow (SLGS) & Tight Regulation (TR) > TIGHT REGULATION (TR)

"Increasing the dose:
Hold the dose for 3 - 5 days (6 - 10 consecutive cycles) if nadirs are less than 200 before increasing the dose by 0.25 unit.
if your cat is new to numbers under 200, it is recommended to hold the dose for at least 8-10 cycles before increasing."

With the first one, I assume that it applies if nadirs are less than 200 at any time during the 5 days; it doesn't have to be continuous, just that they made an appearance, there. This probably sounds nit-picky but I just want to know.

Then with the second, if we're talking about Stache's total data from both insulins, he is definitely not new to numbers under 200. (That said, this apparently illustrates a strong difference between the dose density of each insulin.)

So anyway, if I've got all of that right, tomorrow's July 10th pmps would mark the end of the fifth day, (10th cycle). So unless it drops into the green between now and then, I would plan to increase his dose by 0.25 unit after the pmps tomorrow, July 10th.
 
I struggled mightliy with understanding TR's guidelines. For some reason I just couldn't get it straight a lot of the time!

We'll see what Marje says, I am curious if you got it right - I think you do
 
Stache said:
Alright, I'll quote from the following location to make sure I understand the statements:

Lantus / Levemir / Biosimilars > Dosing Methods: Start Low, Go Slow (SLGS) & Tight Regulation (TR) > TIGHT REGULATION (TR)

"Increasing the dose:
Hold the dose for 3 - 5 days (6 - 10 consecutive cycles) if nadirs are less than 200 before increasing the dose by 0.25 unit.
if your cat is new to numbers under 200, it is recommended to hold the dose for at least 8-10 cycles before increasing."

With the first one, I assume that it applies if nadirs are less than 200 at any time during the 5 days; it doesn't have to be continuous, just that they made an appearance, there. This probably sounds nit-picky but I just want to know.

Then with the second, if we're talking about Stache's total data from both insulins, he is definitely not new to numbers under 200. (That said, this apparently illustrates a strong difference between the dose density of each insulin.)

So anyway, if I've got all of that right, tomorrow's July 10th pmps would mark the end of the fifth day, (10th cycle). So unless it drops into the green between now and then, I would plan to increase his dose by 0.25 unit after the pmps tomorrow, July 10th.
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Excellent with two clarifications:
1. Correct that it does not have to be continuous but we start the cycle count after the first blue whether it is a “toe dip” or hours between 50-200 (human meter) and
2. We don’t consider his time in blue numbers on Vetsulin. We are only looking at Lantus so he is new to BGs below 200 on that insulin. And correct that if he doesn’t see anything more than what he’s done so far on Lantus, I would raise his dose to 2.25u on the morning of the 11th.

Great job finding the answer!!!
 
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Marje and Gracie said:
Excellent with two clarifications:
1. Correct that it does not have to be continuous but we start the cycle count after the first blue whether it is a “toe dip” or hours between 50-100 (human meter) and
2. We don’t consider his time in blue numbers on Vetsulin. We are only looking at Lantus so he is new to BGs below 200 on that insulin. And correct that if he doesn’t see anything more than what he’s done so far on Lantus, I would raise his dose to 2.25u on the morning of the 11th.

Great job finding the answer!!!
Click to expand...

Wow,...thank you! This is kind of fun. However believe it or not, now I have two more questions:
a) On "1", did you mean 100-200?
b) Then on "2", AMPS 7/11 completes five days. This would be an exception to the original second statement: "if your cat is new to numbers under 200, it is recommended to hold the dose for at least 8-10 cycles before increasing." If this was your intent, I'm curious, why the exception?
 
Stache said:
Wow,...thank you! This is kind of fun. However believe it or not, now I have two more questions:
a) On "1", did you mean 100-200?
b) Then on "2", AMPS 7/11 completes five days. This would be an exception to the original second statement: "if your cat is new to numbers under 200, it is recommended to hold the dose for at least 8-10 cycles before increasing." If this was your intent, I'm curious, why the exception?
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Actually on 1, I meant 50-200 and I fixed that. Sorry for the typo. Does that clear it up?

On 2, you don’t count the first cycle he went below 200. So that’s two cycles each on 7/6, 7/7, 7/8, 7/9, 7/10 for five days. Of course, if he drops below 50 at any time, you would reduce the dose by 0.25u. Theoretically, because he hasn’t really seen that much blue, if he doesn’t get into some better BGs tonight, you could raise the dose in the morning as long as you are aware he could be clearing a bounce tomorrow.
 
You know what, on 2 somehow I read "8-10 cycles" as 8-10 days, crazy!! Wake up, Pete.

Regarding number 1 however, I was a little surprised. Since 100-200 is blue and 50-100 is green, I thought the change in color might bring a change in dose. Any nadir in that range will be music to my ears! It would be nice if I could manage to get some numbers from +5 to +9 this PM cycle. That might be a bigger priority to me than starting tomorrow. We'll see what happens.

Well, as far along as Stache might be, (who knows?), I'm not going to expect remission. But it will be great if he can experience life with good numbers again! As I enter my third week here, I feel like I've already turned more than one corner. It wouldn't be possible for me without you & the FDMB gang. I can't thank you enough!
 
Stache said:
You know what, on 2 somehow I read "8-10 cycles" as 8-10 days, crazy!! Wake up, Pete.

Regarding number 1 however, I was a little surprised. Since 100-200 is blue and 50-100 is green, I thought the change in color might bring a change in dose. Any nadir in that range will be music to my ears! It would be nice if I could manage to get some numbers from +5 to +9 this PM cycle. That might be a bigger priority to me than starting tomorrow. We'll see what happens.

Well, as far along as Stache might be, (who knows?), I'm not going to expect remission. But it will be great if he can experience life with good numbers again! As I enter my third week here, I feel like I've already turned more than one corner. It wouldn't be possible for me without you & the FDMB gang. I can't thank you enough!
Click to expand...
That’s the best attitude to have; regulation first and then see what happens.

Unless you miraculously see some green tonight, it’s time to increase to 2.25u in the morning. Good luck with the increase.
 
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