3/22 Floyd AMPS 598

New here - here is my intro thread from 2 days ago - which has some of Floyd's info. Floyd is about 16 yrs old.

I have been trying to follow the TR protocol for the past few weeks but realized that I was following only for higher numbers, but when Floyd starting hitting lower numbers, I've been moving the dose around too much, too fast. As you can see from his SS, we haven't been used to lower number due to various factors. (Insulin, diet, not testing enough, etc)

A note about his SS - it is in opposite order, i.e. today is at the top, and older info at the bottom. I was directed to do this by Dr. Pierson so that she can review it as this is how medical records are set up. I can change it and post a new one if that is going help folks here.

Soooo.... after having some low numbers yesterday, and reviewing the TR protocol again last night, we are at 4 units today. My plan is to slow down and hold this dose for 8-10 cycles, then curve and go from there. I am open to any other ideas, suggestions, comments.

Take it easy on me - I am trying to learn!!! Also, I have a DH who has been resistant to even 0.5 unit increment changes (he has trouble seeing the marks even with his reading glasses), so the idea of 0.25 increment changes is even more troubling. But, he'll have to accept it!

Thanks for reading, sorry so long.

 

Hi Floyd's mom! Happy to meet you!

Looks like your into a bounce today and quite the bounce it is!


I don't follow TR with Jones but I would hold that 4 unites for another 8 cycles. Give him time to clear the bounce and see where the new dose is taking him.

 

Thank you for the input! Glad to know I'm getting on the right track.

 

I have the same problem. The first brand of syringes I tried (easy touch) had the marks for whole and half units one after another. It was very difficult for me to see. I switched to the Relion brand. The whole and half unit marks are staggered. Makes it much easier to see. Second, I put a head lamp on so I can see better. And, I have a magnifying glass on hand just in case. I also use the head lamp when testing sometimes. My whole family makes fun of me. But, I do what I gotta do to see.

 

The syringes we have do have the staggered marks, but he still complains. We have a headlamp at work for dental work (we are both vets) - maybe I'll tell him we need one at home too!!

 

Hey Floyd's mom! Glad you made it over to L & L land.

Those tiny syringes are murder on the eyes. I use 3.0 reading glasses AND a magnifying glass to dose.

Yes, Floyd sure did bounce from seeing those greens yesterday. The bounce can take up to 6 cycles to clear. Once it does you'll know where this dose is taking him.

It might be best if you do switch the SS to the way we do it here so there isn't any confusion. I'm tagging some of the veterans to look at Floyd's SS to see what they think and offer up their wisdom. @Wendy&Neko @Jill & Alex (GA) @Marje and Gracie

 

Will do. Thanks!

 

Yes, it will help immensely. One other modification that will help us. Insert a blank line after the day you stopped Prozinc and started Lantus. Then put something like "starting Lantus" on that line.

Many of us use digital calipers for measuring a dose. Here is a link to a post on how to do that. Between good light, a magnifying glass and calipers, it was easier to be consistent dosing. Neko was often sensitive to 0.125 unit changes when she was on small doses. Couldn't have done it without calipers. Some people have nice attractive looking magnifying head lamps. Available sometimes in craft stores.

I think you were OK going down to 4.0 units. If after six cycles you aren't seeing green, we would consider it a failed reduction, and you can go back up to 4.25 units. You can do a curve if you want at that time, though we find that spot checks at various times of the cycle are often as good. Provided of course, you have enough data to have a handle on his onset, nadir and duration. Curves can help with that. Don't forget those night time tests. So many kitties choose the night time as the time to go low. And we dose by the low points. You don't have to stay up all hours of the night, but a before bed test is a good one. Sometimes though, you will have to stay up later. On the PM cycle of 3/15, I would have stayed up until I knew the numbers were rising on their own, without influence of carbs.

 

Done. New SS linked in signature.

Looking into this, thanks. Although I know DH will roll eyes.....

Do you mean seeing green at pre-shot or seeing green at onset and/or nadir?

Gotcha. I am now understanding that many of the AMPS of 600 are due to this. Kicking myself that I didn't see it sooner.
Thank you!!

 

At any point in the cycle. Some cats, like mine, are inconsistent with nadirs times. I used to joke that I could reliably find her nadir between +3.5 and +13 when she was on Lantus.

Thanks for changing the spreadsheet. The permissions still need to be changed. Check the spreadsheet setup instructions, you have to publish to the web.

I think most of us neglected the night cycle at first, assuming for some reason that our cats were predictable. Which of course they are not.

 

Welcome to Lantus and Levemir Land! We are glad you found us and are open to suggestions

At any time during the cycle because when he clears a bounce, you might see the nadir at preshot. You might also see a green number at onset if the bounce is clearing at preshot and continues down afterwards. When onset occurs, the BG could keep dropping.

I want to explain why Wendy said “after six cycles”. Normally, on a reduction, you don’t need to hold the dose six cycles as you would on an increase. If the kitty’s BG is in a bounce, it can take up to six cycles to clear. You want to let the bounce clear to see what the BG comes back down to before you decide whether the reduction has failed.

However, if the bounce clears in three cycles and the BG doesn’t come back to green, you can take the dose back up to the last good dose ( which is not one that got him into the 30s). You dont want to wait six cycles, in that circumstance, and leave him in high numbers.

Normally, for where his dose is, we wouldn’t decrease by 0.5u but I understand why you did. It takes time to get used to microdosing. The good thing is that if he fails the reduction, you can take him up to 4.25u.

One thing I notice is he is occasionally losing duration. Remember that after mid-cycle, the insulin is usually waning (unless he’s clearing a bounce) so it’s best to not go overboard on feeding. It takes less carbs after mid-cycle to control the insulin. For instance, on 3/21, feeding 1/2 can at +7 probably contributed to the numbers shooting up so fast,

Think of it as a car coming up to a stop sign. If you slam on the brakes too soon (i.e. feed after nadir), the car won’t make it to the stop sign.

I’m not sure what’s going on with his SS. It shouldn’t be turning turquoise in the U column. There are a few other tweaks on it I could make for you. I’ll send you a private message so check your inbox