8/30 Ember AMPS 347, +4 353L Custom dosing pondering

[Elaine and Ember]

Well last night was interesting. I thought it was going to be boring but she had a late-starting drop. I didn’t carb aggressively since I figured we only had a short time to go until her nadir, but she’s been throwing in some later nadirs lately. The Libre was over-enthusiastic, as usual (I usually mentally add at least 20 to whatever it says when it starts alarming and double check with the Relion a few times to verify) so I didn’t get much sleep.
I’ve been happy with how well we’ve been doing with our recent custom dosing (reduce if 3x below 90 in a week). We’ve been getting more high greens, which is awesome. I’m thinking of changing it to 5x, but I don’t want to put her in an unsafe situation. The IAA makes things more unpredictable but overall her numbers are still higher than I’d like. The other option would be to lower the reduction point, but since she still has some Dr Elsey’s in the mix, I think keeping the 90 but increasing the acceptable frequency is the way to go.
Safe surfing all!
8/29 Ember AMPS 358, +3 342 L, +5 236 L, +7 128 L

 

[Wendy&Neko]

Couple questions regarding dosing. When did you start the 3x below 90? Also wondering what happens if she does 3x under 90 in 8 days vs a week. Are those below 90's on the Libre or Relion? Just asking cause you said you mentally add 20 to whatever the Libre gives you.

 

[Elaine and Ember]

Couple questions regarding dosing. When did you start the 3x below 90? Also wondering what happens if she does 3x under 90 in 8 days vs a week. Are those below 90's on the Libre or Relion? Just asking cause you said you mentally add 20 to whatever the Libre gives you.

I started the 3x below 90 just a couple weeks ago. I’m going by my Relion numbers for reductions since the Libre ones aren’t as accurate. (I didn’t count my Libre 86 on 8/19 since I’m 99% sure it didn’t actually get that low.) If she starts going low in the mornings more I’ll have to change that though, since I’m not home mornings to verify with the Relion.
As for adding 20, I just add 20 in my head when I’m deciding if I need to panic or wait a few minutes to see the trend when the low glucose alarm goes off. All the numbers on the spreadsheet are actual numbers.

 

[Wendy&Neko]

One thing you might want to think about is an addition to the guideline of 3 under 90. For TR for cats who don't hold reductions well, the guideline is 3 between 40 and 49 on three separate days OR if under 40. It's that last part you might want to consider - do you have a number below which you reduce, regardless if it's the 1st, 2nd, or 3rd time under 90.

The above is somewhat related to my thoughts on waiting for 5 under 90. BTW, this is brand new territory, even TR cats reduce for 3 times under, meaning we don't know the benefits or dangers of waiting for 3 vs 5, but lots of experience with 3 drops. If you go for 5 under 90, keep an eye on how her nadir is trending. If it's dropping fast, 5 times may be too long to wait.

By my count, are you 4 times under 90 on this dose now?

 

[Elaine and Ember]

One thing you might want to think about is an addition to the guideline of 3 under 90. For TR for cats who don't hold reductions well, the guideline is 3 between 40 and 49 on three separate days OR if under 40. It's that last part you might want to consider - do you have a number below which you reduce, regardless if it's the 1st, 2nd, or 3rd time under 90.

The above is somewhat related to my thoughts on waiting for 5 under 90. BTW, this is brand new territory, even TR cats reduce for 3 times under, meaning we don't know the benefits or dangers of waiting for 3 vs 5, but lots of experience with 3 drops. If you go for 5 under 90, keep an eye on how her nadir is trending. If it's dropping fast, 5 times may be too long to wait.

By my count, are you 4 times under 90 on this dose now?

Yes, we’re at 4 but I was thinking that first night at 3.75 was still from the 4 depot. I feel like in the past we ended up on way too low a dose from taking back to back reductions so I didn’t want to fall into that trap again since I have to hold it for 7 days.
I see your point about sticking with 3– I don’t want to go TOO rogue. Also it seems like keeping track of the week time period is going to be too confusing — You made that comment about 8 days and already I had been trying to calculate the number of days it had been this morning when I was deciding to reduce or not, and that would take that complication out.
I’m thinking 3 under 90 or once under 60 if I add a hard cutoff number, which I really like the idea of. Does that seem reasonable?
Thanks for the feedback! I really appreciate it.

 

[Wendy&Neko]

I’m thinking 3 under 90 or once under 60 if I add a hard cutoff number, which I really like the idea of. Does that seem reasonable?

That's a good start. The thing about custom dosing, is you have to learn what works for Ember. Try this change for a few reductions and see how it works, before thinking about adding another change. Any other changes I'd try just one at a time. The back to back reductions thing is only for people following TR, not SLGS.

Note to any lurkers, this discussion is just for Elaine and Ember. Ember has IAA, which makes her a little more complicated and these ideas are not meant for anyone else.